Transcription
Does HA and PRP work better together to treat knee arthritis? Hyaluronic acid injections, as well as platelet-rich plasma injections, have both been shown to be excellent treatment options for knee arthritis. But does getting them together result in better outcomes? Let's see what the data shows.
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Hey everyone, Dr. Jeff Peng here. Now, if this is the first time you're watching one of my videos, my goal is to help each and every one of you live an active and healthy lifestyle. So, if that's something you're interested in, please consider subscribing to my channel.
Both hyaluronic acid injections and PRP injections are great treatment options for knee arthritis. They're part of my multimodal approach to treating arthritis. But when we talk about monotherapy, multiple head-to-head trials comparing PRP injections to hyaluronic acid injections show just that, the people that get PRP have more favorable outcomes. More recently, there is a trend towards combining the two injections together with the hopes of achieving a synergistic effect. The thought process behind this is that PRP has mainly a biologic effect in treating the microenvironment of an arthritic knee. Hyaluronic acid has a mechanical effect in lubricating the knee and to a lesser degree, a biologic effect. PRP and hyaluronic acid both have anti-inflammatory properties that can occur through different pathways. Theoretically, combining these two treatment options will result in better outcomes because it allows us to treat as many degenerative pathways as possible. So, that's the theory behind combining these treatment options.
Now, let's look at what clinical trials show. This randomized control trial compared PRP injection alone, to hyaluronic acid injection alone, to combining PRP and hyaluronic acid injections together. They found that at both 6 and 12 months, synovial hyperplasia in the PRP and PRP plus hyaluronic acid groups was improved. They also found that inflammatory cytokine expressions of interleukin-1 beta, TNF alpha, and matrix metalloproteinases were decreased in both the PRP and the PRP plus hyaluronic acid groups, with more notable effects in the combination PRP plus HA group. The authors conclude that PRP combined with hyaluronic acid is more effective than PRP alone or HA alone at inhibiting synovial inflammation and can effectively improve pain and function.
Now, that's pretty amazing results, but that's just data from one trial. The next thing we need to do is to combine data from multiple trials and look at systematic reviews and meta-analyses to see if the conclusions still hold. This first study is a systematic review and meta-analysis of seven studies comparing the effects of combining PRP and hyaluronic acid injections. They found that compared with injection of PRP alone, that of PRP combined with hyaluronic acid can improve functional and pain scores at 12 months follow-up. So far, things look promising.
However, this next study is also a systematic review and meta-analysis of eight studies looking at combining PRP and hyaluronic acid injections. They concluded that combination therapy with PRP and hyaluronic acid improved patient outcomes and is superior to HA alone, but is not superior to PRP alone. We have two systematic reviews and meta-analyses coming up with different conclusions. What's interesting is that their inclusion criteria were different, and because of this, they only had two overlapping studies. The first study did not include two randomized control trials which showed no benefit of combination therapy over PRP alone. However, the second study did not include four other studies that potentially showed benefits of combination therapy.
So, what can we conclude from these results? Well, as with most things in medicine, we still don't know, and we need more data. What's clear is that the science and the rationale behind using combination therapy is pretty compelling, but until more clinical trials are done, we still don't know what the best treatment is. As of right now, I'm not convinced that combining the two injections at the same time will give more benefit. What I am currently recommending to my patients is to consider both treatments, but instead of combining them, try to stagger them. Currently, it seems like PRP injections are the way to go to control symptoms, reduce pain, and improve function. And once we are successful in treating an arthritic knee flare-up, then we want to get patients on a maintenance program. And that maintenance program should include regular booster PRP injections and possibly even staggering them with hyaluronic acid injections. This, in theory, will keep the environment of a knee with arthritis as neutral and as healthy as possible. Of course, all of this can and will likely change with more research.
Now, if you're interested in learning more about how to take a multimodal approach to treating knee arthritis, check out this video next. Thanks for watching.