PRP vs Hyaluronic Acid Injections for Knee Arthritis

are you struggling with knee pain and unsure whether PRP also known as platelet-rich plasma or ha also known as hyaluronic acid is the better injection treatment for your knee osteoarthritis I'm going to compare PRP and ha injections in terms of Effectiveness cost and safety we'll also explore the potential benefits of combining the two treatments together my goal is to help you make an informed decision about which injection treatment to choose in addition I'll reveal the one essential question that you must ask your health care provider before getting treated as the answer can significantly impact your

outcomes hey everyone Dr Jeff Pang here let's first start with what is hyaluronic acid ha is a naturally occurring substance found in synovial fluid it plays a key role in lubricating and cushioning the joints when injected hyaluronic acid has anti-inflammatory properties as well as pain relieving properties the the goal of ha therapy is to try to augment and restore the normal viscosity and elasticity of the synovial fluid which can then help improve joint mobility and improve joint pain platelet-rich plasma injections or PRP involves injecting a concentrated solution of a patient's own platelets into the knee

joint PRP contains an incredible amount of growth factors that can activate the body's own natural mechanisms to reduce pain and improve inflammation randomized controlled trials have demonstrated that PRP injections can lower inflammatory markers such as il1 beta and tnf Alpha inside the knee joint this results in healthier cartilage and slower progression of arthritis so let's first address the question on everyone's mind if both options are available which one yields better results this study was a systematic review and meta-analysis that included 14 randomized controlled trials in terms of pain scores PRP outperform hyaluronic acid the authors

looked at visual analog pain scores and found that PRP injections resulted in significantly lower pain scores at three months and at 12 months when compared to how uranic acid injections similarly functional scores favored PRP the researchers looked at the Womack osteoarthritis index score which is a measure of physical function pain and stiffness PRP injections resulted in considerably better scores at 1 3 6 and 12 months when compared to hyaluronic acid injections and what about side effects according to the authors there were no differences in complication rates between the two groups that being said they did

find that PRP injections led to higher rates of local pain following the injection the authors of the study go on to conclude that for patients with knee osteoarthritis platelet-rich plasma injections can effectively relieve pain enhance joint function and improve quality of life life when compared to hyaluronic acid injections so to answer the question which treatment is better PRP or hyaluronic acid the evidence points to PRP now let's consider the possibility of combining PRP and hyaluronic acid since these injections work through different mechanisms many providers believe there could be an additive or synergistic effect potentially leading

to improved outcomes but that's in theory let's look at what the evidence says this is a systematic review examining whether combination therapy PRP plus ha is more effective than monotherapy for the treatment of knee osteoarthritis after final analysis the researchers found that combination therapy was Superior to hyaluronic acid alone however they report that combination therapy was not Superior to PRP alone so does this imply that everyone should be getting PRP injections because they are more effective not necessarily there are several several other variables each person needs to consider and cost is the first and most

obvious consideration platelet-rich plasma injections are not covered by insurance and according to this study the average cost of PRP treatments in the United States is around seven hundred dollars per injection and depending on the severity of your arthritis you may need one two or even three injections followed by annual booster injections for maintenance therapy this can contribute to the overall cost of treatment which may not be affordable for everyone in contrast hyaluronic acid injections are often covered by many insurance plans as well as by Medicare and most Medicaid plans including where I practice in California

it's important to note that while hyaluronic acid injections are covered for knee arthritis they are often not covered for arthritis and other joints such as the hips ankles and shoulders if your insurance covers hyaluronic acid injections it may make Financial sense for some people to try h treatment first before moving on to PRP insurance plans typically cover hyaluronic acid injections every six months making them a viable option for ongoing maintenance therapy now there also are a few other clinical scenarios where hyaluronic acid injections might be a more suitable choice and I'd like to briefly discuss

them one such instance is when a patient has underlying cardiovascular disease such as coronary artery disease or has experienced a stroke this is because these patients are typically prescribed antiplatelet agents like aspirin or Clopidogrel administering PRP injections to these patients is not advisable as they would need to discontinue their anti-platelet medications for around four to six weeks this could significantly increase their risk for a major cardiovascular event in these cases the risks of stopping the anti-platelet agents far outweigh the benefits of PRP especially when we know that hyaluronic acid injections are an effective alternative another

clinical scenario where someone might opt for hyaluronic acid over PRP is when they have inflammatory conditions such as rheumatoid arthritis patients with these conditions often experience pain in multiple joints and body parts and may require taking daily NSAIDs or even low-dose steroids to manage their symptoms the same is true for people who are undergoing other medical procedures or surgeries these patients may need to take NSAIDs for other reasons and unfortunately that would interfere with the effects of platelet-rich plasma okay now let's talk quickly about safety both PRP and hyaluronic acid injections are remarkably safe with

minimal to no side effects while all injections carry a small risk of infection using sterile technique can reduce this risk to near zero hyaluronic acid injections have a slight risk of allergic reactions whereas platelet-rich plasma injections have virtually no risk in this regard it's also worth noting that PRP injections do have higher rates of post-injection pain swelling and soreness this occurs because the activation of platelets and the release of growth factors can trigger a localized inflammatory response although this reaction usually resolves on its own after a few days it can be quite uncomfortable additionally I

advise patients who receive PRP injections to take one to two weeks off from exercising and to avoid anything more than light physical activity excessive pressure on the knee can negatively affect platelet activation and interfere with outcomes with hyaluronic acid injections there are no such restrictions on physical activity by the way if you're finding value with this video please do me a favor and click the like button doing so will help this information spread to more people and help them too thanks for doing that I really appreciate it so those are some of the variables that

can help you decide which injection to pursue if costs were not a concern I would recommend PRP injections for most people with knee osteoarthritis particularly those with mild to moderate arthritis PRP has Superior efficacy in reducing pain and improving function and its effects last longer than other treatments in addition hyaluronic acid injections are traditionally three shots spaced one week apart and that needs to be done every six months some studies suggest that one high-dose PRP injection can last an entire year additionally platelet-rich plasma has been shown to help protect healthy cartilage and slow down the

progression of arthritis but with all that said there is one more crucial factor that can significantly impact your results regardless of which treatment you choose and that's how your health care provider administers the injection it is essential to ask your health care provider whether the injections are done with ultrasound guidance both PRP and hyaluronic acid injections must be done with imaging guidance don't let anyone convince you otherwise it doesn't matter how many years of experience your doctor has even the most skilled and seasoned orthopedic surgeons can miss their injections you certainly don't want to be

the one that they miss to illustrate my point here is a comparison of accuracy for common injections using ultrasound guided and landmark based techniques as reported by Daniels at all the data speaks for itself some Physicians using landmark-based techniques have an accuracy of 55 when doing knee injections ultrasound guidance is almost always guaranteed the last thing you want to do is pay out of pocket for a procedure only for your health care provider to do a landmark based injection and then miss the target at the end of the day both PRP injections and hyaluronic acid

injections are excellent options however it's crucial to recognize that they are only one component of a multimodal approach to treating knee osteoarthritis another fundamental aspect is exercise and physical therapy this video demonstrates exercises that can help relieve pressure on your joints additionally treating the muscles around the knee is also an overlooked aspect of knee arthritis treatment this next video will help you learn more thanks for watching