Frequently asked questions about treating knee osteoarthritis with PRP and hyaluronic acid together: Is this the ideal combination for knee osteoarthritis?

Knee osteoarthritis (KOA) presents an increasing therapeutic challenge worldwide. Intra-articular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) are widely used both individually and in combination. The combined PRP + HA therapy has been proposed as a synergistic option that may improve clinical and structural outcomes, although its effectiveness compared to each treatment alone remains under debate.

Below is a review of the most recent clinical evidence based on controlled trials and meta-analyses published in 2025 and previous years, evaluating the efficacy and safety of this combination in patients with KOA.

1. PRP + HA vs HA alone: Clinical and structural efficacy

The most notable study published in the Journal of Clinical Medicine (2025) compared PRP + HA combination with HA alone in patients with grade 2 and 3 osteoarthritis. Both groups showed improvement in pain and function at 12 months, without statistically significant differences in standard clinical scales (VAS, WOMAC). However, the PRP + HA group demonstrated a significant reduction of bone marrow edema visible in MRI, indicating potential long-term structural benefits that may delay disease progression.

2. PRP + HA vs PRP alone: Better together?

Two 2025 meta-analyses provide solid information on this comparison:

• Du & Liang (Journal of Orthopaedic Surgery and Research) concluded that the PRP + HA combination offers superior improvements in pain (VAS), joint function (WOMAC and Lequesne), and lower adverse event rates compared to PRP alone.
• Liu et al. (2024) supported these findings, noting that although differences do not always reach the minimum clinically important difference, the combination generally provides more durable and safer benefits.

Other systematic reviews also highlight that combined therapy may be especially effective in mild to moderate stages of osteoarthritis and in the early phases of treatment, offering better tolerance and fewer side effects.

3. Additional comparisons:

• The PRP + HA combination is more effective than HA alone in reducing pain and improving joint mobility.
• Compared to PRP alone, the combination may provide faster and sustained clinical improvement during the first months, though long-term results tend to be comparable.
• The combination shows better overall tolerance and a favorable safety profile with fewer transient side effects.

It is important to note that variability in protocols (type of PRP, concentration, type and viscosity of HA, number and frequency of injections) poses a challenge for definitive and generalizable conclusions.

4. Final considerations:

Recent studies suggest that the combination of PRP + HA is a safe, well-tolerated, and effective option, especially for patients with mild to moderate osteoarthritis. It may offer clinical-functional advantages (less pain, improved mobility) and safety benefits (lower adverse event rates) compared to isolated therapies.

However, treatment choice should be individualized considering the patient profile, osteoarthritis severity, resource availability, and patient expectations.

References

1. Clinical Efficacy of Platelet Rich Plasma and Hyaluronic Acid Versus Hyaluronic Acid for Knee Osteoarthritis with MRI Analysis: A Randomized Controlled Trial. J. Clin. Med. 2025;14(10):3553.
2. Du D, Liang Y, et al. PRP + HA versus PRP alone for knee osteoarthritis (KOA): Systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025.
3. Liu et al. The efficacy and safety of intra-articular platelet-rich plasma versus sodium hyaluronate for the treatment of osteoarthritis: Meta-analysis. 2024.
4. Systematic review and meta-analysis: PRP + HA vs HA alone for KOA. 2024.
5. Intra-articular injections of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone in the treatment of knee osteoarthritis: a systematic review and meta-analysis. 2025.

Frequently Asked Questions about PRP-HA Treatment

1. What is combined PRP and hyaluronic acid therapy?

It is a treatment that mixes platelet-rich plasma (PRP) with hyaluronic acid to relieve pain and improve mobility in people with knee osteoarthritis.

2. What is PRP combined with hyaluronic acid used for?

It is used to improve joint lubrication, reduce inflammation, and stimulate tissue regeneration.

3. What is the difference between PRP alone and PRP with hyaluronic acid?

PRP works by regenerating tissues; hyaluronic acid lubricates and cushions the joint. Together they can offer combined benefits.

4. Does this treatment cure knee osteoarthritis?

No, it does not cure it but can improve pain and joint function.

5. How many sessions are needed?

Usually between 1 and 3 injections, depending on the protocol and osteoarthritis severity.

6. Does the injection hurt?

There may be mild discomfort during the injection and some inflammation afterward, but it is generally well tolerated.

7. How long does it take to work?

Benefits may begin to be noticed in 2 to 4 weeks, with maximum effect at 2–3 months.

8. How long do the effects last?

Effects usually last from 6 to 12 months, although this varies by patient.

9. Is it better than corticosteroid injections?

Yes, in the long term PRP + HA provides longer relief and fewer adverse effects than corticosteroids.

10. Are there side effects?

There may be swelling or transient pain at the injection site. It is a safe procedure.

11. Can everyone receive this treatment?

No. It is mainly indicated for mild to moderate osteoarthritis and should be evaluated by a specialist.

12. Is it an approved and safe treatment?

Yes. It is supported by clinical studies and its safety is well documented.

13. How much does it cost?

The cost varies depending on country, clinic, and product types used. It is not always covered by insurance.

14. Can it be used in other joints?

Yes, it is also applied in shoulders, hips, ankles, among others.

15. Where can I get this treatment?

At clinics specialized in traumatology, regenerative medicine, or sports medicine experienced in joint injections.

 

Make an appointment with Dr. Jordi Jiménez. He will see you in the center of Palma de Mallorca and help you regain your quality of life.