Hyaluronic Acid (Gel Injections) vs PRP (Platelet Rich Plasma)
Platelet-Rich Plasma (PRP) is a high concentration of platelets from your blood often used for patients with osteoarthritis or other musculoskeletal conditions. Hyaluronic Acid (HA or gel injection) is a shot that contains an artificial joint lubricant often used for patients with knee osteoarthritis.
There are now dozens of randomized controlled trials showing that PRP injections improve pain and function in patients with mild to moderate knee arthritis. Many of these studies have compared PRP to Hyaluronic Acid and have concluded PRP to be superior .
However, there are also 5 studies that have looked at the addition of PRP to HA and have found hopeful results with the combination of the two injectates together. The idea behind this is that the addition of hyaluronic acid can create a more hospitable environment for new cells to grow and for the PRP to be more effective.
Let’s take a brief look at the studies in question:
- 2016 RCT from Brazil looked at 105 patients comparing PRP+HA, PRP, and HA groups and found that the combination group had the best outcomes and also reported earlier relief than the HA or PRP groups .
- 2018 RCT out of China compared 360 patients in four different treatment groups: PRP, HA, PRP+HA, and placebo. They measured a number of different metrics including serum inflammatory and cartilage breakdown markers and concluded that the PRP+HA group had the best outcomes .
- 2019 RCT from Italy compared PRP+HA to HA alone given as three serial injections in 60 patients and found that the combination was better in most metrics at 6 and 12 months, but in some metrics, there was no difference between the groups .
- 2020 RCT out of China used 122 knees and compared PRP+HA to PRP and HA alone with a 2-year follow-up. They also measured inflammatory cytokines in the knee and found that PRP+HA was superior to PRP or HA alone .
- 2021 RCT with 84 total patients compared PRP alone to PRP+HA and found better pain relief at 6 months for the combination product .
The data is still coming in, 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. Don’t forget to ask your physician to review the evidence regarding these treatments with you if you have knee osteoarthritis and are looking for options.
Have questions about PRP or Hyaluronic Acid? Contact one of our experts at Regenexx.
(1)Migliorini, F., Driessen, A., Quack, V., Sippel, N., Cooper, B., Mansy, Y. E., Tingart, M., & Eschweiler, J. (2020). Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: A bayesian network meta-analysis. Archives of Orthopaedic and Trauma Surgery, 141(9), 1473–1490. https://doi.org/10.1007/s00402-020-03551-y
(2) 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.
(3) 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.
(4) 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.
(5) 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.
(6) 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.