Single- and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial

Table 1 Comparison of baseline characteristics of the patients in the three groups

Variables	Group PRP-1 (Single injection; n = 28 patients)	Group PRP-2 (Double injection; n = 28 patients)	Group hyaluronic acid (n = 27 patients)	P value
Gender, M/F, n	5/23	6/22	8/19	0.323
Age, mean ± SD, yr-old	63.23 ± 8.03	66.04 ± 7.58	63.30 ± 8.87	0.121
Weight, mean ± SD, kg	73.36 ± 7.02	76.57 ± 6.58	75.37 ± 8.10	0.252
Height, mean ± SD, cm	160.57 ± 7.25	160.43 ± 6.57	159.37 ± 17.27	0.504
BMI, mean ± SD, kg/m2	28.43 ± 2.11	29.61 ± 1.64	28.94 ± 2.26	0.097
Ahlback grade, n	(n = 56 knees)	(n = 56 knees)	(n = 54 knees)	0.509
1	21	17	22
2	35	39	32
WOMAC score, mean ± SD	(n = 56 knees)	(n = 56 knees)	(n = 54 knees)
Pain	12.03 ± 2.31	12.11 ± 2.53	12.07 ± 2.41	0.958
Stiffness	4.39 ± 1.53	5.04 ± 2.01	4.85 ± 1.84	0.077
Physical function	46.93 ± 7.59	44.39 ± 7.82	46.19 ± 6.32	0.236
Total	63.71 ± 9.87	61.57 ± 11.29	63.11 ± 8.94	0.695
VAS score, mean ± SD	8.25 ± 0.92	8.29 ± 0.80	8.15 ± 0.81	0.631

BMI: Body mass index; F: Female; M: Male; PRP: Platelet-rich plasma; VAS: Visual analog scale; WOMAC: Western Ontario and McMaster Universities Arthritis Index.

Table 2 Number of patients having at least a 30% and 50% decrease in the summed score for the Western Ontario and McMaster Universities Arthritis Index and Visual Analog Scale, n (%)

	Follow-up
Variables	1st (wk 4)	2nd (wk 8)	3rd (wk 12)	1st (wk 4)	2nd (wk 8)	3rd (wk 12)	1st (wk 4)	2nd (wk 8)	3rd (wk 12)
	Group PRP-1 (Single injection; n = 28 patients)			Group PRP-2 (Double injection; n = 28 patients)			Group hyaluronic acid (n = 27 patients)
	Patients having at least a 30% decrease in the summed score for the scales
WOMAC pain score	28 (100)	27 (96.4)	24 (85.7)	28 (100)	28 (100)	28 (100)	6 (22.2)	5 (18.5)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
WOMAC stiffness score	26 (92.9)	25 (89.3)	19 (67.9)	28 (100)	28 (100)	25 (89.3)	16 (59.3)	17 (63)	5 (18.5)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
WOMAC physical function score	26 (92.9)	23 (82.1)	12 (42.9)	28 (100)	26 (92.9)	23 (82.1)	2 (7.4)	0 (0)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
Total WOMAC score	27 (96.4)	26 (92.9)	17 (60.7)	28 (100)	28 (100)	24 (85.7)	2 (7.4)	0 (0)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
	Patients having at least a 50% decrease in the summed score for the scales
WOMAC pain score	14 (50)	11 (39.3)	6 (21.4)	25 (89.3)	23 (82.1)	16 (19.3)	0 (0)	0 (0)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
WOMAC stiffness score	17 (60.7)	16 (57.1)	7 (25)	26 (92.9)	26 (92.9)	16 (57.1)	8 (29.6)	8 (29.6)	1 (3.7)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
WOMAC physical function score	5 (17.9)	5 (17.9)	1 (3.6)	17 (60.7)	11 (39.3)	5 (17.9)	0 (0)	0 (0)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
Total WOMAC score	6 (21.4)	5 (17.9)	0 (0)	19 (67.9)	17 (60.7)	7 (25)	0 (0)	0 (0)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-
VAS pain score	17 (60.7)	11 (39.3)	2 (7.1)	28 (100)	25 (89.3)	17 (60.7)	3 (11.1)	2 (7.4)	0 (0)
P value1	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	-	-	-

¹In comparison with hyaluronic acid group. VAS: Visual analog scale; WOMAC: Western Ontario and McMaster Universities Arthritis Index.

Table 3 Comparison of mean scores and percentage change in each parameter of the Western Ontario and McMaster Universities Arthritis Index and Visual Analog Scale with baseline at each follow-up for the three groups

	Follow-up
Variable-s	0	Wk 4	Wk 8	Wk 12	0	Wk 4	Wk 8	Wk 12	0	Wk 4	Wk 8	Wk 12
	Group PRP-1 (Single injection; n = 28 patients)				Group PRP-2 (Double injection; n = 28 patients)				Group hyaluronic acid (n = 27 patients)
WOMAC subscales
Pain
Mean	12.03	6.11	6.46	7.32	12.11	5	5.29	6.25	12.07	9.41	9.67	10.63
P value	Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)
% change1 (vs baseline)		-49.09	-45.81	-39.09		-59.47	-56.95	-48.61		-22.01	-19.80	-11.34
P value	At each follow-up, the percentage change from baseline was greater in group PRP-2 than in group PRP-1, and greater in group PRP-1 than in group hyaluronic acid (P < 0.001).
Stiffness
Mean	4.39	2.14	2.25	2.79	5.04	1.75	1.89	2.57	4.85	3.11	3.07	3.93
P value	Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)
% change1 (vs baseline)		-50.64	-47.36	-32.87		-67.96	-65.12	-47.65		-32.50	-33.16	-14.42
P value	At each follow-up, the percentage change from baseline was greater in group PRP-2 than in group PRP-1, and greater in group PRP-1 than in group hyaluronic acid (P < 0.001).
Physical function
Mean	46.93	28.14	28.04	31.89	44.39	22	23.39	26.54	46.19	37.85	39.41	42.52
P value	Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)
% change1 (vs baseline)		-39.28	-39.30	-30.97		-49.46	-46.31	-38.91		-18.31	-14.53	-7.69
P value	At each follow-up, the percentage change from baseline was greater in group PRP-2 than in group PRP-1, and greater in group PRP-1 than in group hyaluronic acid (P < 0.001).
Total
Mean	63.71	36.46	37.14	42.5	61.57	28.75	30.61	35.32	63.11	50.44	52.67	57.26
P value	Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)
% change1 (vs baseline)		-42.34	-41.13	-32.66		-52.77	-49.79	-41.75		-20.35	-16.61	-9.12
P value	At each follow-up, the percentage change from baseline was greater in group PRP-2 than in group PRP-1, and greater in group PRP-1 than in group hyaluronic acid (P < 0.001).
VAS
Mean	8.25	4.32	4.61	5.39	8.29	2.89	3.79	4.46	8.15	5.96	6.37	7.04
P value	Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)				Mean scores decreased significantly (P < 0.05)
% change1 (vs baseline)		-47.6	-44.25	-34.44		-65.28	-54.31	-46.25		-26.69	-21.99	-13.71
P value	At each follow-up, the percentage change from baseline was greater in group PRP-2 than in group PRP-1, and greater in group PRP-1 than in group hyaluronic acid (P < 0.001).

¹Negative percent shows improvement from baseline. VAS: Visual analog scale; WOMAC: Western Ontario and McMaster Universities Arthritis Index.