A single intra-articular stromal vascular fraction with platelet-rich plasma injection yields superior clinical outcomes than a hyaluronic acid injection in patients with knee osteoarthritis: A prospective comparative study.

Abstract

The present study aimed to compare the efficacy and safety of a combined injection of stromal vascular fraction (SVF) and platelet rich plasma (PRP) versus a high molecular weight (HMW) hyaluronic acid (HA) injection in patients with knee osteoarthritis (KOA). A prospective comparative analysis was conducted for patients with KOA who underwent either a single intra-articular mechanical SVF combined with PRP injection (Group A) or a single intra-articular injection of HMW HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) and the EuroQol EQ-5D (EQ-5D-5L) were assessed at baseline, 3, 6 and 12 months postinjection. PRP was coded according to the DEPA classification. The study included 108 knees from 67 patients (Group A: 31; Group B: 36). The VAS, KOOS total and EQ-5D-5L scores significantly improved within each group in every timepoint compared to baseline. The SVF-PRP group significantly outperformed the HMW-HA group in VAS, KOOS total and EQ-5D-5L scores at 6 months and 12 months follow-up. The proportion of patients who achieved Minimal Clinically Important Difference (MCID) at 12 months was 87.0% versus 57.4% (p = 0.0003) in KOOS, 74.1% versus 61.1% in VAS (p = 0.152) and 64.8% versus 40.7% (p = 0.005) in EQ-5D-5L, for the SVF-PRP vs HA group, respectively. No serious adverse events were reported in either group. Minor local adverse events were more common in the SVF-PRP group and spontaneously resolved within days. The implemented PRP was coded as CCA. Both SVF-PRP and HA injections are safe treatments, with no serious adverse events, and significantly improve pain, function and quality of life in patients with KOA. The SVF-PRP outperformed the HA group in all three PROMs at 6 months and 12 months follow-up, and in the proportion of patients who achieved MCID at 12 months postinjection. Level II.