Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in Treatment of Knee Osteoarthritis (Systematic Review and Meta-analysis)

Abstract

Abstract Background Although PRP is one of the options in the management of knee OA, its effectiveness and wide application is still controversial. Therefore, we conducted the present systematic review and meta-analysis to compare the safety and effectiveness of PRP versus HA injection for knee OA. Objective The purpose of this study is to compare between the efficacy of intra-articular injections of Platelet-Rich Plasma versus Hyaluronic Acid in treatment of knee osteoarthritis. Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The overall effect favoured PRP over HA for WOMAC function score, WOMAC pain score, WOMAC stiffness score, and WOMAC total score; mostly 6 and 12 months after treatment. According VAS score, we found that the overall effect favoured PRP over HA at 12 months only. In contrary, the overall effect did not favour PRP over HA for VAS score at 3 and 6 months. PRP is superior to HA for IKDC scores at 6 and 12 months with similar results at 3 months. Conclusion Intra-articular PRP injection is more effective in terms of pain relief and function improvement at short-term follow-up in the treatment of knee OA than HA, and there is no significant difference in the risk of adverse events between PRP and HA. A randomized controlled trial with larger group sizes is necessary to find the predictors of the response to PRP and HA intra-articular injection.