Comparison of clinical efficiency between intra-articular injection of platelet-rich plasma and hyaluronic acid for osteoarthritis: a meta-analysis of randomized controlled trials

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Abstract

Background:

Platelet-rich plasma (PRP) and hyaluronic acid (HA) are non-surgical treatments for osteoarthritis (OA), but the comparison of their efficiency is still inconclusive.

Objectives:

The objectives of this study were to compare the efficacy of PRP and HA in the treatment of OA by meta-analysis and to explore the effects of different injection times and leukocyte concentration on the efficacy of PRP.

Design:

Meta-analysis and subgroup analysis were conducted. The data were analyzed by Review Manager v5.4.1.

Data sources and methods:

Articles were retrieved and screened from PubMed, the Cochrane Library, Web of Science, and Embase. The outcome included the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS), adverse events (AEs), the International Knee Documentation Committee (IKDC), and the satisfaction rate.

Results:

A total of 30 articles involving 2733 patients were included. The total WOMAC score and IKDC score of the PRP group were better than those of the HA group at the last follow-up time, while there was no significant difference in AEs, satisfaction rate, and VAS between the two groups. In our subgroup analysis, there was no significant difference between single-injection PRP and triple-injection PRP. Leukocyte-poor PRP (LP-PRP) was better than leukocyte-rich PRP (LR-PRP) in IKDC, but there was no significant difference between them in the other scores.

Conclusions:

In the treatment of OA, compared with HA, PRP performed better in the improvement of the patient’s function. There was no significant difference in VAS and AEs between the two groups, and the safety was comparable. LP-PRP looked to be superior to LR-PRP in functional recovery, but there appeared to be no significant difference in pain relief between them. There was no significant difference between single PRP and triple PRP in the subgroup analysis.

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Most cited references 75

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Osteoarthritis.

S. Glyn-Jones, A. J. R. Palmer, R Agricola … (2015)

Osteoarthritis is a major source of pain, disability, and socioeconomic cost worldwide. The epidemiology of the disorder is complex and multifactorial, with genetic, biological, and biomechanical components. Aetiological factors are also joint specific. Joint replacement is an effective treatment for symptomatic end-stage disease, although functional outcomes can be poor and the lifespan of prostheses is limited. Consequently, the focus is shifting to disease prevention and the treatment of early osteoarthritis. This task is challenging since conventional imaging techniques can detect only quite advanced disease and the relation between pain and structural degeneration is not close. Nevertheless, advances in both imaging and biochemical markers offer potential for diagnosis and as outcome measures for new treatments. Joint-preserving interventions under development include lifestyle modification and pharmaceutical and surgical modalities. Some show potential, but at present few have proven ability to arrest or delay disease progression.

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Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).

David M. Dohan Ehrenfest, Lars Rasmusson, Tomas Albrektsson (2009)

The topical use of platelet concentrates is recent and its efficiency remains controversial. Several techniques for platelet concentrates are available; however, their applications have been confusing because each method leads to a different product with different biology and potential uses. Here, we present classification of the different platelet concentrates into four categories, depending on their leucocyte and fibrin content: pure platelet-rich plasma (P-PRP), such as cell separator PRP, Vivostat PRF or Anitua's PRGF; leucocyte- and platelet-rich plasma (L-PRP), such as Curasan, Regen, Plateltex, SmartPReP, PCCS, Magellan or GPS PRP; pure plaletet-rich fibrin (P-PRF), such as Fibrinet; and leucocyte- and platelet-rich fibrin (L-PRF), such as Choukroun's PRF. This classification should help to elucidate successes and failures that have occurred so far, as well as providing an objective approach for the further development of these techniques.

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Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Nicholas J. Kassebaum, Megha Arora, Ryan M Barber … (2016)

Summary Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation.

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Author and article information

Contributors

Lili Chen:

ORCID: https://orcid.org/0000-0002-8572-9663

Role: ConceptualizationRole: Data curationRole: Writing - original draftRole: Writing - review & editing

Shirong Jin:

ORCID: https://orcid.org/0000-0002-1862-4677

Role: ConceptualizationRole: Data curationRole: ValidationRole: Writing - review & editing

Yunheng Yao:

ORCID: https://orcid.org/0000-0002-7279-6306

Role: ConceptualizationRole: Data curationRole: SoftwareRole: ValidationRole: Writing - review & editing

Sixian He:

ORCID: https://orcid.org/0000-0002-7543-6613

Role: ConceptualizationRole: Data curationRole: ValidationRole: Writing - review & editing

Jinshen He:

ORCID: https://orcid.org/0000-0003-0277-3819

Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: SupervisionRole: Writing - original draftRole: Writing - review & editing

Journal

Journal ID (nlm-ta): Ther Adv Musculoskelet Dis

Journal ID (iso-abbrev): Ther Adv Musculoskelet Dis

Journal ID (publisher-id): TAB

Journal ID (hwp): sptab

Title: Therapeutic Advances in Musculoskeletal Disease

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1759-720X

ISSN (Electronic): 1759-7218

Publication date (Electronic): 17 March 2023

Publication date Collection: 2023

Volume: 15

Electronic Location Identifier: 1759720X231157043

Affiliations

[1-1759720X231157043]Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China

[2-1759720X231157043]Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China

[3-1759720X231157043]Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China

[4-1759720X231157043]Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China

[5-1759720X231157043]Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha 410013, China

Author notes

[*] Jinshen.he@ 123456Hotmail.com

Author information

Lili Chen https://orcid.org/0000-0002-8572-9663

Shirong Jin https://orcid.org/0000-0002-1862-4677

Yunheng Yao https://orcid.org/0000-0002-7279-6306

Sixian He https://orcid.org/0000-0002-7543-6613

Jinshen He https://orcid.org/0000-0003-0277-3819

Article

Publisher ID: 10.1177_1759720X231157043

DOI: 10.1177/1759720X231157043

PMC ID: 10026092

PubMed ID: 36950089

SO-VID: 3f2146a8-6431-4ad7-b017-c90fe3e8fcd4

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 14 August 2022

Date accepted : 27 January 2023

Funding

Funded by: Natural Science Foundation of Hunan Province, ;

Award ID: No. 2021JJ40922

Funded by: The Education Reform Foundation of Central South University, ;

Award ID: No. 2021JY188

Funded by: National Natural Science Foundation of China, FundRef https://doi.org/10.13039/501100001809;

Award ID: No. 81802208

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cover-date January-December 2023

typesetter ts1

Keywords: hyaluronic acid,intra-articular injection,meta-analysis,osteoarthritis,platelet-rich plasma

Data availability:

Keywords: hyaluronic acid, intra-articular injection, meta-analysis, osteoarthritis, platelet-rich plasma

Comparison of clinical efficiency between intra-articular injection of platelet-rich plasma and hyaluronic acid for osteoarthritis: a meta-analysis of randomized controlled trials

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Abstract

Background:

Objectives:

Design:

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Results:

Conclusions:

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Most cited references 75

Osteoarthritis.

Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

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