Paper 14: Leukocyte-Poor Platelet Rich Plasma versus Leukocyte-Poor Platelet Rich Plasma Plus Hyaluronic Acid for the Treatment of Symptomatic Knee Osteoarthritis: A Prospective, Randomized Control Trial with 2 Year Follow Up
Authors: Branch Eric , Emami Alex , Plummer Hillary , Anz Adam 
Published: July 2022

Objectives:

The main objective of this study was to determine if hyaluronic acid (HA) injected at the same time as leukocyte-poor platelet rich plasma LP-PRP would improve the performance compared to LP-PRP alone in the treatment of symptomatic knee osteoarthritis. We hypothesized that the addition of hyaluronic acid would improve the efficacy of LP-PRP.

Methods:

Patients between the ages of 30 and 80 who had symptomatic Kellgren-Lawrence grades 1-4 were eligible for the study. Patients were offered enrollment and screened with inclusion and exclusion criteria. The participants were randomized into two study groups and scheduled to receive a three-injection series. Group 1 [LP-PRP] received 3 intra-articularinjections of LP-PRP dosed at one week intervals. Group 2 [LP-PRP/HA] received 3 intra-articular injections of LP-PRP dosed at one week intervals, with hyaluronic acid (Hymovis) injected concomitantly for the first two injections. The Arthrex Autologous Conditioned Plasma system was used to prepare all LP-PRP injections. Participants were blinded to injection randomization and wore a blind fold for the first two injections. Participants completed patient reported outcome questionnaires prior to their injections and at 1, 3, 6, 12, 18, and 24 months after the final injection. The questionnaires included the Western Ontario and McMaster Universitys Osteoarthritis Index (WOMAC), International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results:

The study population included 63 total subjects, 32 subjects were randomized to Group 1 (ACP) with average age 55.8 +/- 11.4, 31 subjects were randomized to group 2 (ACP+HA) with average age 60.4 +/- 9.0. Both groups demonstrated improvement over baseline at 1 and 3 months, with improvement plateauing at 3 months. Both groups demonstrated improvement over baseline out to 24 months. The LP-PRP/HA group demonstrated increased improvement compared to group 1 at 1 and 3 months but consistently trended down in both the WOMAC, IKDC, and KOOS scores however statistical significance was not reached. The LP-PRP groups improvement was consistent until the 18 month time point. Complete patient reported outcome data is included in Table 1. Change in WOMAC, IKDC and KOOS scores over time are represented in Figures 1, 2, and 3 respectively.

Conclusions:

Both groups demonstrated improvement over baseline at 1 and 3 months, with improvement plateauing at 3months. Both groups demonstrated improvement over baseline out to 24 months. The LP-PRP/HA group demonstrated increased improvement compared to the LP-PRP group at 1 and 3 months, however statistical significance was not reached and the improvement diminished after the 12 month time point. The LP-PRP group did not see a diminishing improvement until the 18 month time point. [Table: see text][Figure: see text][Figure: see text][Figure: see text]