Platelet-rich plasma plus hyaluronic acid versus hyaluronic acid alone in the management of grade I–II knee osteoarthritis

Objectives: To evaluate the comparative effectiveness of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) versus HA alone in patients with Kellgren-Lawrence (KL) grade I–II knee osteoarthritis (OA), with particular focus on pain relief, functional improvement, and safety outcomes over a 6-month follow-up period. Methods: This prospective, non-randomized, comparative study included 134 patients with early knee OA, recruited through consecutive non-probability sampling at a tertiary care orthopedic center from January 2024 to September 2024. Patients were assigned to two groups: Group A (PRP + HA, n = 67) and Group B (HA alone, n = 67). Pain and functional outcomes were assessed using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities OA Index (WOMAC) at baseline, 3 months, and 6 months after injection. Statistical analyses were conducted using independent-samples t -tests and repeated-measures analysis of variance. Results: Both groups demonstrated improvement in pain and function during follow-up. However, patients treated with PRP combined with HA showed significantly greater improvement compared with those receiving HA alone. At 6 months, the mean VAS score decreased to 2.7 ± 0.8 in the PRP + HA group compared with 4.5 ± 1.1 in the HA group ( p < 0.001). Similarly, WOMAC scores improved more markedly in the PRP + HA group (35.6 ± 5.4) compared with the HA group (47.2 ± 6.5; p < 0.001). The follow-up duration was 6 months, and the final analysis included 64 patients in each group after loss to follow-up. Effect size analysis demonstrated large clinical effects, with Cohen’s d = 1.7 for VAS and 1.5 for WOMAC at 6 months. No major adverse events were reported. Conclusion: Intra-articular PRP combined with HA appears to provide greater short-term improvement in pain relief and function than HA alone in patients with early knee OA. Larger randomized multicenter studies with longer follow-up are required to confirm durability and broader clinical applicability.