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Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):485-492. doi: 10.1007/s00167-016-4110-5. Epub 2016 Apr 7.

Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.

Author information

1
Department of Orthopaedics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey. dr.tahirmutlu@gmail.com.
2
Department of Orthopaedics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey.
3
Department of Physical Medicine and Rehabilitation, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey.
4
Department of Orthopedic Surgery and Traumatology, Haydarpaşa Numune Education and Research Hospital, 34668, Üsküdar, Istanbul, Turkey.
5
Physical Medicine and Rehabilitation Education and Research Hospital, Kocasinan Merkez Mah. Karadeniz Cad.No 48, 34147, Bahcelievler, Istanbul, Turkey.

Abstract

PURPOSE:

This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas.

METHODS:

A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP × 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone × four doses. Weight-bearing anteroposterior-lateral and Merchant's radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months.

RESULTS:

At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p < 0.001). At the 6th month, while the clinical efficacies of PRP and HA were similar and continued, the clinical effect of ozone had disappeared (p < 0.001). At the end of the 12th month, PRP was determined to be both statistically and clinically superior to HA (p < 0.001).

CONCLUSION:

In the treatment of mild-moderate knee OA, PRP was more successful than HA and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities.

LEVEL OF EVIDENCE:

Therapeutic study, Level I.

KEYWORDS:

Hyaluronic acid; Intra-articular injection options; Knee osteoarthritis; Ozone; Platelet-rich plasma

PMID:
27056686
DOI:
10.1007/s00167-016-4110-5
[Indexed for MEDLINE]

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