Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial

Yung-Tsan Wu; Tsung-Ying Li; Kuei-Chen Lee; King Hei Stanley Lam; Chih-Ya Chang; Cheng-Kuang Chang; Liang-Cheng Chen

doi:10.3390/jcm11113241

Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial

J Clin Med. 2022 Jun 6;11(11):3241. doi: 10.3390/jcm11113241.

Authors

Yung-Tsan Wu^{1

2

3}, Tsung-Ying Li^{1

2}, Kuei-Chen Lee^{1

4}, King Hei Stanley Lam^{5

6

7

8}, Chih-Ya Chang^{1

9}, Cheng-Kuang Chang¹⁰, Liang-Cheng Chen¹

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan.
² Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan.
³ Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan.
⁴ Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan.
⁵ The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China.
⁶ Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong, China.
⁷ Department of Family Medicine, The University of Hong Kong, Hong Kong, China.
⁸ Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
⁹ Department of Physical Therapy and Assistive Technology, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan.
¹⁰ Department of Radiology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan.

Abstract

Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection. Moreover, the simultaneous injection of PRP and HA may offset the combined effect. Hence, the aim of this prospective, randomized, double-blind study was to assess their combined efficacy with a novel injection protocol. Forty-six study subjects with unilateral knee osteoarthritis were randomized to receive either a single-dose injection of HA (intervention group) or normal saline (control group) 1 week after a single-dose injection of leukocyte-poor PRP. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and static balance and the risk of falls measured by Biodex Balance System were, respectively, the primary and secondary outcome measures. Evaluations were performed at baseline, 1 month, 3 months, 6 months, and 12 months post-injection. The intervention group exhibited significant declines in WOMAC pain, stiffness, and total scores, as well as static balance, compared to the control group (p < 0.05). These randomized double-blind control trials, with novel protocol of intra-articular injection of PRP 1-week prior to HA, provide greater symptom relief and improve static balance compared to PRP alone in patients with knee osteoarthritis.

Keywords: balance; hyaluronic acid; knee; osteoarthritis; platelet-rich plasma.

Grants and funding

The study was sponsored by TCM Biotech International Corporation (the manufacturer of PLTenus Plus Platelet Concentrate Separator) and Teh-Tzer Study Group for Human Medical Research Foundation. Two authors (Y.T.W. and L.-C.C.) received the funding. The funds were used to pay for consultancy in study planning and realization without involving in study subjects enrollment, data collection, and data analysis or manuscript preparation.