Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Figures & data

Figure 1 Flowchart of the study selection process.

Table 1 Detailed information of the included studies

Reference	Group	Age (years)	Gender (M/F)	OA type (C/E/A)	BMI (kg/m^2)	Intervention	Follow-up (months)
Kon et al, 2011^Citation9	PRP HWHA LWHA	50.6±13.8 54.9±12.6 53.2±13.0	30/20 25/25 27/23	C22; E20; A8 C21; E19; A10 C19; E22; A9	24.6±3.2 24.8±3.5 26.2±2.2	3 times, 5 mL, every 2 weeks 30 mg/2 mL, 1,000 to 2,900 kDa 20 mg/2 mL, 500 to 730 kDa	2, 6
Cerza et al,^Citation26 2012	PRP HA	66.5±11.3 66.2±10.6	25/35 28/32	E 21/24/15 E 25/22/13	N N	4 times, 5.5 mL, weekly 4 times, 20 mg/2 mL	1, 2, 6
Sanchez et al,^Citation20 2012	PRP HA	60.5±7.9 58.9±8.2	43/46 42/45	E 45/32/12 E 42/32/11	27.9±2.9 28.2±2.7	3 times, 8 mL, weekly 3 times	1, 2, 6
Spakova et al,^Citation25 2012	PRP HA	52.8±12.4 53.2±14.5	33/27 31/29	E 2/39/19 E 2/37/21	27.9±4.1 28.3±4.0	3 times, 3 mL, weekly 3 times	3, 6
Say et al,^Citation24 2013	PRP LWHA	55.2±7.8 56.2±5.1	5/40 6/39	E 1/17/27 E 1/15/29	32.4±4.0 32.3±3.3	1 time 3 times, 25 mg/2.5 mL, 730 to 900 kDa, weekly	3, 6
Vaquerizo et al,^Citation27 2013	PRP HWHA	62.4±6.6 64.8±7.7	16/32 22/26	E 0/14/26; A8 E 0/18/21; A9	30.7±3.6 31.0±4.6	3 times, 8 mL, every 2 weeks 1 time, 60 mg/3 mL	6, 12
Filardo et al,^Citation28 2015	PRP HWHA	53.3±13.2 57.6±11.8	60/34 52/37	E 2.0±1.1 E 2.0±1.1	26.6±4.0 26.9±4.4	3 times, 5 mL, weekly 3 times, 20 mg/2 mL, >1,500 kDa, weekly	2, 6, 12
Gormeli et al,^Citation29 2017	PRP* PRP# HA	53.7±13.1 53.8±13.4 53.5±14	23/16 25/19 22/17	E 26; A13 E 25; A14 E 27; A13	28.7±4.8 28.4±4.4 29.7±3.7	3 times, 5 mL, weekly 1 time, 5 mL 3 times, 20 mg/2 mL, weekly	6
Raeissadat et al,^Citation30 2015	PRP LWHA	56.9±9.1 61.1±7.5	8/69 15/47	E6/44/38; A12 E0/47/37; A16	28.2±4.6 27.0±4.2	2 times, 5 mL, monthly 3 times, 20 mg/2 mL, 500 to 730 kDa, monthly	1, 6, 12
Lana et al,^Citation31 2016	PRP HWHA P&A	60.9±7 60±6.6 62±6.1	7/29 3/33 6/27	E 9/14/13 E 9/16/11 E 5/14/14	27.4±6.9 28.2±8.8 29.2±7.3	1 time, 5 mL 20 mg/2 mL, 2,400 to 3,600 kDa 5 mL+2 mL	1, 3, 6, 12
Duymus et al,^Citation32 2017	PRP HWHA	60.4±5.1 60.3±9.1	1/32 1/33	E 0/22/11 E 0/24/10	27.6±4.6 28.4±3.6	2 times, 5 mL per time, every 2 weeks 40 mg/2 mL, 1,600 kDa	1, 3, 6, 12
Montanez-Heredia et al,^Citation33 2016	PRP LWHA	66.3±8.3 61.5±8.6	12/15 9/17	E 5/10/12 E 2/9/15	29.0±5.5 30.4±4.9	3 times, every 2 weeks 3 times, 25 mg/2.5 mL, 799 kDa	3, 6
Cole et al,^Citation21 2017	PRP LWHA	55.9±10.4 56.8±10.5	28/21 20/30	E 3/2620 E 1/27/22	27.4±3.9 29.0±6.4	3 times, 4 mL, weekly 3 times, 16 mg/2 mL, 6,000 kDa	3, 6, 12

Notes:

* Three injections of PRP;

# one injection of PRP. OA type (C/E/A): chondropathy, Kellgren grade 0/early, Kellgren grade I to III/advanced, Kellgren grade IV.

Abbreviations: OA, osteoarthritis; BMI, body mass index; PRP, platelet-rich plasma; HA, hyaluronic acid; HWHA, high-molecular weight hyaluronic acid; LWHA, low-molecular weight hyaluronic acid; P&A, PRP and HA.

Table 2 Quality assessment for nonrandomized trials

Quality assessment for nonrandomized trials	Kon et al^Citation9	Say et al^Citation24	Spakova et al^Citation25
A clearly stated aim	2	2	2
Inclusion of consecutive patients	2	0	0
Prospective data collection	0	0	0
Endpoints appropriate to the aim of the study	2	2	2
Unbiased assessment of the study endpoint	0	0	0
A follow-up period appropriate to the aims of study	2	2	2
Less than 5% loss to follow-up	2	2	2
Prospective calculation of the sample size	2	0	2
An adequate control group	2	2	2
Contemporary groups	2	2	2
Baseline equivalence of groups	2	2	2
Adequate statistical analyses	2	2	2
Total score	20	16	18

Figure 2 The summary of risk of bias of randomized controlled trials.

Table 3 Results of the meta-analysis

Follow-up	Evaluation tools	Studies	Patients (PRP/HA)	MD	95% CI	P<0.05	I^2
3 months	WOMAC total score	3	153/154	−10.82	−19.74 to −1.91	Yes	89%
	WOMAC pain	2	82/84	−0.5	−1.66 to 0.66	No	81%
	VAS	2	78/79	−0.98	−2.55 to 0.59	No	95%
	EQ VAS	2	144/139	5.91	−1.51 to 13.34	No	79%
6 months	WOMAC total score	5	290/289	−14.18	−26.12 to −2.23	Yes	95%
	WOMAC pain	4	219/219	−2.0	−3.60 to −0.39	Yes	90%
	VAS	2	78/79	−0.82	−1.80 to 0.16	No	83%
	WOMAC function	3	170/169	−5.78	−14.73 to 3.16	No	92%
	EQ VAS	4	232/228	2.19	−11.47 to 15.85	No	98%
	IKDC	4	232/228	8.53	4.52 to 12.53	Yes	79%
12 months	WOMAC total score	4	207/194	−15.25	−22.17 to −8.32	Yes	81%
	WOMAC pain	3	158/144	−2.22	−3.65 to −0.79	Yes	92%
	WOMAC function	3	158/144	−11.17	−16.37 to −5.98	Yes	83%
	EQ VAS	2	143/139	−4.64	−21.79 to 12.51	No	98%
	IKDC	2	143/139	6.84	−1.96 to 15.63	No	91%

Abbreviations: CI, confidence interval; EQ VAS, EuroQol-visual analog scales; HA, hyaluronic acid; IKDC, Subjective International Knee Documentation Committee; MD, mean difference; PRP, platelet-rich plasma; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.

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