Abstract
BackgroundOur study compare the short and long-term efficacy of the intra articular injections (IAIs) of hyaluronic acid (HA), platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), and ozone in patients with knee osteoarthritis (OA).MethodsIn this randomized clinical trial, 238 patients with mild to moderate knee OA were randomized into 4 groups of IAIs: HA (3 doses weekly), PRP (2 doses with 3 weeks interval), PRGF (2 doses with 3 weeks interval), and Ozone (3 doses weekly). Our outcome measures were the mean changes from baseline (immediately from the first injections) until 2,6, and 12 months post intervention in scores of visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index.ResultsA total of 200 patients enrolled in the final analysis. The mean age of patients was 56.9 ± 6.3 years, and 69.5% were women. In 2 months follow up, significant improvement of pain, stiffness, and function were seen in all groups compared to the baseline, but the ozone group had the best results (P < 0.05). In 6 month follow up HA, PRP, and PRGF groups demonstrated better therapeutic effects in all scores in comparison with ozone (P < 0.05). At the end of the 12th month, only PRGF and PRP groups had better results versus HA and ozone groups in all scores (P < 0.05). Despite the fact that ozone showed better early results, its effects begin to wear off earlier than other products and ultimately disappear in 12 months.ConclusionsOzone injection had rapid effects and better short-term results after 2 months, but its therapeutic effects did not persist after 6 months and at the 6-month follow up, PRP,PRGF and HA were superior to ozone. Only patients in PRP and PRGF groups improved symptoms persisted for 12 months. Therefore, these products could be the preferable choices for long-term management.Trial registrationRegistered in the Iranian Center of Clinical Trials (www.irct.ir) in 11/11/2017 with the following code: IRCT2017082013442N17.
Highlights
Our study compare the short and long-term efficacy of the intra articular injections (IAIs) of hyaluronic acid (HA), platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), and ozone in patients with knee osteoarthritis (OA)
Ozone injection had rapid effects and better short-term results after 2 months, but its therapeutic effects did not persist after 6 months and at the 6-month follow up, PRP,PRGF and HA were superior to ozone
Among the minimally invasive methods recommended for knee OA management is intra-articular injections for which a large array of products have been used such as corticosteroids, dextrose, hyaluronic acid (HA), plasma derivatives including platelet-rich plasma (PRP) and plasma rich in growth factors (PRGF), and ozone [12, 13]
Summary
Our study compare the short and long-term efficacy of the intra articular injections (IAIs) of hyaluronic acid (HA), platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), and ozone in patients with knee osteoarthritis (OA). Worldwide prevalence of symptomatic knee OA has estimated 3.8% [3]. It affects more than 20% of over 45-year-old population [4]. Among the minimally invasive methods recommended for knee OA management is intra-articular injections for which a large array of products have been used such as corticosteroids, dextrose, hyaluronic acid (HA), plasma derivatives including platelet-rich plasma (PRP) and plasma rich in growth factors (PRGF), and ozone [12, 13]. The intra-articular injections of corticosteroids have been shown to be effective, but in some situations these products may be less favored because of their short-term activity and adverse effects [14]
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