REGENERATIVE ULTRASOUND-GUIDED PRP PLUS HYALURONIC ACID PROVIDES DURABLE PAIN CONTROL IN KNEE OSTEOARTHRITIS

V. Caminiti | Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy

Background and Aims. Knee osteoarthritis (OA) is a major cause of chronic nociceptive and inflammatory pain. Intra-articular hyaluronic acid (HA) is widely used, but its analgesic effect is often temporary. Platelet-rich plasma (PRP), through growth factor release and modulation of synovial inflammation, may enhance and prolong pain relief. This study aimed to evaluate whether ultrasound-guided PRP combined with high-molecular-weight HA provides superior and sustained analgesia compared with HA alone in patients with knee OA.
Methods. In this prospective observational study, 100 patients with MRI-confirmed knee OA (Kellgren–Lawrence II–III) received three ultrasound-guided intra-articular injections at 30-day intervals. Group A received leukocyte-poor PRP plus 60 mg high-molecular-weight HA; Group B received identical HA alone. Pain intensity was assessed using the Numeric Rating Scale (NRS, 0–10) and functional status using WOMAC at baseline, 30 days, 2, 3, 6, and 12 months. Statistical significance was set at p < 0.05.
Results. The PRP + HA group demonstrated progressive and sustained analgesia, with mean NRS decreasing from 7.0 at baseline to 2.1 at 12 months (−70%). WOMAC improved from 62 to 24 (−61%). In contrast, the HA-only group showed early transient improvement, with NRS changing from 6.9 to 6.8 at 12 months and WOMAC from 60 to 58. Between-group differences at 6 and 12 months were statistically significant (p < 0.05).
Conclusions. Ultrasound-guided PRP combined with high-molecular-weight HA provides clinically meaningful and durable pain reduction compared with HA alone in knee OA, supporting its role in regenerative pain management (see Table below).