Intra-articular Injection of Hyaluronic Acid (HA) and Plateletrich Plasma (PRP) in the Treatment of Mild and Moderate Osteoarthritis of Knee

Abstract

Background: Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Introduction of platelet-rich plasma (PRP) injection has been viewed as an advance in the management of OA knee. Objective: To compare the effectiveness of PRP and Hyaluronic Acid (HA) in the treatment of mild and moderate OA knee Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 2018 to 2019. A total of 154 patients with mild and moderate OA knee were randomly allocated into two groups: group A (received PRP injection) and group B (received HA injection) where 133 patients completed the follow-up schedule. Outcomes were measured by OA specific translated and validated Bengali instrument- Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and visual analogue scale (VAS 0-10). They were followed-up for 6 months. Results: There was no significant statistical difference at the baseline between the groups regarding age, sex, grading of OA knee, side involvement, mean duration of the disease, VAS scores and WOMAC scores. After one month, VAS score significantly decreased in PRP group compared to HA group (p<0.001). However, there was no statistical difference regarding total WOMAC scores between two groups (p=0.063). In third and sixth month, VAS score significantly decreased in PRP group compared to HA group (p<0.001). Though the stiffness and physical activity scores of WOMAC did not reduce significantly, the pain score reduced significantly in PRP group compared to HA group. In both groups, significant reduction of VAS and WOMAC total scores was observed after six months follow-up compared to baseline values (p<0.001). Conclusion: Intra-articular platelet-rich plasma improves pain and function of the knee in patients with osteoarthritis. Though intra-articular hyaluronic acid also improves pain and function in the foot, PRP is more effective than hyaluronic acid. Multi-centered clinical trial with long term follow-up should be conducted to see the effects of PRP and HA. Bangladesh Med Res Counc Bull 2021; 47(1): 62-69