Comparison Between Intra-articular Infiltrations of Placebo, Steroids, Hyaluronic and PRP for Knee Osteoarthritis: a Bayesian Network Meta-analysis

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2020 Jul 30

PMID 32725315

Citations 60

Authors

Filippo Migliorini

Arne Driessen

Valentin Quack

Nadja Sippel

Brian Cooper

Yasser El Mansy

Markus Tingart

Jorg Eschweiler

Affiliations

Soon will be listed here.

Abstract

Introduction: Regarding the efficacy of intra-articular injections of platelet-rich plasma, hyaluronic acid and corticosteroids, current evidence is controversial. The superiority of one technique over another is questioned and debates are ongoing. The purpose of the present study was to compare and investigate the efficacy of these intra-articular infiltrations in patients with knee osteoarthritis (OA). A Bayesian network meta-analysis of randomized clinical trials (RCTs) was conducted comparing patient outcomes at 3, 6 and 12-months of follow-up.

Materials And Methods: This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions. All the RCTs comparing the outcomes of two or more intra-articular infiltrations of interest for knee OA were considered for inclusion. The outcomes of interest were the WOMAC and VAS scores. The network meta-analyses were performed using the STATA routine for Bayesian hierarchical random-effects models.

Results: Data from 30 RCTs (3463 patients) were collected. At 3-months follow-up, PRP showed the best WOMAC scores, followed by the Placebo, CCS and HA. At 6-months follow-up, PRP showed the best WOMAC scores, followed by HA, CCS and Placebo. At 12-months follow-up, PRP showed the best WOMAC scores, followed by the Placebo, HA and CCS. At 3-months follow-up, the PRP showed the best VAS scores, followed by CCS, HA and Placebo. At 6-months follow-up, PRP showed the best VAS scores, followed by CCS, Placebo and HA. At 12-months follow-up, the PRP showed the best VAS scores, followed by CCS, Placebo and HA.

Conclusion: Intra-articular injections of PRP demonstrated the best overall outcome compared to steroids, hyaluronic acid and placebo for patients with knee osteoarthrosis at 3, 6 and 12-months follow-up. Among CCS, hyaluronic acid and placebo, no discrepancies were detected.

Level Of Evidence: I, Bayesian network meta-analysis of RCTs.

Citing Articles

Long-term effectiveness of intra-articular injectables in patients with knee osteoarthritis: a systematic review and Bayesian network meta-analysis.

Gupta N, Khatri K, Lakhani A, Dahuja A, Randhawa A, Bansal V J Orthop Surg Res. 2025; 20(1):227.

PMID: 40025522 PMC: 11874392. DOI: 10.1186/s13018-025-05574-w.

Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: A Systematic Umbrella Review.

Glinkowski W, Tomaszewski W J Clin Med. 2025; 14(4).

PMID: 40004802 PMC: 11856182. DOI: 10.3390/jcm14041272.

Intra-articular injections of hyaluronic acid versus plasma rich in growth factors (PRGF) for knee osteoarthritis: a meta-analysis of randomised controlled trials : A meta-analysis.

Migliorini F, Maffulli N, Pipino G, Jeyaraman M, Ramasubramanian S, Jeyaraman N Orthopadie (Heidelb). 2025; 54(3):218-226.

PMID: 39964439 DOI: 10.1007/s00132-025-04615-w.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Elbow Disorders: A Review of Current Clinical Evidence.

Gupta A, Migliorini F, Bardazzi T, Maffulli N Pain Ther. 2025; .

PMID: 39878915 DOI: 10.1007/s40122-025-00707-9.

Comparison of Different Molecular Weights of Intra-Articular Hyaluronic Acid Injections for Knee Osteoarthritis: A Level I Bayesian Network Meta-Analysis.

Migliorini F, Maffulli N, Nijboer C, Pappalardo G, Pasurka M, Betsch M Biomedicines. 2025; 13(1).

PMID: 39857759 PMC: 11762473. DOI: 10.3390/biomedicines13010175.

References

Migliorini F, Rath B, Colarossi G, Driessen A, Tingart M, Niewiera M . Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up: a systematic review of the literature. Arch Orthop Trauma Surg. 2019; 140(7):853-868. DOI: 10.1007/s00402-019-03267-8. View

Migliorini F, Maffulli N, Eschweiler J, Quack V, Tingart M, Driessen A . Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review. Arch Orthop Trauma Surg. 2020; 141(2):283-292. PMC: 7886734. DOI: 10.1007/s00402-020-03689-9. View

Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J . Unicompartmental versus total knee arthroplasty for knee osteoarthritis. Eur J Orthop Surg Traumatol. 2018; 29(4):947-955. DOI: 10.1007/s00590-018-2358-9. View

Migliorini F, Eschweiler J, Tingart M, Rath B . Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: a meta-analysis of clinical trials. Eur J Orthop Surg Traumatol. 2019; 29(4):937-946. DOI: 10.1007/s00590-019-02370-1. View

Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M . The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014; 73(7):1323-30. DOI: 10.1136/annrheumdis-2013-204763. View

Uslu Guvendi E, Askin A, Guvendi G, Kocyigit H . Comparison of Efficiency Between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients With Knee Osteoarthritis. Arch Rheumatol. 2019; 33(3):273-281. PMC: 6328223. DOI: 10.5606/ArchRheumatol.2018.6608. View

Bannuru R, Natov N, Obadan I, Price L, Schmid C, McAlindon T . Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009; 61(12):1704-11. DOI: 10.1002/art.24925. View

Baron D, Flin C, Porterie J, Despaux J, Vincent P . Hyaluronic Acid Single Intra-Articular Injection in Knee Osteoarthritis: A Multicenter Open Prospective Study (ART-ONE 75) with Placebo Post Hoc Comparison. Curr Ther Res Clin Exp. 2018; 88:35-46. PMC: 6066596. DOI: 10.1016/j.curtheres.2018.04.001. View

Colen S, van den Bekerom M, Mulier M, Haverkamp D . Hyaluronic acid in the treatment of knee osteoarthritis: a systematic review and meta-analysis with emphasis on the efficacy of different products. BioDrugs. 2012; 26(4):257-68. DOI: 10.2165/11632580-000000000-00000. View

10.

Malhotra A, Pelletier M, Yu Y, Walsh W . Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes. Arch Orthop Trauma Surg. 2012; 133(2):153-65. DOI: 10.1007/s00402-012-1641-1. View

11.

Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X, Garcia-Balletbo M . Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg. 2010; 131(3):311-7. DOI: 10.1007/s00402-010-1167-3. View

12.

Fu C, Sun J, Bi Z, Wang X, Yang C . Evaluation of platelet-rich plasma and fibrin matrix to assist in healing and repair of rotator cuff injuries: a systematic review and meta-analysis. Clin Rehabil. 2016; 31(2):158-172. DOI: 10.1177/0269215516634815. View

13.

Simental-Mendia M, Vilchez-Cavazos J, Pena-Martinez V, Said-Fernandez S, Lara-Arias J, Martinez-Rodriguez H . Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Arch Orthop Trauma Surg. 2016; 136(12):1723-1732. DOI: 10.1007/s00402-016-2545-2. View

14.

Hart R, Safi A, Komzak M, Jajtner P, Puskeiler M, Hartova P . Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg. 2013; 133(9):1295-301. DOI: 10.1007/s00402-013-1782-x. View

15.

Ackerman I, Tacey M, Ademi Z, Bohensky M, Liew D, Brand C . Using WOMAC Index scores and personal characteristics to estimate Assessment of Quality of Life utility scores in people with hip and knee joint disease. Qual Life Res. 2014; 23(8):2365-74. DOI: 10.1007/s11136-014-0667-y. View

16.

Annaniemi J, Pere J, Giordano S . Platelet-rich plasma versus hyaluronic acid injections for knee osteoarthritis: a propensity-score analysis. Scand J Surg. 2018; 108(4):329-337. DOI: 10.1177/1457496918812218. View

17.

Askari A, Gholami T, Naghizadeh M, Farjam M, Kouhpayeh S, Shahabfard Z . Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail. Springerplus. 2016; 5:442. PMC: 4828353. DOI: 10.1186/s40064-016-2020-0. View

18.

Cerza F, Carni S, Alessandro Carcangiu , Di Vavo I, Schiavilla V, Pecora A . Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012; 40(12):2822-7. DOI: 10.1177/0363546512461902. View

19.

Cole B, Karas V, Hussey K, Pilz K, Fortier L . Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Am J Sports Med. 2017; 45(2):339-346. DOI: 10.1177/0363546516665809. View

20.

Trueba Davalillo C, Trueba Vasavilbaso C, Navarrete Alvarez J, Coronel Granado P, Garcia Jimenez O, Gimeno Del Sol M . Clinical efficacy of intra-articular injections in knee osteoarthritis: a prospective randomized study comparing hyaluronic acid and betamethasone. Open Access Rheumatol. 2015; 7:9-18. PMC: 5045121. DOI: 10.2147/OARRR.S74553. View