High molecular-weight hyaluronan or rich plasma platelet for osteoarhtritic knee - real world experience from specific treatment regimens

Abstract

Purpose: Our study aims at assessing the clinical effectiveness and comparing treatment response in patients injected with intra-articular high-molecular-weight cross-linked hyaluronic acid (HMWHA) or platelet-rich plasma (PRP) in the routine clinical practice. Methods: Fifty-one consecutive patients aged 40 to 80 years were included in this open-label, prospective, longitudinal study. They suffered from symptomatic unilateral or bilateral KOA, involving the medial tibiofemoral space, with a complaint duration of more than 6 months. All the patients met the ACR criteria for knee osteoarthritis (KOA) and were treated with intra-articular HMWHA or PRP. The treatment protocols were as follows: 2 courses 6 months apart of 3 intra-articular PRP injections per week or 2 injections of HWMHA at 6 months apart. Patients were prospectively followed for 1 year. They were evaluated by visual analogue scale (VAS) for pain, Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) for disease activity, and HAQ-DI for disability. Response to therapy was determined using OMERACT-OARSI responder criteria. The statistical analysis was carried out in SPSS 21.0. Results: Significant differences in the perception of pain and disease activity assessed by VAS and WOMAC, respectively, were found between the initial visit and at the end of the follow-up in both groups (p < 0.001, p < 0.001, respectively). The levels of disability (HAQ-DI) were significantly lower in both groups, too. The mean one-year differences in the reported pain (ΔVAS) were 19.16 ± 13.32 mm and 22.08 ± 15 mm for the HWMHA and PRP groups, respectively, without a significant intergroup difference (p > 0.05). The two groups also did not differ significantly in their WOMAC one-year change (p > 0.05). OMERACT-OARSI responders to treatment at the end of the year were 60% (15/25) and 84.6% (22/26) in groups I and II, respectively, with no statistically significant difference between the groups. Conclusions: The above-proposed treatment regimens of intra-articular PRP and HWMHA injections resulted in statistically significant alleviation of pain and improvement of disease activity under real-world conditions. More than half of the participants responded positively to therapy in both groups after one year.