Vol. 10, Issue 4 (2024)

Background: Osteoarthritis (OA) is one of most common musculoskeletal disease, is a chronic degenerative joint disease characterized by progressive destruction of articular cartilage, narrowing of joint space and crepitus over the joint and results in thinning and eventual wearing of articular cartilage thus resulting in painful, limited joint movement which impairs daily functional activity. The use of autologous platelet rich plasma (aPRP) either alone or in combination with hyaluronic acid (HA) for treatment of knee osteoarthritis will continue to get attention due to its anti-inflammatory and growth factors. The aim of this study was to compare the effects of addition of hyaluronic acid on platelet rich plasma in treatment of chronic osteoarthritis.

Methods: This was a prospective, randomized; single-blind study was carried out at Department of Orthopedic Surgery, BSMMU, Dhaka, Bangladesh from January to June 2023. 60 patients with stage 2 and 3 moderate osteoarthritis based on the following upright front, back, and lateral radiographs of all patients were evaluated. Staging was based on the Kellgren-Lawrence classification. Patients with bilateral knee OA, diabetes mellitus, metabolic syndrome, coagulopathy, and Kellgren-Lawrence class 4, and 4 patients (2 lost to follow-up from each group) were excluded from the study. Pain intensity and functional disability were assessed, with numerical pain rating (NPR) scale and pain disability questionnaire (PDQ), at 1, 3 and 6 months follow up.

Results: Majority of the patients (90.0%) were in the age range of 41-60 years. Mean age of the study population was 54±5.12 and 57.35±6.67, male to female ratio was 1:5 and 1:4 for group A and B respectively. At 6 months follow up, significant reductions in pain intensity (NRS) in the two groups were observed 7.15±1.0 vs. 1.33±0.5 and 7.10±1.2 vs. 2.65±1 respectively for groups A and B. The lower pain score observed among group A at 6 months follow up was statistically significant, p<0.05. There was an improvement in functional activity (assessed by activity rating scale) among both groups. Pre intervention, 26.6% and 73.4% of patients in group A had moderate and severe limitations to movement respectively in comparison with 66.6% who reported no limitation and 16.7% with mild limitation to movement at the end of 6 months follow up. Similarly, 40% and 60% of patients in group B had moderate and severe limitations to movement respectively before treatment. At the end of 6 months follow up, 60% and 36.7% of patients in group B had no limitation and mild limitation to movement respectively. Patients in group A had lower PDQ scores, indicating better functional and psychological improvement. Patients in group A had lower PDQ scores, indicating better functional and psychological improvement.

Conclusion: This study found that the addition of hyaluronic acid to autologous platelet-rich plasma resulted in significant pain relief and improved psychological and functional performance compared with platelet-rich plasma alone in patients with chronic knee osteoarthritis.