Observation on the Clinical Efficacy of Platelet-rich Plasma Combined with Intra-articular Injection of Sodium Hyaluronate in the Treatment of Mild to Moderate Knee Osteoarthritis

Songchao Bi

doi:10.26689/bas.v3i5.12620

Songchao Bi Civil Aviation Shanghai Hospital, Department of Orthopedics, Shanghai 200050, China

DOI: https://doi.org/10.26689/bas.v3i5.12620

Keywords: Platelet-rich plasma, Sodium hyaluronate, Knee osteoarthritis, Oxidative stress, MRI-T2 mapping, Cartilage metabolism

Abstract

Objective: To explore the clinical efficacy of platelet-rich plasma (PRP) combined with intra-articular injection of sodium hyaluronate in the treatment of mild to moderate knee osteoarthritis (KOA) and its effects on cartilage metabolism, oxidative stress status and cartilage structure. Methods: A total of 120 patients diagnosed with mild to moderate KOA in the orthopedics department of the hospital from January 2023 to October 2024 were selected and randomly divided into a control group and a study group, with 60 cases in each group. The control group was treated with intra-articular injection of sodium hyaluronate, while the study group was treated with PRP in combination on this basis. The treatment course was 4 weeks. The clinical efficacy, serum matrix metalloproteinase-13 (MMP-13), type II collagen degradation products (CTX-II), superoxide dismutase (SOD), malondialdehyde (MDA) levels and MRI-T2 mapping results of the two groups after 12 months of treatment were compared. Result: The total effective rate of the study group was 91.67%, which was higher than 75.00% of the control group (p < 0.05). After 12 months of treatment, the levels of serum MMP-13, CTX-II and MDA in the study group were all lower than those in the control group, and the level of SOD was higher than that in the control group (p < 0.01). MRI-T2 mapping showed that the average T2 value of cartilage in the study group was significantly lower than that in the control group, while the cartilage thickness increased significantly (p < 0.05). No serious adverse reactions occurred in either group. Conclusion: Intra-articular injection of PRP combined with sodium hyaluronate can significantly relieve pain in patients with KOA, improve joint function, inhibit cartilage degradation, reduce oxidative stress levels and promote cartilage repair. Its therapeutic effect is superior to that of sodium hyaluronate alone, and it has good safety.

References

Zhang R, Wang Q, Jiang X, et al., 2024, The Clinical Efficacy of Jinggu Xiaotong Powder Combined with Platelet-Rich Plasma in Patients with Knee Osteoarthritis. Chinese Patent Medicine, 46(02): 465–469.

Ma X, Yuan X, Zhang L, et al., 2020, Study on the Protective Effect and Mechanism of Ozone Combined with Platelet-Rich Plasma on IL-1β-Induced Inflammatory Injury of Human Chondrocytes. Chinese Journal of Pain Medicine, 31(08): 602–611.

Cui B, Li D, Li B, 2025, The Effect of Platelet-Rich Plasma Compound Vibration on OPF Rats. Chinese Journal of Osteoporosis, 31(08): 1137–1141 + 1151.

Zhang W, Ma X, Zhang D, et al., 2020, The Immunomodulatory Effect of White Blood Cell-Rich Platelet-Rich Plasma (L-PRP) on the Microenvironment of Spinal Cord Injury. Chinese Journal of Pathogenic Biology, 20(08): 982–987 + 993.

Bone and Joint Branch of China Association of Geriatric Health Care, 2024, Guidelines for Diagnosis and Non-Surgical Treatment of Early Knee Osteoarthritis (2024 Edition). Chinese Medical Journal, 104(31): 2895–2909.

Dong H, Wang W, Lu Y, et al., 2024, Protective Effect of Passive Exercise on Articular Cartilage in Rats with Knee Osteoarthritis Based on the NF-κB Signaling Pathway. Chinese Journal of Gerontology, 44(05): 1141–1145.

Shang X, Wang F, Yang Q, et al., 2020, Clinical Study on the Treatment of Cold-Dampness Obstruction Syndrome in Knee Osteoarthritis by Platelet-Rich Plasma Injection Combined with Warm Acupuncture. Journal of Beijing University of Chinese Medicine, 48(02): 270–279.

Zhang Y, Liu S, Xie S, et al., 2020, Re-Evaluation of the Systematic Review of Platelet-Rich Plasma and Hyaluronic Acid in the Treatment of Knee Osteoarthritis. Chinese Journal of Tissue Engineering Research, 29(28): 6138–6145.

Mei B, Rao Y, Cai Y, et al., 2024, Influence of Internal Heat Injection Combined with PRP Injection on Serum TNF-α and NF-κB Levels in Patients with Knee Osteoarthritis. Shi Zhen Chinese Medicine and Chinese Materia Medica, 35(07): 1664–1666.

Chen X, Dong H, Wang X, et al., 2024, Efficacy of Combined PRP and Ozone in the Treatment of Knee Osteoarthritis. Chinese Journal of Gerontology, 44(05): 1065–1068.

Yoshioka T, Arai N, Sugaya H, et al., 2024, Effectiveness of Leukocyte-Poor Platelet-Rich Plasma Injections for Symptomatic Mild to Moderate Osteoarthritis of the Knee with Joint Effusion or Bone Marrow Lesions in a Japanese Population: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. The American Journal of Sports Medicine, 52(10): 3635465241263073.

Aalishan S, Ahmed A, Majid J, et al., 2024, MRI-Based Cartilage Changes and Clinical Effectiveness of Autologous Intra-Articular Platelet-Rich Plasma Injections in Symptomatic Patients with Moderate Osteoarthritis of the Knee. Egyptian Journal of Radiology and Nuclear Medicine, 55(1): 23–27.

Su F, Tong M, Lansdown D, et al., 2023, Leukocyte-Poor Platelet-Rich Plasma Injections Improve Cartilage T1ρ and T2 and Patient-Reported Outcomes in Mild-to-Moderate Knee Osteoarthritis. Arthroscopy, Sports Medicine, and Rehabilitation, 5(3): e817–e825.

Jayaram P, Mitchell P, Shybut B, et al., 2023, Leukocyte-Rich Platelet-Rich Plasma Is Predominantly Anti-Inflammatory Compared with Leukocyte-Poor Platelet-Rich Plasma in Patients with Mild-Moderate Knee Osteoarthritis: A Prospective, Descriptive Laboratory Study. The American Journal of Sports Medicine, 51(8): 2133–2140.

Elena T, 2023, Letter to the Editor Regarding “Clinical Benefit of High Tibial Osteotomy Combined with the Intervention of Platelet-Rich Plasma for Severe Knee Osteoarthritis.” Journal of Orthopaedic Surgery and Research, 18(1): 207–207.

Xu H, Zhang T, Yin Q, et al., 2025, Effect of Hip Cavity Injection of Platelet-Rich Plasma Under Ultrasound Combined with Silver Needle in the Treatment of Femoral Head Necrosis. Journal of Practical Medicine, 41(11): 1711–1717.

Chen C, Liu Y, Yin H, 2024, Microscopic Clearance of Platelet-Rich Plasma for the Treatment of Mild to Moderate Knee Osteoarthritis. Chinese Journal of Orthopedic Surgery, 32(04): 314–319.

Ma C, Pan H, Cui R, et al., 2024, Effect of Platelet-Rich Plasma Combined with Sodium Hyaluronate on Osteoporotic Fracture Rats. Chinese Journal of Osteoporosis, 30(01): 44–49.

Dong W, Wang X, Gu Y, et al., 2024, HTO Combined with Platelet-Rich Plasma for Joint Cleanup in the Treatment of Medial Knee Osteoarthritis. Chinese Journal of Orthopedic Surgery, 32(01): 11–17.