Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma therapy in association with hyaluronic acid injection: three case reports

Szu-Hsuan Chen, Ta-Shen Kuan, Mu-Jung Kao, Wei-Ting Wu, Li-Wei Chou, Szu-Hsuan Chen, Ta-Shen Kuan, Mu-Jung Kao, Wei-Ting Wu, Li-Wei Chou

Abstract

Osteoarthritis (OA) is a degenerative disorder resulting from loss of joint cartilage and underlying bone and causes pain and loss of function. The treatment of knee OA is still a challenge because of the poor self-regeneration capacity of cartilage. The nonsurgical interventions include control of the aggravating factor (such as weight control and the use of walking aids), symptomatic treatment (such as acetaminophen or nonsteroidal anti-inflammatory drugs), prolotherapy, and viscosupplementation. However, the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) has not been widely used because of lack of clinical evidence and several limitations in patients with severe knee OA. Three patients who suffered from knee pain and poor walking endurance were diagnosed with advanced knee OA. They underwent PRP treatment in association with intra-articular HA injection and showed pain relief and functional improvement. The follow-up standard weight-bearing X-ray images of knees also confirmed the improvement and indicated the possibility of regeneration of the articular cartilage. These cases provide clinical and radiographic evidence for a new therapy for advanced knee OA. This treatment strategy of PRP in association with HA injection can offer a chance to treat severe knee OA, rather than immediate surgery, or a chance for those who cannot undergo surgery. It can also postpone the need of arthroplasty and can significantly improve the daily activity function.

Keywords: X-ray; hyaluronic acid injection; knee osteoarthritis; platelet-rich plasma; regeneration.

Figures

Figure 1
Figure 1
Standard weight-bearing knee X-rays of a 77-year-old female before (A) and 8 months after (B) one course of intra-articular PRP in association with HA injection, showing the increase in medial joint space (white arrows). Abbreviations: HA, hyaluronic acid; PRP, platelet-rich plasma.
Figure 2
Figure 2
Standard weight-bearing knee X-rays of a 69-year-old female before (A) and 15 months after (B) one course of intra-articular PRP in association with HA injection, showing significant improvement in the narrowing joint space (white arrows). Abbreviations: HA, hyaluronic acid; PRP, platelet-rich plasma.
Figure 3
Figure 3
Standard weight-bearing knee X-rays of a 76-year-old female before (A) and 1 year after (B) two courses of intra-articular PRP in association with HA injection, showing more significant bone spur growth and the cartilage remains at a healthy size with the normal joint space (white arrows). Abbreviations: HA, hyaluronic acid; PRP, platelet-rich plasma.

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