Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis
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INVITED PAPERS
Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis Ron Gilat 1,2 & Eric D. Haunschild 1 & Derrick M. Knapik 3 & Aghogho Evuarherhe Jr 1 & Kevin C. Parvaresh 1 & Brian J. Cole 1 Received: 4 May 2020 / Accepted: 4 September 2020 # SICOT aisbl 2020
Abstract Purpose Symptomatic knee osteoarthritis (OA) remains a substantial cause of pain and disability worldwide and effective management in young patients without indications for total knee arthroplasty remains challenging. Intra-articular injections represent a viable option in the non-operative treatment of knee OA. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two commonly utilized intra-articular treatment modalities that are of particular clinical interest in the current literature. The purpose of this manuscript is to provide a concise review of the current literature on the use of HA, PRP, and HA-PRP conjugates for the treatment of symptomatic knee OA. Methods A review of the literature utilizing PubMed, OVID/Medline, and Cochrane databases on basic science and clinical literature pertaining to preparation, composition, and outcomes of HA, PRP, and HA-PRP conjugates in patients with symptomatic knee OA. Results Both HA and PRP have been shown to be efficacious for the treatment of symptomatic knee OA, with HA injections providing limited short-term improvement, while PRP may provide greater therapeutic relief, particularly with the use of leukocyte-poor (LP-PRP) formulations. Despite limited data, the combination of different formulations of HA-PRP conjugates may provide a synergistic effect, resulting in a clinically significant improvement in both pain and function. Conclusion In patients with symptomatic knee OA, intra-articular HA and PRP provide short-term improvement in pain and function, while the efficacy of HA-PRP conjugates warrants further study. Keywords Knee . Osteoarthritis . Hyaluronic acid . Hyaluronate . Platelet-rich plasma . PRP . LP-PRP
Introduction Knee osteoarthritis (OA) represents one of the most frequent causes of debilitating pain, disability, and loss of function in adults [1, 2]. As a result, knee OA results in a significant social and economic burden, accounting for lost wages and treatment costs totaling more than $460 billion annually [3]. As a progressive and complex disease involving metabolic, genetic, and biomechanical factors, no curative therapies currently
* Brian J. Cole [email protected] 1
Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
2
Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
3
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
exist for OA [4, 5]. While knee arthroplasty offers an effective solution for severe OA in the elderly population, concerns regarding implant longevity and revision surgery in young and middle-aged patients with less severe OA necessitates attention to conservative moda
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