Backgound The clinical evidence of Platelet-Rich Plasma (PRP) is still insufficient. The aim of this research is to compare the efficacy of hyaluronic (HA) and HA-PRP injection on osteoarthritis (OA) of the knee joint.

Material and methods A cross-sectional study using 58 patients medical record of Al Fauzan Hospital, Jakarta Indonesia. 27 patients received HA injections, and 31 patients received HA-PRP injections. Patients were evaluated using IKDC and WOMAC score until 2 months after injections. The data were analysing with Shapiro Wilk, Paired t, Wilcoxon, Mann Whitney, Kruskal Wallis and Post Hoc test.

Results On the 2nd month of follow up, HA-PRP shows greater increase in IKDC (p = 0.000) and WOMAC (Pain p = 0.004; Stiffness p = 0.008; Knee function p = 0.007) score compared to HA injection. There’s no association on gender, age, and body mass index towards the IKDC and WOMAC score increase on either HA or HA-PRP injection. There was no significant difference on osteoarthritis degree towards IKDC and WOMAC score increase on HA injection. However, there was a relationship between the degree of osteoarthritis in IKDC score (p = 0.003) and WOMAC (pain p = 0.015; stiffness p = 0.041; knee function p = 0.027) on patients with HA-PRP. In detailed, HA-PRP treated patients showed significant difference between osteoarthritis degree 2 and 4 in IKDC (p = 0.002) and WOMAC score (pain p = 0.042; stiffness p = 0.018; knee function p = 0.042), and between osteoarthritis degree 2 and 3 in WOMAC Pain (p = 0.008) and WOMAC Knee function (p = 0.018).

HA-PRP injection is superior to HA, because HA only provide protection from mechanical damage on the joint surface while the growth factor contained in PRP induced differentiation of mesenchymal stem cells, phenotypic expression of chondrocytes, suppressed the inflammatory mediators, matrix deposition and lower catabolism speed to help cartilage regeneration and prevented cartilage degeneration.^1,2 These effects were not influenced by the characteristics of the patients but by the degree of illness. HA-PRP on grade 2 and 3 reduced pain and stiffness, as well as improved daily activities and exercise; because the cells respond to growth factors more responsive in lower degree of OA.³

Conclusion HA-PRP injection showed better results to reduce OA symptoms, compared to HA injections. Better results were observed in patients with less severe osteoarthritis degree.

References

1. Banciu M, Tuduce P, Marian L. Viscosupplementation in Osteoarthritis. Arad Medical Journal. Vasile Goldis University Press 2010;XIII(3):5–9.

2. Spakova T, Rosocha J, LAcko M, Harvanova D, Gharaibeh A. Platelet-Rich Plasma in comparison with Hyaluronic Acid. Am J Phys Med Rehabil 2012;9(4).

3. Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, et al. Platelet-Rich Plasma Intra-Articular Knee Injections for the Treatment of Degenerative Cartilage Lesions and Osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2011;19:528–35.