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Research article
Jun Liu
Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine(Guangdong Provincial Hospital of Chinses Medicine)
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1943-3880
License:
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Background Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA.
Methods The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation.
Results Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: -0.31; 95% confidence interval (CI): -0.55 to -0.06; P=0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: -0.54 to -0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: -0.67 to -0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: -0.67 to -0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P>0.05).
Conclusions Compared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone.
Keywords
Platelet-Rich Plasma, Hyaluronic Acid, Knee Osteoarthritis, Meta-analysis
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View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 27 Mar, 2020
No community comments so far
Editor assigned
On 23 Mar, 2020
Submission checks complete
On 22 Mar, 2020
Editor invited
On 22 Mar, 2020
No comments provided
Editorial decision: Major revision
On 09 Mar, 2020
Review #2 received
Received 05 Mar, 2020
Review #1 received
Received 05 Mar, 2020
Review #3 received
Received 28 Feb, 2020
Reviewer #3 agreed
On 26 Feb, 2020
Reviewer #2 agreed
On 20 Feb, 2020
Reviewers invited
Invitations sent on 15 Feb, 2020
Reviewer #1 agreed
On 15 Feb, 2020
Editor assigned
On 02 Feb, 2020
Submission checks complete
On 01 Feb, 2020
Editor invited
On 01 Feb, 2020
First submitted
On 30 Jan, 2020
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Subject Areas
Orthopedics
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A new preprint design is coming!
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Jun Liu
Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine(Guangdong Provincial Hospital of Chinses Medicine)
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1943-3880
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 27 Mar, 2020
No community comments so far
Editor assigned
On 23 Mar, 2020
Submission checks complete
On 22 Mar, 2020
Editor invited
On 22 Mar, 2020
No comments provided
Editorial decision: Major revision
On 09 Mar, 2020
Review #2 received
Received 05 Mar, 2020
Review #1 received
Received 05 Mar, 2020
Review #3 received
Received 28 Feb, 2020
Reviewer #3 agreed
On 26 Feb, 2020
Reviewer #2 agreed
On 20 Feb, 2020
Reviewers invited
Invitations sent on 15 Feb, 2020
Reviewer #1 agreed
On 15 Feb, 2020
Editor assigned
On 02 Feb, 2020
Submission checks complete
On 01 Feb, 2020
Editor invited
On 01 Feb, 2020
First submitted
On 30 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA.
Methods The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation.
Results Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: -0.31; 95% confidence interval (CI): -0.55 to -0.06; P=0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: -0.54 to -0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: -0.67 to -0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: -0.67 to -0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P>0.05).
Conclusions Compared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
This is a list of supplementary files associated with this preprint. Click to download.
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