Superior clinical outcomes with combined intra-articular platelet-rich plasma and hyaluronic acid compared with hyaluronic acid alone in knee osteoarthritis: A prospective comparative study.

PURPOSE: Although platelet-rich plasma (PRP) and hyaluronic acid (HA) are widely used for knee osteoarthritis (KOA), it remains unclear whether combining them provides greater benefit than HA alone. This study compared the efficacy and safety of three combined injections of PRP and high molecular weight (HMW) HA to three injections of HMW HA alone in patients with KOA. METHODS: A prospective comparative analysis was conducted in patients with Kellgren-Lawrence (KL) Grade II-IV KOA who underwent either three intra-articular PRP-HA injections (Group A) or three intra-articular injections of HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and subscales, the visual analogue scale (VAS) and the EuroQuality of Life-5 Dimensions-5 Levels (EQ-5D-5L) were assessed at baseline, 3, 6 and 12 months post-injection. Statistical analysis was applied to compare the outcomes between the two groups. The HA used in both groups had a concentration of 1% (20 mg/2 mL) and a molecular weight of 2.8-3.2 MDa. The PRP used had been previously analysed and classified according to the Dose of injected Platelets, Efficiency of production, Purity of the PRP, Activation of the PRP (DEPA) classification as CCA. RESULTS: The study included 150 knees from 150 patients (Group A: 75 and Group B: 75). The VAS, KOOS total and EQ-5D-5L scores significantly improved within each group at every time point compared to baseline (p < 0.05). The PRP-HA group achieved significantly superior outcomes than the HMW-HA group in VAS, KOOS total and EQ-5D-5L scores at 6- and 12-month follow-up post-injection (p < 0.05). No serious adverse events were reported in either group. CONCLUSION: Both PRP-HA and HA only injections significantly improved pain, function and quality of life in patients with KOA. The PRP-HA group achieved significantly better outcomes than the HA group in all three patient-reported outcome measures at 6- and 12-month follow-up, and in the proportion of patients who achieved Patient Acceptable Symptom State and minimum clinically important difference, especially at 12 months post-injection. LEVEL OF EVIDENCE: Level II.