Platelet-rich plasma versus hyaluronic acid for the treatment of knee osteoarthritis: A meta-analysis

doi:10.3877/cma.j.issn.2096-0263.2022.01.008

Abstract

Abstract:

Objective

This study aimed to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA) injection for the treatment of patients diagnosed with knee osteoarthritis (KOA).

Methods

Online databases including PubMed, Embase, Ovid and, Cochrane Library, CNKI and Wanfang database were systematically searched to collect the random controlled trials (RCT) comparing the clinical efficacy between PRP and HA in the treatment of KOA. The primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function score. Secondary outcomes were WOMAC total score, WOMAC stiffness score, International Knee Documentation Committee (IKDC) score, visual analog scale (VAS) score, EuroQol (EQ)-VAS score, Knee and Osteoarthritis Outcome System (KOOS) score, Lequesne Index score and adverse events. The pooled results were calculated by Review Manager 5.3.

Results

A total of 19 RCTs were enrolled in present study. The pooled results demonstrated that PRP injection was more effective than HA injection in pain relief at 6-month and 12-month of follow-up evaluated by WOMAC pain score and VAS score. EQ-VAS score in the patients treated with PRP injection was lower than that in patients with HA injection at 12-month. Moreover, the patients with PRP injection had a better function recovery than those with HA injection at 1 month, 3-month, 6-month and 12-month after surgery, as evaluated by WOMAC function score. WOMAC total score showed significant difference at 6-months and 12-month after surgery. The IKDC score indicated PRP injection was significantly more effective than HA injection at 3-month and 6-month after surgery. However, the Lequesne Index score, KOOS score and adverse events didn't show any significant difference between the groups.

Conclusions

Intra-articular PRP injection appeared to be more efficacy than HA injection for the treatment of KOA in terms of short-term functional recovery. Moreover, PRP injection was superior to HA injection in terms of long-term pain relief and function improvement. In addition, PRP injection didn't increase the risk of adverse events compared to HA injection.

Key words: Osteoarthritis, knee, Injection, intra-articular, Platelet-rich plasma, Hyaluronic acid, Meta-analysis

Hong Sun, Mengzhao Su, Zexi Xu, Guoxuan Peng, Jin Deng, Xu Ning, Hua Yang. Platelet-rich plasma versus hyaluronic acid for the treatment of knee osteoarthritis: A meta-analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(01): 44-53.

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Figures/Tables 9

References 40

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文献	患者数		年龄（岁）		性别（男/女）		体重指数		随访时间（月）	评价体系
	PRP组	HA组	PRP组	HA组	PRP组	HA组	PRP组	HA组
Cerza等^[6]	60	60	66.5	66.2	25/35	28/32	NR	NR	1，3，6	WOMAC（total）
Duymus等^[7]	33	34	60.4	60.3	1/32	1/33	27.6	28.4	1，3，6，12	VAS，WOMAC
Filardo等^[9]	94	89	53.3	57.6	60/34	52/37	26.6	26.9	2，6，12	IKDC，KOOS，EuroQol-VAS
Görmeli等^[21]	39（PRP/T）	39	53.7	53.5	16/23	17/22	28.7	29.7	6	IKDC，EuroQol-VAS
	44（PRP/S）		53.8		19/25		28.4
Paterson等^[23]	11	10	49.9	52.7	8/3	7/3	27.9	30.9	3	KOOS，VAS，KQoL-26
Raeissadat等^[24]	77	62	56.9	61.1	8/69	15/47	28.2	27	1，12	WOMAC，SF-36
Sanchez等^[14]	89	87	60.5	58.9	43/46	42/45	27.9	28.2	1，2，6	WOMAC，LIS
Vaquerizo等^[25]	48	48	62.4	64.8	16/32	22/26	30.7	31	6，12	WOMAC，LIS
Montañez-Heredia等^[22]	27	26	66.3	61.5	12/15	9/17	29	30.4	3，6	KOOS，VAS，EuroQol-VAS
Cole等^[10]	49	50	55.9	56.8	28/21	20/30	27.4	29	3，6，12	WOMAC，VAS，IKDC
Ahmad等^[19]	45	44	56.2	56.8	14/31	14/30	26.7	26.5	3，6	IKDC，VAS，US
Yu等^[17]	104	88	46.2	51.5	50/54	48/40	NR	NR	12	WOMAC
Louis等^[18]	24	24	53.2	48.5	14/10	11/13	25.6	27	1，3，6	VAS，WOMAC
Buendia-Lopez等^[20]	33	32	56.2	56.6	16/17	15/17	24.9	24.9	6，12	VAS，WOMAC X-ray，MRI
Li等^[26]	15	15	57.6	58.2	6/9	7/8	24.3	24	3，4，6	IKDC，WOMAC，LIS
Su等^[13]	25	30	54.2	53.1	11/14	12/18	28.2	28.7	1，3，6，12，18	VAS，WOMAC
	27（PRP/O）		50.7		10/17		28.2
Lin等^[15] #	31	29	61.2	62.5	9/22	10/19	24	26.3	1，2，6，12	IKDC，WOMAC
Huang等^[16]	40	40	54.5	54.8	25/15	19/21	25.2	24.5	3，6，9，12	VAS，WOMAC
Di等^[8]	85	82	52.7	57.5	53/32	47/35	27.2	26.8	2，12，24，60	IKDC，EuroQol-VAS

文献	患者数		年龄（岁）		性别（男/女）		体重指数		随访时间（月）	评价体系
	PRP组	HA组	PRP组	HA组	PRP组	HA组	PRP组	HA组
Cerza等^[6]	60	60	66.5	66.2	25/35	28/32	NR	NR	1，3，6	WOMAC（total）
Duymus等^[7]	33	34	60.4	60.3	1/32	1/33	27.6	28.4	1，3，6，12	VAS，WOMAC
Filardo等^[9]	94	89	53.3	57.6	60/34	52/37	26.6	26.9	2，6，12	IKDC，KOOS，EuroQol-VAS
Görmeli等^[21]	39（PRP/T）	39	53.7	53.5	16/23	17/22	28.7	29.7	6	IKDC，EuroQol-VAS
	44（PRP/S）		53.8		19/25		28.4
Paterson等^[23]	11	10	49.9	52.7	8/3	7/3	27.9	30.9	3	KOOS，VAS，KQoL-26
Raeissadat等^[24]	77	62	56.9	61.1	8/69	15/47	28.2	27	1，12	WOMAC，SF-36
Sanchez等^[14]	89	87	60.5	58.9	43/46	42/45	27.9	28.2	1，2，6	WOMAC，LIS
Vaquerizo等^[25]	48	48	62.4	64.8	16/32	22/26	30.7	31	6，12	WOMAC，LIS
Montañez-Heredia等^[22]	27	26	66.3	61.5	12/15	9/17	29	30.4	3，6	KOOS，VAS，EuroQol-VAS
Cole等^[10]	49	50	55.9	56.8	28/21	20/30	27.4	29	3，6，12	WOMAC，VAS，IKDC
Ahmad等^[19]	45	44	56.2	56.8	14/31	14/30	26.7	26.5	3，6	IKDC，VAS，US
Yu等^[17]	104	88	46.2	51.5	50/54	48/40	NR	NR	12	WOMAC
Louis等^[18]	24	24	53.2	48.5	14/10	11/13	25.6	27	1，3，6	VAS，WOMAC
Buendia-Lopez等^[20]	33	32	56.2	56.6	16/17	15/17	24.9	24.9	6，12	VAS，WOMAC X-ray，MRI
Li等^[26]	15	15	57.6	58.2	6/9	7/8	24.3	24	3，4，6	IKDC，WOMAC，LIS
Su等^[13]	25	30	54.2	53.1	11/14	12/18	28.2	28.7	1，3，6，12，18	VAS，WOMAC
	27（PRP/O）		50.7		10/17		28.2
Lin等^[15] #	31	29	61.2	62.5	9/22	10/19	24	26.3	1，2，6，12	IKDC，WOMAC
Huang等^[16]	40	40	54.5	54.8	25/15	19/21	25.2	24.5	3，6，9，12	VAS，WOMAC
Di等^[8]	85	82	52.7	57.5	53/32	47/35	27.2	26.8	2，12，24，60	IKDC，EuroQol-VAS

文献	PRP				HA
文献	注射量	次数	间隔	PRP种类	注射量	次数	间隔
Cerza等^[6]	5.5 ml	4	1周	LP-PRP	20 mg/2 ml	4	1周
Duymus等^[7]	5 ml	2	1月	LR-PRP	40 mg/2 ml	1	1月
Filardo等^[9]	5 ml	3	1周	LR-PRP	30 mg/2 ml	3	1周
Gormeli等^[21]	5 ml	3	1周	LR-PRP	30 mg/2 ml	3	1周
Paterson等^[23]	3 ml	3	1周	LR-PRP	3 ml	3	1周
Raeissadat等^[24]	4~6 ml	2	1月	LR-PRP	20 mg/2 ml	3	1周
Sanchez等^[14]	8 ml	3	1周	LP-PRP	NR	3	1周
Vaquerizo等^[25]	8 ml	3	2周	LP-PRP	NR	1	NR
Montañez-Heredia等^[22]	NR	3	2周	LP-PRP	NR	3	2周
Cole等^[10]	4 ml	3	1周	LP-PRP	16 mg/2 ml	3	1周
Ahmad等^[19]	4 ml	3	2周	LR-PRP	20 mg/2 ml	3	2周
Yu等^[17]	2~14 ml	4	1周	LR-PRP	0.1~0.3 mg	4	1周
Louis等^[18]	3 ml	1	NR	LP-PRP	60 mg/3 ml	1	NR
Buendia-Lopez等^[20]	5 ml	NR	NR	LP-PRP	60 mg/2 ml	NR	NR
Li等^[26]	3.5 ml	3	3周	LR-PRP	2 ml	3	3周
Su等^[13]	6 ml	2	2周	LR-PRP	2 ml	5	1周
Lin等^[15]	5 ml	3	1周	LP-PRP	20 mg/2 ml	3	1周
Huang等^[16]	2 ml	3	1周	LP-PRP	4 ml	3	1周
Di等^[8]	5 ml	3	1周	LR-PRP	30 mg/2 ml	3	1周

文献	PRP				HA
文献	注射量	次数	间隔	PRP种类	注射量	次数	间隔
Cerza等^[6]	5.5 ml	4	1周	LP-PRP	20 mg/2 ml	4	1周
Duymus等^[7]	5 ml	2	1月	LR-PRP	40 mg/2 ml	1	1月
Filardo等^[9]	5 ml	3	1周	LR-PRP	30 mg/2 ml	3	1周
Gormeli等^[21]	5 ml	3	1周	LR-PRP	30 mg/2 ml	3	1周
Paterson等^[23]	3 ml	3	1周	LR-PRP	3 ml	3	1周
Raeissadat等^[24]	4~6 ml	2	1月	LR-PRP	20 mg/2 ml	3	1周
Sanchez等^[14]	8 ml	3	1周	LP-PRP	NR	3	1周
Vaquerizo等^[25]	8 ml	3	2周	LP-PRP	NR	1	NR
Montañez-Heredia等^[22]	NR	3	2周	LP-PRP	NR	3	2周
Cole等^[10]	4 ml	3	1周	LP-PRP	16 mg/2 ml	3	1周
Ahmad等^[19]	4 ml	3	2周	LR-PRP	20 mg/2 ml	3	2周
Yu等^[17]	2~14 ml	4	1周	LR-PRP	0.1~0.3 mg	4	1周
Louis等^[18]	3 ml	1	NR	LP-PRP	60 mg/3 ml	1	NR
Buendia-Lopez等^[20]	5 ml	NR	NR	LP-PRP	60 mg/2 ml	NR	NR
Li等^[26]	3.5 ml	3	3周	LR-PRP	2 ml	3	3周
Su等^[13]	6 ml	2	2周	LR-PRP	2 ml	5	1周
Lin等^[15]	5 ml	3	1周	LP-PRP	20 mg/2 ml	3	1周
Huang等^[16]	2 ml	3	1周	LP-PRP	4 ml	3	1周
Di等^[8]	5 ml	3	1周	LR-PRP	30 mg/2 ml	3	1周

随访时间	评估量表	文献数量	膝关节例数（PRP/HA）	标准差	95% CI	P值	I²
1个月	VAS	3	69/74	0.36	-0.38，0.10	No	80%
2个月	EQ-VAS	2	179/171	0.61	-2.10，3.31	No	0%
	IKDC	3	210/200	-1.35	-6.06，3.35	No	58%
3个月	VAS	5	138/142	0.06	-0.54 0.67	No	79%
	IKDC	2	60/59	5.16	0.23，10.10	<0.05	0%
	KOOS symptom	2	105/99	-0.02	-0.54，0.50	No	40%
	KOOS pain	2	105/99	-0.02	-0.29，0.26	No	0%
	KOOS ADL	2	105/99	-0.11	-0.39，0.16	No	0%
	KOOS sport	2	105/99	0.03	-0.24，0.31	No	0%
6个月	VAS	4	136/140	-0.28	-0.98，0.42	No	90%
	EQ-VAS	3	218/210	4.35	-2.30，11.01	No	89%
	IKDC	5	224/216	8.20	1.81，14.58	<0.05	85%
	Lequesne Index	3	152/150	-0.57	-1.59，0.45	No	37%
12个月	VAS	4	131/136	-0.70	-1.03，-0.37	<0.05	63%
	EQ-VAS	2	179/171	3.08	0.34，5.82	<0.05	0%

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