Research and reviews of Hyaluronic injections for Knee Osteoarthritis

Ross A. Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C. 

Hyaluronic injections for Knee Osteoarthritis: Good or bad?

It should be noted that we see many patients who have tried hyaluronic acid injections. These injections have worked for these people in the short term. These patients are now in our office because the short-term has not transpired to the long-term and now a different treatment approach needs to be undertaken.

The idea behind hyaluronic acid injections is to protect the knee by reintroducing lost or diminished hyaluronic acid in the knee’s synovial fluid or “providing a cushion.” The synovial fluid is a thick gel-like liquid that helps cushion the knee and acts to absorb the daily impact of walking and running and stair climbing our knees are subjected to.

The treatment of Hyaluronic Acid Injections is also called Viscosupplementation – supplementing the “viscosity” or the thick, sticky, gel-like properties of the synovial fluid.

In our office we also find patients calling Viscosupplementation “rooster comb injections,” “rooster shots,” “chicken shots,” as well as by trade names Euflexxa ®, Supartz ® Supartz FX ®, Synvisc-One ®, Synvisc ®, Hyalgan ®, Orthovisc ®, et al. All these products offer subtle differences in their treatment goals including the number of injections – however, none of them offer a permanent solution. This is what the American Academy of Orthopaedic Surgeons posted on their website:

“The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain. The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.” (1)

This should be enough for anyone considering Hyaluronic Acid Injections to seek alternatives. However many people do not understand that there are alternatives, especially if their doctor does not tell them there are.

Alternatives to Hyaluronic Acid Injections – Just get a knee replacement?

You are going to see in the research below that surgeons are writing that patients should not waste time and money with hyaluronic acid injections. The best alternative to these injections is knee replacement surgery. While we agree that there are better options than hyaluronic acid injections, we differ with the surgeons, we recommend a comprehensive regenerative medicine injection program which we will discuss below.

But I don’t want a knee replacement. Is Hyaluronic Acid Injections or knee replacement really my only two options?

Doctors in Germany, writing in the medical journal The Orthopedist, (2) give a good summary of the patient with knee pain heading into “conservative” treatments.

The German doctors were uncertain if hyaluronic acid had any benefit. The doctors in the research below were more certain.

Two studies are in conflict over the benefits of Hyaluronic Acid Injections


One study suggests that Hyaluronic Acid is a waste of time, money, and resources.

In the first study from UCLA on the benefits of delaying surgery with Hyaluronic Acid Injections doctors found:

A July 2018 study in the American Journal of Orthopedics (5) recognized that for some people: “Total knee replacement is a significant procedure with potential risk for serious complications and high costs. Alternative lower risk therapies that can delay or (prevent) total knee replacement are valuable to those who are poor candidates for surgery or wish to avoid total knee replacement as long as possible.” Are Hyaluronic Acid Injections the answer? Here is what the study concluded: “Repeated courses of treatment with Hyaluronic Acid are safe and are associated with the delay of total knee replacement for up to 3 years.” So again, we have a three-year delay after repeated courses of Hyaluronic Acid injections supported in the research. But what about the study that says “Hyaluronic Acid Injections that delay inevitable knee replacement are a waste of time, money, and resources.”

This research appearing in the publication American Health and Drug Benefits has this to say about Hyaluronic Acid Injections

A review of 14 studies that assessed outcomes of Hyaluronic Acid Injections demonstrated that the overall effect was not clinically meaningful.

Are Hyaluronic injections low-value health care? Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections.

In the Canadian Medical Association Journal(6) a study led by Austrian researchers found that “according to the currently available evidence, intra-articular hyaluronic acid has not been proven clinically effective and may be associated with a greater risk of adverse events.”

A research letter in the Journal of the American Medical Association Internal Medicine, (7) with the title: Are Hyaluronic injections low-value health care? Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections, backed that up with “based on high-quality evidence that hyaluronic acid injections were not associated with clinically meaningful improvement in symptoms compared with placebo injections.”

Side-Effects and Reactions

A recent study compiled 89 studies on hyaluronic acidThis study found that hyaluronic acid supplementation to the knee produced minimal to non-existent results when it came to pain and function in knee osteoarthritis patients. (8)

In this systematic review of 89 randomized medical trials that were summarized in the medical publication Medscape, doctors compared hyaluronic acid injections to a sham or to non-intervention patients. There were a total of 12,667 patients where the primary measure was pain intensity and the secondary measure was physical functioning.

“Viscosupplementation, the intra-articular injection of hyaluronic acid, produced “minimal or nonexistent” effects on pain and function in patients with knee osteoarthritis but did increase the risks for serious adverse events and local adverse reactions, according to a systematic review and meta-analysis in the Annals of Internal Medicine.

A flare-up in the injected knee within 24 to 72 hours of injection was the primary safety outcome. Secondary safety outcomes were serious adverse events, withdrawals or dropouts because of adverse events, adverse events overall, effusions at the injected knee, any local adverse event in the injected knee, and dropouts and withdrawals overall (regardless of reason).”

That means thousands of patients in numerous studies received minimal results in pain relief and non-existent results in function.

Then why is your doctor still recommending this treatment?

Let’s look at a well-cited editorial from 2016 published in the journal Clinical Orthopaedics and Related Research. (9) Here are the summary learning points presented by Seth S. Leopold, MD:

So why is this treatment being recommended?

According to Dr. Leopold:

Does adding more synovial type fluid in a knee swollen with synovial fluid really help?

A paradox of knee injection treatment may be found in the idea that if you have pain is caused by fluid retention and water build up in your knee, that injecting more of the same type of fluid can help reduce this pain. This is the paradox of viscosupplementation. Many people find great relief from their knee pain when they have their knees drained and the fluid removed. Here more fluid is being added. This is why there is a debate over the long-term effectiveness of hyaluronic acid injections for knee osteoarthritis.

A January 2021 study in the medical journal Rheumatology (10) explains it. What the researchers in this study set out to do was to determine whether ultrasound-detected synovitis affects the therapeutic efficacy of hyaluronic acid injection for treating knee osteoarthritis.

Hyaluronic Acid Injections cause accelerated knee degeneration. Injections may be rushing you towards knee replacement.

In a study published in the journal Clinical Neurology and Neurosurgery, (11) doctors revealed that “Hyaluronic Acid Injections can provide significant pain relief and improvement in activity of daily living function for patients with knee osteoarthritis. However, the reduction in pain and the increase in knee adduction moment may last up to 6 months. This may cause excessive loading on the knee joints, which may further accelerate the rate of knee degeneration. As a result, longer study time is needed to determine whether the observed kinetic findings in this study are associated with detrimental outcomes on the knee joints.”

But I don’t want a knee replacement

Throughout our website, we offer realistic options to not only knee surgery but other treatments that you may have already tried and found less than effective. These treatments are considered regenerative medicine treatments and involve Prolotherapy, Platelet Rich Plasma, and sometimes stem cell therapy or bone marrow aspirate concentrate treatment.

Now while you are here exploring Hyaluronic Acid Injections we are going to briefly summarize these treatments and link you over to more detailed articles covering the research on these treatments.


Researchers ask: “Is Intra-Articular Injection of Synvisc Associated with a Delay to Knee Arthroplasty in Patients with Knee Osteoarthritis?”

As demonstrated in this article, there is a debate over the effectiveness of hyaluronic acid injections. An October 2019 paper published in the medical journal Cartilage (12) had researchers asking do hyaluronic acid injections or Synvisc delay knee replacement? If the patient received more hyaluronic acid injections did this further delay the need for knee replacement? What did they find? They could not tell. This they could tell:

Then what could they not tell? Seems straightforward enough, there was a delay to knee replacement. The researchers wrote that the delay “cause and effect could not be examined.” It is not clear if the delay was because of the hyaluronic acid injections although the more injections the longer the delay.

So again, were people continuing with the injections because they delayed the knee replacement, or did the injections just prolong the delay for something the patients should have had in the first place, as outlined in the research above.

Comparing injection treatments

In this next section, we will discuss some options for hyaluronic acid injections. We have a detailed article that offers more knee injection comparisons among various treatments including:

That article can be found here on our website: What are the different types of knee injections for bone on bone knees.

Study: A comparison between Prolotherapy, Botox, Physical Therapy and Hyaluronic Acid Injections

Here we have a September 2020 study published in the International Journal of Rehabilitation Research. (13) In it, researchers compared the effectiveness of four treatments in the management of knee osteoarthritis.

Findings:

A January 2021 study in the journal Arthroscopy (14) also compared the effectiveness and safety of PRP and hyaluronic acid. In this research 2430 knee osteoarthritis, the patient’s results were documented. What these researchers found was that in 26 previously published studies, the cumulative results in 2430 patients revealed that pain and function scores in patients receiving PRP group were superior to those of the hyaluronic acid group when compared at three, six, and twelve months.

Prolotherapy for knee osteoarthritis

In our article The evidence for Prolotherapy Injections for knee osteoarthritis and as an option to knee surgery, we describe Prolotherapy as a remarkable treatment in its simplicity. Simple in the fact that these are dextrose (simple sugar) injections. The treatment can help many patients avoid joint replacement.

In this video, Danielle R. Steilen-Matias, MMS, PA-C, of Caring Medical demonstrates how we treat a patient with a primary complaint of knee osteoarthritis.

Prolotherapy has been shown to be an effective and safe treatment for many patients. On our Prolotherapy research page, we present the studies.

Comprehensive  Prolotherapy utilizes various ingredients in the injections to induce inflammation in the joint in order to mimic an injury and bring rebuilding immune cells and healing factors to the area to repair and rebuild the injured and degenerated soft tissue of the knee.

Caring Medical doctors investigated Prolotherapy in patients with unresolved knee pain at a charity clinic in rural Illinois. Eighty patients, representing a total of 119 knees, were treated every three months with Prolotherapy. On average, 15 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment. The results of this study showed that patients had:

Platelet Rich Plasma injections comparison

Platelet Rich Plasma Therapy is a “blood injection” taken from the patient’s own blood and “reduced” down to plasma that is heavy with platelets. Blood plasma platelets hold and encourage many healing growth factors that stimulate healing in degenerated tissues. PRP has also been shown to be superior to hyaluronic acid injections in many studies documented below.

In our article Platelet Rich Plasma for Knee Osteoarthritis: When it works, when it does not, we point to more research on when the treatment can be successful and when the treatment may not help you.

Research comparing PRP injections, cortisone injections, and hyaluronic acid injections 

Doctors wrote in a January 2019 study (16) that while PRP injections, cortisone injections, and hyaluronic acid injections are considered equally effective at relieving patient symptoms at three months, at 6, 9, and 12 months the PRP injections delivered significantly better results.

A July 2020 study (17) published in the Journal of Pain Research also suggested that PRP injections provided better results for patients than hyaluronic acid injections. The study’s conclusions were: Besides significantly higher satisfaction belonging to the (PRP) group, there was a statistically significant improvement in pain and function scores at 12 months compared to hyaluronic acid injections.

In research published in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, PRP was shown to provide significant healing of the meniscus (18as well as out out-perform hyaluronic acid in patients with knee joint cartilage degeneration. Similar results were documented in the journal Archives of Physical Medicine and Rehabilitation. (19)

In the medical journal Arthroscopy, researchers noted: “Plasma rich in growth factors showed superior short-term results when compared with hyaluronic acid in a randomized controlled trial, in alleviating symptoms of mild to moderate osteoarthritis of the knee.”(20)

Here is a summary of further research findings:

Combining PRP and hyaluronic acid

A team of Italian researchers examined the role of a combined hyaluronic acid and PRP treatment in a March 2021 published study. (28)

In this study, clinical outcomes of patients suffering from mild or moderate knee osteoarthritis (stage II and stage III) were treated with Leukocyte (immune white blood cells) – and platelet-rich plasma or PRP + hyaluronic acid intra-articular injections. Outcomes were observed 3 months and 1 year after the injective treatment.

A significant improvement of pain score was present in both groups, the Leukocyte PRP group, and the PRP + hyaluronic acid. Pain reduction was effective after 3 months and improved after 1 year. The group treated with PRP + hyaluronic acid showed a significant improvement in knee mobility and function scores. In both groups, however, the improvement in Knee injury and Osteoarthritis Outcome Score (KOOS), a self-reported measure of functional ability and knee-related quality of life, did not reach significance.

What does this mean? The researchers concluded: “In our point of view, we encourage the use of PRP injections as a simple, safe, and minimally invasive treatment approach. Our comparison of PRP + hyaluronic acid and Leukocyte-PRP suggests that PRP + hyaluronic acid could possibly determine better functional and mobility outcomes. However, our work could not be sufficient to definitively suggest a therapeutic choice: Further evidence is needed.”

What is Leukocyte- and platelet-rich plasma (L-PRP) treatment? What is its connection to hyaluronic acid?

The researchers of this study cited previous papers where outcomes demonstrated that L-PRP stimulates chondrocytic secretion (the cells that make collagen and secrete a “binding” fluid to help them adhere to lesions. Within this fluid is naturally produced hyaluronic acid.) The challenge with Leukocyte- and platelet-rich plasma is that as an immune system cell the Leukocyte can provide benefit in being an anti-inflammatory and bring down inflammation BUT it comes at a price, if the Leukocytes bring down inflammation it may counteract the benefit of the pro-inflammatory response Platelet Rich Plasma. Some suggested that PRP could reduce inflammatory cytokine production. Therefore according to these researchers: “The absence of a strong stimulating effect for the production of hyaluronic acid and the benefits of a viscosupplementation effect led to the idea of combining PRP + hyaluronic acid.”

A December 2020 study in the medical journal Arthroscopy (29) compared using hyaluronic acid injections with combined PRP treatment versus using hyaluronic acid injections alone.

The researchers of this study compared four previous studies, (total of 377 patients – 193 patients received PRP and hyaluronic acid injections, 184 patients received hyaluronic acid injections alone.)

This was not the first study to suggest combining the two treatments, and while some people do have success with this treatment, it is still seen only as a means to delay an inevitable knee replacement. This was suggested by researchers in a July 2016 study: (30)

“Our study is strongly suggestive that the combination of hyaluronic acid and PRP to be more effective compared to hyaluronic acid alone. Hence, we suggest a combination of intra-articular hyaluronic acid and PRP injection as an optional treatment modality in the treatment of grade III and IV knee osteoarthritis in terms of functional outcome and pain control for up to 6 months of duration when surgical treatment is not an option.”

Combination therapy with PRP combined with hyaluronic acid improves Patient-Reported Outcomes and is superior to hyaluronic acid alone but is not superior to PRP alone

An April 2021 review study comes to us from the Department of Physical Medicine and Rehabilitation, Sports Medicine Research Institute, The Ohio State University. It was published in The American Journal of Sports Medicine. (31) In this study, the researchers examined the effectiveness of the combined hyaluronic acid and PRP injection. Here are the learning summary points:

We do not combine these two treatments at our center. The treatments we do combine as mentioned above are PRP and Prolotherapy treatments. PRP to address the more advanced conditions in the knee, Prolotherapy to address knee instability and weakness due to knee ligament weakness and laxity.

Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding your knee problems and knee instability.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

Subscribe to our newsletter 


References: 
1. Diehl P, Gerdesmeyer L, Schauwecker J, Kreuz PC, Gollwitzer H, Tischer T. Conservative therapy of osteoarthritis. Orthopade. 2013 Feb 1. [Google Scholar]
2. Altman R, Lim S, Steen RG, Dasa V. Hyaluronic Acid Injections Are Associated with Delay of Total Knee Replacement Surgery in Patients with Knee Osteoarthritis: Evidence from a Large U.S. Health Claims Database. PLoS One. 2015 Dec 22;10(12):e0145776. doi: 10.1371/journal.pone.0145776. eCollection 2015.[Google Scholar]
3. Pasquale MK, Louder AM, Cheung RY, Reiners AT, Mardekian J, Sanchez RJ, Goli V. Healthcare Utilization and Costs of Knee or Hip Replacements versus Pain-Relief Injections. Am Health Drug Benefits. 2015 Oct;8(7):384-94.
4. Hauser RA, Hauser MA. A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois Journal of Prolotherapy. 2009;1(1):11-21.
5. Dasa V, Lim S, Heeckt P. Real-world evidence for safety and effectiveness of repeated courses of hyaluronic acid injections on the time to knee replacement surgery. American journal of orthopedics (Belle Mead, NJ). 2018 Jul;47(7). [Google Scholar]
6 Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005 Apr 12;172(8):1039-43. [Google Scholar]
7 Schmajuk G, Bozic KJ, Yazdany J. Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections.JAMA Intern Med. 2014 Oct 1;174(10):1702-4. doi: 10.1001/jamainternmed.2014.3926. [Google Scholar]
8. Jüni P, Rutjes AW, da Costa BR, Reichenbach S. Viscosupplementation for osteoarthritis of the knee. Ann Intern Med. 2013 Jan 1;158(1):75. [Google Scholar]
9. Leopold SS. Editorial: Getting Evidence Into Practice–or Not: The Case of Viscosupplementation. Clin Orthop Relat Res. 2016 Feb;474(2):285-8. doi: 10.1007/s11999-015-4632-z. Epub 2015 Nov 16. PMID: 26573320; PMCID: PMC4709311. [Google Scholar]
10 Wang CC, Wang CT, Tsai KL, Chou CL, Chao JK, Huang HY, Kao CL. Effect of ultrasound-detected synovitis on therapeutic efficacy of hyaluronic acid injection for symptomatic knee osteoarthritis. Rheumatology. 2021 Jan 25. [Google Scholar]
11 Tang AC, Tang SF, Hong WH, Chen HC. Kinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis. Clin Neurol Neurosurg. 2015 Feb;129 Suppl 1:S21-6. doi: 10.1016/S0303-8467(15)30007-X. [Google Scholar]
12 Ong KL, Runa M, Lau E, Altman R. Is Intra-Articular Injection of Synvisc Associated with a Delay to Knee Arthroplasty in Patients with Knee Osteoarthritis?. Cartilage. 2019;10(4):423–431. doi:10.1177/1947603518775792 [Google Scholar]
13 Rezasoltani Z, Azizi S, Najafi S, Sanati E, Dadarkhah A, Abdorrazaghi F. Physical therapy, intra-articular dextrose prolotherapy, botulinum neurotoxin, and hyaluronic acid for knee osteoarthritis: randomized clinical trial. Int J Rehabil Res. 2020;43(3):219-227. doi:10.1097/MRR.0000000000000411 [Google Scholar]
14 Tan J, Chen H, Zhao L, Huang W. Platelet Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: a Meta-Analysis of 26 randomized controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Jul 15.
15 Hauser RA, Hauser MA. A retrospective study on dextrose Prolotherapy for unresolved knee pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;1(1):11-21. [Google Scholar]
16 Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis : A prospective randomized controlled study. Intraartikuläre Injektionen mit plättchenreichem Plasma, Hyaluronsäure oder Kortikosteroiden bei Kniearthrose : Eine prospektive, randomisierte, kontrollierte Studie. Orthopade. 2019;48(3):239-247. doi:10.1007/s00132-018-03659-5 [Google Scholar]
17 Raeissadat SA, Gharooee Ahangar A, Rayegani SM, Minator Sajjadi M, Ebrahimpour A, Yavari P. Platelet-Rich Plasma-Derived Growth Factor vs Hyaluronic Acid Injection in the Individuals with Knee Osteoarthritis: A One Year Randomized Clinical Trial. J Pain Res. 2020;13:1699-1711. Published 2020 Jul 8. doi:10.2147/JPR.S210715 [Google Scholar]
18 Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH. A novel hypothesis: The application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears. Med Sci Monit. 2012 Aug;18(8):HY47-50. [Google Scholar]
19 Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2013 Nov 27. pii: S0003-9993(13)01212-4. [Google Scholar]
20 Sánchez M, Fiz N, Azofra J, et al. A Randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012 Aug;28(8):1070-8. [Google Scholar]
21 Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis.  Br J Sports Med. 2014 Nov 21. pii: bjsports-2014-094036.  [Google Scholar]
22 Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, Azma K. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord. 2015 Jan 7;8:1-8. [Google Scholar]
23 Kanchanatawan W et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015 Sep 19. [Google Scholar]
24 van der Weegen W, Wullems JA, Bos E, Noten H, van Drumpt RA. No Difference Between Intra-Articular Injection of Hyaluronic Acid and Placebo for Mild to Moderate Knee Osteoarthritis: A Randomized, Controlled, Double-Blind Trial. J Arthroplasty. 2014 Dec 13. pii: S0883-5403(14)00943-7. [Google Scholar]
25 Abate M, Verna S, Schiavone C, Di Gregorio P, Salini V. Efficacy and safety profile of a compound composed of platelet-rich plasma and hyaluronic acid in the treatment for knee osteoarthritis (preliminary results) Eur J Orthop Surg Traumatol. 2015 Sep 24. [Google Scholar]
26 Sakata R, Reddi AH. Platelet-Rich Plasma Modulates Actions on Articular Cartilage Lubrication and Regeneration. Tissue Eng Part B Rev. 2016 Oct;22(5):408-419. Epub 2016 Jun 27.Tissue Eng Part B Rev. 2016 Oct;22(5):408-419. [Google Scholar]
27 Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections for knee osteoarthritis. World J Orthop. 2014 Jul 18;5(3):351-61. doi: 10.5312/wjo.v5.i3.351. eCollection 2014. [Google Scholar]
28 Palco M, Fenga D, Basile GC, Rizzo P, Cavalieri B, Leonetti D, Alito A, Bruschetta A, Traina F. Platelet-Rich Plasma Combined with Hyaluronic Acid versus Leucocyte and Platelet-Rich Plasma in the Conservative Treatment of Knee Osteoarthritis. A Retrospective Study. Medicina. 2021 Mar;57(3):232. [Google Scholar]
29 Karasavvidis T, Totlis T, Gilat R, Cole BJ. Platelet-rich plasma combined with hyaluronic acid improves pain and function compared with hyaluronic acid alone in knee osteoarthritis: A systematic review and meta-analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Dec 3. [Google Scholar]
30 Saturveithan C, Premganesh G, Fakhrizzaki S, Mahathir M, Karuna K, Rauf K, William H, Akmal H, Sivapathasundaram N, Jaspreet K. Intra-articular hyaluronic acid (HA) and platelet rich plasma (PRP) injection versus hyaluronic acid (HA) injection alone in patients with grade III and IV knee osteoarthritis (OA): a retrospective study on functional outcome. Malaysian orthopaedic journal. 2016 Jul;10(2):35. [Google Scholar]
31 Baria MR, Vasileff WK, Borchers J, DiBartola A, Flanigan DC, Plunkett E, Magnussen RA. Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review. Am J Sports Med. 2021 Apr 8:363546521998010. doi: 10.1177/0363546521998010. Epub ahead of print. PMID: 33831332.

This article was updated October 27, 2021

 

 

Make an Appointment |

Subscribe to E-Newsletter |

Print Friendly, PDF & Email
SEARCH
for your symptoms
Prolotherapy, an alternative to surgery
Were you recommended SURGERY?
Get a 2nd opinion now!
WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!See why patients travel from all
over the world to visit our center.
Current Patients
Become a New Patient

Caring Medical Florida
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider. Treatments discussed on this site may or may not work for your specific condition.
© 2021 | All Rights Reserved | Disclaimer