Knee arthritis is a common disease in the general population. A recent study found that twice as many people have this condition as 10 years ago. The most effective treatment for arthritis is exercise and weight loss. In some cases, injections play a role in treating knee arthritis pain. We use cortisone, hyaluronic acid, or PRP. But can we use hyaluronic acid and PRP together? 

What is PRP?

PRP is also known as platelet-rich plasma.

We get PRP from whole blood taken from the arm or elbow. First, the blood is spun in a centrifuge, separating the heavier red cells from the plasma. Then, we inject the plasma into the knee joint.

PRP contains a high number of growth factors that reduce inflammation and pain. Over 23 high-level studies show that PRP reduces pain and improves activity and sport in knee arthritis.

Recent evidence suggests that higher concentrations of platelets have a better effect than lower concentrations. A few seco

What is hyaluronic acid?

Hyaluronic acid is a natural substance in normal joints and bones. It forms the building blocks and nourishment for cartilage in joints. Injecting hyaluronic acid into joints improves lubrication and reduces inflammation. Like PRP, evidence suggests that hyaluronic acid injections effectively treat knee arthritis. Moreover, the high molecular weight hyaluronic acid, such as Durolane, has shown improved effectiveness compared to other types of hyaluronic acid, such as Ostenil Plus.

natural gel injection

What about both in one injection?

It makes sense. If one injection of platelet-rich plasma or hyaluronic acid lowers pain, you would think both would be better. Combining platelet-rich plasma and hyaluronic acid improves cell communication and tissue healing. But what do the studies show in knee osteoarthritis?

When comparing hyaluronic acid and PRP, we think PRP is slightly better.

However, a recent study suggests that adding both in the same injection is even better. They compared people who had combined PRP and hyaluronic acid to those who had just hyaluronic acid. At 3, 6, and 12 months, there was a big difference in favour of the combined injection. Another study compared this dual therapy with PRP alone and found a similar result: improved pain scores at 12 months and fewer side effects.

If combined hyaluronic acid and PRP injections are so good, why not use them all the time?

Firstly, the combined injection is more expensive than either one. Second, some patients cannot have PRP due to a blood problem such as low platelets. Conversely, some patients are allergic to hyaluronic acid. Third, we need evidence of a better effect with both together before making a solid recommendation. Nevertheless, this finding is exciting and may change our view on injections in knee arthritis.

Recently, a new system combines PRP and hyaluronic acid in one syringe (rather than two syringes). However, this system incorporates a low molecular weight hyaluronic acid with a low platelet count, so it is not ideal.

Another option is to combine a higher concentration of PRP (such as Arthrex ACP Max) with high molecular weight hyaluronic acid (Durolane). 

Irrespective of whether you have one or both injections, we believe you should have your injections done with ultrasound guidance.

Final word from Sportdoctorlondon about hyaluronic acid and PRP injection

No doubt, combining hyaluronic acid and PRP is controversial. However, evidence suggests that this combination may be better than one.

Dr Masci advises two standard PRP injections with one Durolane injection for knee and hip osteoarthritis. Recently, he introduced a second-generation PRP called Arthrex ACP max, which needs only one injection with Durolane. 

Review his self-paying injection fees here. 

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