PRP and HA Combination Therapy Improves Results

Platelet-Rich Plasma (PRP) and Hyaluronic Acid Combination Therapy for Osteoarthritis Knee osteoarthritis (KOA) is a leading cause of joint pain and reduced mobility, affecting millions of adults each year. While standard therapies such as anti-inflammatory medications, corticosteroid injections, and physical therapy provide symptomatic relief, they do not address the underlying joint degeneration. In recent years, regenerative medicine treatments such as
platelet-rich plasma (PRP) have emerged as promising alternatives. In 2024, new research continues to highlight the growing potential of PRP, especially when combined with hyaluronic acid (HA), in improving knee joint health.

PRP is an autologous treatment derived from the patient’s own blood. After
centrifugation, the plasma is concentrated with platelets, which release growth factors that promote healing and reduce inflammation. As the American Orthopaedic Society for Sports Medicine (2024) notes, PRP has gained popularity for its safety profile, cost-effectiveness, and strong clinical outcomes. Recent efforts have also focused on standardizing preparation methods and identifying optimal platelet doses to ensure consistent patient results.

A 2021 meta-analysis by Karasavvidis, Totlis, Gilat, & Cole compared PRP + HA to PRP alone in treating knee osteoarthritis. The study reviewed data from multiple randomized controlled trials and found that the combination therapy resulted in significantly greater improvements in pain, stiffness, and physical function at 3, 6, and 12 months (Karasavvidis et al., 2021). The enhanced benefit is likely due to the dual action of PRP’s regenerative capabilities and HA’s lubricating and cushioning properties. However, recent work by Zhang et al. (2022) provides a more nuanced interpretation. In their meta-analysis of 13 studies involving over 1,100 patients, they found that although PRP + HA offered statistically significant improvements in several key outcome measures—such as the
Visual Analog Scale (VAS), WOMAC, KOOS, IKDC, and Lequesne Index—these
improvements did not consistently meet minimum clinically important differences (MCIDs). Notably, the combination therapy was associated with fewer adverse events than PRP alone, making it a potentially safer alternative.
Taken together, this evolving evidence helps guide clinical decision-making. While PRP remains a strong standalone option, especially for patients aiming to delay surgery, the addition of HA may offer incremental benefits in comfort and function, along with a lower risk of injection-related side effects.

At Sports Health Northwest, we tailor PRP protocols to meet each patient’s needs, including the option of combining it with HA based on individual goals and risk
profiles.

References: Stokes, D. J., & Frank, R. M. (n.d.). Platelet-Rich Plasma for Osteoarthritis in 2024 – More Hype. American Orthopaedic Society for Sports Medicine. https://www.sportsmed.org/membership/sports-medicine-update/spring-2024/platelet-rich-plasma-for-osteoarthritis-in-2024

Karasavvidis, T., Totlis, T., Gilat, R., & Cole, B. J. (2021). 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 : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 37(4), 1277–1287.e1. https://doi.org/10.1016/j.arthro.2020.11.052
Zhang, Q., Liu, T., Gu, Y., Gao, Y., & Ni, J. (2022). Efficacy and safety of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone for knee osteoarthritis: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17, 499. https://doi.org/10.1186/s13018-022-03398-6

Author

David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.