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After 5 years, platelet-rich plasma = hyaluronic acid injections for patients with knee osteoarthritis
Clinical Question
Are platelet-rich plasma injections as effective as hyaluronic acid injections in patients with unilateral osteoarthritis of the knee?
Bottom line
After 5 years of follow-up, patients with unilateral mild to moderate knee osteoarthritis treated with either platelet-rich plasma or hyaluronic acid injections had comparable degrees of improvement. Since other studies have found viscosupplementation is minimally better than sham treatments, we can infer that neither of the tested interventions are more effective than placebo. 1b-
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Unknown/not stated
Setting: Outpatient (specialty)
Synopsis
This paper provides the 5-year follow-up results of a study we reviewed in 2015. The patients had unilateral mild to moderate severe knee osteoarthritis. The researchers randomized the patients to receive 3 weekly injections of either platelet-rich plasma (n = 96) or hyaluronic acid (n = 96). At the end of 5 years, the authors only had complete follow up on 88% and 85% of the original patients, respectively, and the patients had comparable degrees of symptom and function score improvement. The paper does not report the funding source for this study, but 3 of the authors report ties to industry. Finally, this paper is one of many that highlight why treatments for painful conditions should have a placebo or sham comparator: A recent systematic review demonstrated that hyaluronic acid injections were slightly better than placebo at improving pain and function, but the improvement was not clinically important.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
How was this allowed through any filter?
Interesting InfoPOEM. Refers to one study that states treatments are efficacious. Then refers to an unrelated study disputing this, and ignores the reams of studies showing both treatments to be effective, and the expert consensus across Canadian Orthopedic boards. Please call Mo Bhandari for a proper evaluation of HA, and the positive results that are found. Anyone who uses these treatments in care of OA knows damn well how much better they work than placebo/dextrose/cortisone, and how much patients benefit and get a life back.
So not only is this information wrong, but it is poorly derived. Classic InfoPOEM, misinforming medicine.
Agree with previous commentary
This Infopoem is inaccurate. Those of us with no ties to the industry (and in my case with 20+ years experience) know from distilled experience that these treatments are efficacious. The evidence for PRP in knee OA is impressive (multiple SR/MA's) and the evaluation by OrthoEvidence(Bhandari and colleagues) for Cisco is convincing, transparent and scientifically accurate. Who penned this poor POEM?
Above should read Visco
Viscosupplementation
Wonderful! Evidence based at it's best
The joule refers to a systemic review, but gives NO reference. Please provide it. The three (3) Anonymous's likewise provide no specific references. Cisco and Visco mean what? How does one go about "calling" Mo Bhandari, whoever he is? Could those of us who do not profit from these injections please have some authoritative references. We don't need "reams", just a few comprehensive ones published in peer reviewed journals.
Greetings Here are 6…
Greetings
Here are 6 positive Systematic reviews pertaining to PRP in OA
1. Meheux, McCulloch et al, Arthroscopy, March 2016
2. Augustinus B M Laudy, et al, British Journal of Sports Medicine, 2015
3. Campbell et al, Arthroscopy: the Journal of Arthroscopic & related Surgery 2015
4. Xing et al, Intra-articular platelet-rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations , International Journal of Rheumatic Diseases 2017; 20: 1612–1630
5. Laver et al, Cartilage, 2017
6. Johal H, Khan M, Bhandari M, Fu F, Bedi A. (2018). Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis. Sports Health
The viscosupplementation review by Bhandari and colleagues can be found here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600311/
I find it convincing
I use both modalities with good results
Best regards
Dr. W Francois Louw
Bill Nelems Pain and Research Centre, Kelowna