Date of Award

2020

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Comments

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Are PRP and HA injections beneficial for symptomatic relief when administered as combination therapy in patients with knee osteoarthritis?”

STUDY DESIGN: A systematic review of two randomized control trials (RCTs) and one case series published between 2016-2018.

DATA SOURCES: Sources were found using PubMed and Cochrane. Sources were selected based on patient-oriented evidence of therapeutic effects from HA and PRP injections as monotherapy and combination therapy in symptomatic relief for patients with knee osteoarthritis.

OUTCOMES MEASURED: Patient-reported pain score was recorded after treatment using Visual Analog Scale (VAS) or Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. One RCT used WOMAC; the other RCT and the case series used VAS.

RESULTS: One RCT (Lana JF, Weglein A, Sampson SE, et. al Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med. 2016;12(2):69–78. Published 2016 Nov 29.) showed a significant improvement in VAS pain score when patients were treated with combination therapy vs monotherapy by HA (p=<0.05). Another RCT (Yu W, Xu P, Huang G, Liu L. Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis. Exp Ther Med. 2018;16(3):2119–2125.) showed that combination therapy also provided significant improvement (p=<0.05) in pain when patients reported using the WOMAC index. The case series also showed improved VAS scores before and after combination treatment (Chen SH, Kuan TS, Kao MJ, Wu WT, Chou LW. Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma therapy in association with hyaluronic acid injection: three case reports. Clin Interv Aging. 2016;11:1213–1219. Published 2016 Sep 8. doi:10.2147/CIA.S114795).

CONCLUSION: The studies that were used in this systematic review conclude that combination of PRP and HA provide significantly improved results in pain when using either VAS or WOMAC indexes to assess pain before and after treatment. Future studies should consider radiographic imaging before and after treatment to produce objective results. Also, bigger sample sizes and monitoring short and long-term effects of combination therapy during trials would be beneficial since combination of HA and PRP is relatively novel.

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