Is platelet-rich plasma better than hyaluronic acid in the treatment of knee osteoarthritis? A meta-analysis of randomized controlled trials

Lichun Wang; Lin Wei; HaoGuang Ma; Mengchang Wang; Sanjay Rastogi

doi:10.5114/wiitm.2022.118777

Is platelet-rich plasma better than hyaluronic acid in the treatment of knee osteoarthritis? A meta-analysis of randomized controlled trials

Wideochir Inne Tech Maloinwazyjne. 2022 Dec;17(4):611-623. doi: 10.5114/wiitm.2022.118777. Epub 2022 Aug 15.

Authors

Lichun Wang¹, Lin Wei², HaoGuang Ma³, Mengchang Wang⁴, Sanjay Rastogi⁵

Affiliations

¹ Rehabilitation Department, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, China.
² Department of Orthopedics, Nanjing Qixia District Hospital, Nanjing, Jiangsu, China.
³ Fourth Department of Surgery, Hot Spring Sanatorium of Linyi, Shandong Coal (Linyi Hedong Central Hospital), Shandong, Linyi city, China.
⁴ Department of Rehabilitation Medicine, Huzhou Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicinal University, Huzhou Zhejiang, China.
⁵ Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India.

Abstract

Introduction: Due to the complicated surgical procedure of knee arthroplasty and low effectivity of hyaluronic acid (HA) in the treatment of knee osteoarthritis, various studies highly recommend the use of platelet-rich plasma (PRP). However, some studies also reported lower efficacy and limited use of PRP.

Aim: To analyze systematically the different randomized controlled trials (RCTs) comparing the effectiveness of HA vs. PRP for the treatment of knee osteoarthritis.

Material and methods: A systematic literature review was conducted using Medline and Central databases for RCTs about the comparison of HA vs. PRP for the treatment of knee osteoarthritis. Studies were included as per the PICOS criteria and relevant event data were extracted. Risk of bias was analyzed and a random-effects model was used to calculate the pooled odds ratio and risk ratio using RevMan software.

Results: A total of 14 studies were included in the meta-analysis from year 2000 to 2021 including 613 patients. The current meta-analysis has a low risk of publication bias and we obtained the pooled odds ratio (OR) of 2.55 (95% CI: 1.35-4.84) with a τ ² value of 1.01, χ ² value of 52.79, I² value of 77%, Z value of 2.87 and p-value < 0.00001. The pooled risk ratio was 1.34 (95% CI: 1.09-1.65) with a τ ² value of 0.09, χ ² value of 73.48, I² value of 84%, Z value of 2.80 and p-value < 0.00001.

Conclusions: The current meta-analysis highly recommends the use of PRP for the treatment of knee osteoarthritis.

Keywords: hyaluronic acid; knee osteoarthritis; meta-analysis; platelet-rich plasma; randomized controlled trials.