How Does Hyaluronic Acid (HA) Help with PRP?

Part I: What are HA injections?

Hyaluronic Acid (HA), or gel injections, are a commonly used orthopedic clinical intervention for those suffering with osteoarthritis and joint-related pain. Hyaluronic acid is similar to a substance that occurs naturally in the joints. It works by acting like a lubricant and shock absorber, and helps the joints to function with less pain^[1]. There are several common brands of Hyaluronic Acid solutions used by orthopedic offices such as Hyalgan^®, Hymovis^®, and Monovisc^®, to name a few. The specific brand of gel injection used is dependent on a few factors such as patient insurance policy and product availability. Each brand can differ in chemical-content and number of injections needed, so it is important to consult your physician about what the best option is for you.

The gel solution is injected directly into an anesthetized joint space in the body and acts as a lubricant or cushion between the two bones where cartilage has degraded. In turn, this temporarily decreases discomfort and can increase mobility until the gel wears away over time. 

Part II: PRP 101

PRP, or Platelet-Rich Plasma, is plasma that’s full of the growth factors and platelets derived from the blood circulating around your body. Through centrifugation techniques, this platelet-rich plasma is concentrated to a high level. Precisely injecting PRP into a painful or damaged joint, which in turn, can aid in healing and the slowing of osteoarthritis progression, as well as other musculoskeletal injuries. You can find more about PRP and its usefulness in treating orthopedic issues here.

Part III: Combining HA and PRP Injections

There are five studies (linked below) that have looked at the addition of PRP to HA and have found hopeful results with the combination of the two injectates together. Like a powerful and dynamic duo, the idea behind this is that the addition of hyaluronic acid to a PRP treatment can create a more hospitable environment for the PRP to be more effective. 

Research Articles:

Study #1 – “Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee.”^{2]

Study #2 – “Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis.”^{3]

Study #3 – “The combined use of platelet rich plasma and hyaluronic acid: prospective results for the treatment of knee osteoarthritis.”^{4]

Study #4 – “Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Inhibiting Inflammation and Improving Pain and Function.”^{5]

Study #5 – “Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis.”^{6]
The combination of these two potent injectates has been found to increase healing within the joint space, providing a greater capacity to reduce discomfort and degradation of the cartilage further. Additionally, due to the nature of gel injections only having only a temporary period of relief (typically 3-6 months), the addition of PRP can increase this duration of symptom relief drastically and promote healing of the area at the same time. New research is being conducted each year and more data is being added, but there is decent evidence from the above five studies to show that adding Hyaluronic Acid to PRP can improve the outcomes in patients with knee osteoarthritis and avoid the need for an invasive and irreversible surgery.

Sources:

1. 1. Hyaluronic acid (injection route) description and brand names (2024) Mayo Clinic. Available at: https://www.mayoclinic.org/drugs-supplements/hyaluronic-acid-injection-route/description/drg-20074557#:~:text=Descriptions,that%20did%20not%20work%20well. (Accessed: 21 May 2024). 

1. 1. Lana JF, Weglein A, Sampson SE, Vicente EF, Huber SC, Souza CV, Ambach MA, Vincent H, Urban-Paffaro A, Onodera CM, Annichino-Bizzacchi JM, Santana MH, Belangero WD. Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med. 2016 Nov 29;12(2):69-78. doi: 10.46582/jsrm.1202011. PMID: 28096631; PMCID: PMC5227106.

1. 1. Yu W, Xu P, Huang G, Liu L. Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis. Exp Ther Med. 2018 Sep;16(3):2119-2125. doi: 10.3892/etm.2018.6412. Epub 2018 Jul 6. PMID: 30186448; PMCID: PMC6122407.

1. 1. Papalia R, Zampogna B, Russo F, Torre G, De Salvatore S, Nobile C, Tirindelli MC, Grasso A, Vadalà G, Denaro V. The combined use of platelet rich plasma and hyaluronic acid: prospective results for the treatment of knee osteoarthritis. J Biol Regul Homeost Agents. 2019 Mar-Apr;33(2 Suppl. 1):21-28. XIX Congresso Nazionale S.I.C.O.O.P. Societa’ Italiana Chirurghi Ortopedici Dell’ospedalita’ Privata Accreditata. PMID: 31168999.

1. 1. Xu Z, He Z, Shu L, Li X, Ma M, Ye C. Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Inhibiting Inflammation and Improving Pain and Function. Arthroscopy. 2021 Mar;37(3):903-915. doi: 10.1016/j.arthro.2020.10.013. Epub 2020 Oct 20. PMID: 33091549.

1. 1. Sun SF, Lin GC, Hsu CW, Lin HS, Liou IS, Wu SY. Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis. Sci Rep. 2021 Jan 8;11(1):140. doi: 10.1038/s41598-020-80333-x. PMID: 33420185; PMCID: PMC7794411.