1. Intra-articular Platelet Rich Plasma and Hyaluronic Acid are effective in Knee Osteoarthritis: A Comparative, Randomized Study
Dr (Prof) Raju Vaishya
MS(Ortho),FRCS,MCh
Senior Consultant Orthopaedics
Indraprastha Apollo Hospital, New Delhi

2. Conflict of interest
Dr(Prof) Raju Vaishya- I have no financial conflicts to disclose

3. BACKGROUND
Osteoarthritis (OA) is a degenerative disease in which catabolic process supervene the reparative process; it has been established by the presence of catabolic enzymes, inflammatory cells and fragmented Hyaluronic Acid (HA).
Management - directed towards reduction of inflammation, lubrication of the joint or stimulating the process of repair.

4. BACKGROUND
An intra-articular injection is an option if conservative treatment fails.
In most of the cases it works but for a variable period and with inconsistent results.
The superiority of one injection over the other is a controversial topic.

5. BACKGROUND
We have done randomized, comparative cohort study to compare the short and midterm results of commonly used an intra-articular injection of HA compared with the relatively newer regenerative technique in the form of intraarticular Platelet Rich Plasma (PRP) in a moderate degree of knee OA.

6. Methods
Total -84 patients (142knees) with moderate OA (Kellgren grade II and III)
Patients randomized with a computer based program.
42 patients (72 knees) were given 6 ml (48 mg) HA (Synviscone TM, Sanofi, and Genzyme).
42 patients (69 knees) were given 6 ml of autologous PRP.

7. Methods The outcome was evaluated as per Knee Society score (KSS), and
Visual analogue scale (VAS) and
Wilcoxon sign rank test and
Wilcoxon rank sum test.
To see how the age and grade of OA affect the result, both the group was further divided into subgroups of age = 50 years versus >50 years and grade II versus grade III for comparison.

8. Result
Baseline demographic data, KSS for pain and function of both groups- statistically comparable (P-value for KSS pain and function were and 0.49).
Large initial improvement in KSS score of HA group was seen compared to PRP group.
Improvement of HA group was maintained till 12 weeks after that it started declining.

11. KSS pain, KSS function and VASscore in HA and PRP group

12. Result
In PRP group, the initial improvement was slow but it was continuously progressive till 24 weeks and at the end of study (24weeks) PRP was statistically significantly better than HA (Pvalue 0.03).
Maximum KSS pain score achieved in HA group was at 12 weeks while that of PRP was at 24 weeks.
Score for KSS function followed a similar trend as KSS pain score.

13. Result
On VAS score, baseline score of HA was significantly better, the gradual decline of the score was noted in HA just after a first week and a decline in PRP group after 12 weeks.
At 24 weeks PRP was significantly better than HA (Pvalue <0.01).
Younger age subgroup and those with a relatively lower degree of OA did better in both groups.

14. Conclusion
Both the intraarticular injections of HA and PRP are effective in pain relief for moderate knee OA.
However, the effect of PRP is long lasting than HA, and the PRP seems to be better for pain relief and functionality in the short and midterm periods, especially in the younger population with a lower degree of OA.

15. THANK YOU