The last few years a number of studies have shown that PRP is better than Hyaluronic acid for osteoarthritis of the knee.  Recent studies comparing PRP and hyaluronic acid injection treatments showed somewhat different results.  One study showed that PRP was superior to hyaluronic acid in all grades of osteoarthritis.  Another study showed that PRP was superior to hyaluronic acid for mild osteoarthritis only, but not for more severe disease.

A few thoughts:
-The manner in which you create PRP makes a big difference.  If a low concentration of PRP was used, or a PRP with a high amount of red blood cells was utilized, then there is room for improvement in the type of PRP that is being studied.  It’s not entirely clear how well produced the PRP  used in most PRP studies.

-The studies comparing PRP and hyaluronic acid treatments focused on treating the arthritis only, which is fair considering hyaluronic acid can only treat arthritis.  But PRP can also treat the ligaments and tendons surrounding the knee as well.  If that isn’t done, then perhaps a comprehensive approach to knee arthritis is not being pursued.  In most people with osteoarthritis of the knee invariably there is pathology affecting the soft tissues supporting the joint as well.  Those should also be treated.

-PRP is a good safe basic cell based treatment.  Stem cells are the next level cell based treatment.  They offer better potential for more severe disease due to the greater reparative ability of stem cells.  For moderate to more advanced osteoarthritis, it makes sense that stem cells may be a better option compared to PRP.  If you have mild to moderate osteoarthritis, consider PRP.  If more severe disease, consider stem cells.  This simple idea is a relatively new and developing concept amongst practitioners working with cell based biologic treatments for osteoarthritis and tendinitis.

-Lastly, where do hyaluronic acid treatments fit into the regimen for osteoarthritis?  They help with pain in osteoarthritis.  That’s it.  They are not reparative.  Their effect seems to last shorter than PRP.  With that said, they are safe and have the ability to reduce pain.  They still fit in my regimen for osteoarthritis treatment.  But over time the newer, more effective, safer cell based options are looking more attractive.

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