Intra-articular hyaluronic acid and platelet-rich plasma as monotherapy or combination therapy in knee osteoarthritis?

AIM

To systematically identify best current evidence on intra-articular combination therapy with hyaluronic acid (HA) and platelet-rich plasma (PRP), compared to monotherapy in knee osteoarthritis.

METHODS

Using the McMaster University and National Health Service five-step systematic approach, we conducted a bottom-up literature search of all existing evidence through Ovid Medline, Ovid Embase, and Cochrane (Central - Wiley) from January 2021 to June 2024.

RESULTS

Of 258 articles retrieved, we systematically narrowed best current evidence to one meta-analysis when evaluating combination therapy versus HA alone. This demonstrated superior outcomes with combination therapy against HA only at 3, 6, and 12 months on the visual acuity scale (VAS,  < 0.001), and with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months in areas of stiffness and physical function ( < 0.001). For combination therapy versus PRP alone, one randomized controlled trial qualified as best current evidence. This demonstrated superior VAS outcomes with combination therapy compared to PRP monotherapy at 6 months ( < 0.02).

CONCLUSION

Best current evidence indicates that intra-articular HA and PRP as combination therapy has superior short and long term symptom control over HA or PRP as monotherapy. Due to the extensive heterogeneity in the studies, results should be interpreted with caution.