A Letter Released to Physicians on
June 06, 2011

Hyaluronic Acid vs. PRP for Knees

At present, patients with osteoarthritis of the knee have limited options, and most of those options are palliative.  Many patients suffer some level of reduced function and ability, long-term.  Platelet-rich plasma injections have emerged as a possible treatment option for patients with osteoarthritis of the knee.  Recently, Italian researcher Dr. Elizaveta Kon and colleagues compared platelet-rich plasma (PRP) intra-articular injection to high molecular weight hyaluronan injections and low molecular weight hyaluronan injections as treatments for osteoarthritis of the knee.1  Their results were presented at the 2010 annual meeting of the American Academy of Orthopedic Surgeons. All patients were evaluated at the end of treatment and at six months.  PRP demonstrated more and longer efficacy than HA in reducing pain, reducing symptoms, and improving articular function.     

Even among patients with recalcitrant chondropathies, PRP has been found to reduce pain by more than half for approximately one year.2  The most encouraging aspect of this recently discovered treatment for osteoarthritis of the knee is that PRP may actually modulate the osteoarthritis process (accelerating cartilage regeneration, stimulating the chondral anabolism, and slowing the catabolic process).  Sampson and colleagues used ultrasound to measure actual cartilage thickening in some patients receiving PRP.2   

PRP treatments involve the injection of a patient’s own plasma concentrated with platelets into a problem area.  For more information on how this is done at my practice in Charlotte, visit our website at TaubMD.com.  Platelets contain multiple growth factors important in cartilage regeneration processes as well as anti-inflammatory cytokines which regulate a number of processes related to healing and regeneration.  The consensus, expert opinion is that an imbalance between proinflammatory cytokines and anti-inflammatory cytokines causes the progression of osteoarthritis.2  A growing body of evidence shows how PRP effectively treats osteoarthritis of the knee and other cartilage degeneration of the knee.3-14  This method of concentrating autologous platelets in problem areas has proven results.  When you have patients struggling with early osteoarthritis or even severe, long-standing chondropathies, please consider the pain medicine treatments available by referral to my private practice.

References

1. Kon E, Buda R, Mandelbaum B, et al. PRP intraarticular injection versus viscosupplementation as treatments for early osteoarthritis. Presented at: American Academy of Orthopaedic Surgeons, New Orleans, LA, March 12, 2010 (podium presentation, 685).
2. Sampson S, Reed M, Silvers H, et al. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis – a pilot study. Am J Phys Med Rehabil. December 2010; 89 (12): 961-969.
3. Sampson S, Reed M, Silvers H, et al. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis – a pilot study. Am J Phys Med Rehabil. December 2010; 89 (12): 961-969.
4. Kon E, Buda R, Filardo G, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surge Sports Traumatol Arthrosc. 2010; 18: 472-479.
5. Sanchez M, Anitua E, Azofra J, et al. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol. 20008; 26: 910-913.
6. Sampson S, Gerhardt M, Mandelaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: A review. Curr Rev Musculoskelet Med 2008; 1: 165-74.
7. Hunziker E, Driesang I, Morris E. Chondrogenesis in cartilage repair is induced by members of the transforming growth factor-beta superfamily. Clin Orthop Relat Res 2001; 391 (suppl): S171-81.
8. Nakagawa K, Sasho T, Arai M, et al. Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes. Presented at International Cartilage Repair Society Meeting, Warsaw, Poland, October 2007 (electronic poster presentatioon, P181.)
9. Kon E, Filardo G, Presti M, et al: Utilization of platelet-derived growth factors for the treatment of cartilage degenerative pathology. Presented at: International Cartilage Repair Society Meeting, Warsaw Poland, October 2007 (electronic poster presentation, 29.3).
10. Anitua E, Sanchez M, Nurden A, et al: Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology 2007; 46: 1769-72.
11. Kon E, Buda R, Mandelbaum B, et al: PRP intraarticular injection versus viscosupplementation as treatments for early osteoarthritis. Presented at: American Academy of Orthopaedic Surgeons, New Orleans, LA, March 12, 2010 (podium presentation, 685).
12. Gaissmaier C, Fritz J, Krackhardt T, et al. Effect of human platelet supernatant on proliferation and matrix synthesis of human articular chondrocytes in monolayer and three-dimensional alginate cultures. Biomaterials. 2005; 26: 1953-1960.
13. Frisbie D, Kaweak C, Werpy N, et al. Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res. 2007; 68: 290-296.
14. Saito M, Takahashi K, Arai Y, et al. Intraarticular administration of platelet-rich plasma with biodegradable gelatin hydrogel microspheres prevents osteoarthritis progression in the rabbit knee. Clin Exp Rheumatol. 2009; 27: 201-207.