Outcome Comparison between Platelet Rich Plasma in Combination with Hyaluronic Acid Versus Steroid Alone in the Treatment of Primary Knee Osteoarthritis

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are two promising intra-articular therapies for osteoarthritis (OA). These agents have demonstrated effectiveness in the healing and regeneration of OA joints. However, a few studies have assessed their combined effect in the treatment of OA in humans. The present study aimed to fill that gap.Methods: This open-label randomized clinical trial was conducted among a total of 51 patients with OA of the knee who did not respond to conservative treatment. Equal number of patients were randomly assigned to one of three intervention groups using the block randomization method. Group S (control group) received intra-articular steroids only, Group P (control group) received only PRP, and Group PH (experimentalgroup) was treated with a combination of PRP and HA. All the participants underwent follow-up examinations at the 1st week, 1st month and 3rd month after the procedure. Outcomes were assessed using the visual analogue scale (VAS). All procedure were in accordance with the Declaration of Helsinki. Statistical analysis was carried out using SPSS version 20.Results: The patient characteristics of the three groups at baseline were statistically similar. Patients had an average age of 46.12 ±7.16, 48.53 ± 4.93 and 48.82 ±2.56 years for groups S, P and PH, respectively (p>0.05). The proportion of males was high in all three groups, and the majority had radiologically grade II disease. The perception of pain assessed by the VAS score showed improvement in all three groups up to 1 month. However, for group S, pain increased after the 1st month. The improvement was considerably higher among the PH patients. Functional outcome assessed by the international knee documentation committee (IKDC) score increased in all three groups over time; the improvement was significantly higher in the PH group than in the other groups although.Conclusion: The combination of PRP and HA is highly effective against knee osteoarthritis over at least a period of 3 months. Further long-term studies could be carried out to ascertain the duration of effectiveness among OA patients.