AANA Lab Course 913 - Advanced Knee Course-Steroid, HA, or PRP_ Are There Clinically Meaningful Differences_ Faculty Lecture

Steroid, HA, or PRP_ Are There Clinically Meaningful Differences_ Faculty Lecture_ Michael J. Alaia, MD

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This presentation by Dr. Michael J. Alaia at the 2019 AANA Advanced Knee Course reviews and compares the effectiveness, safety, and patient perceptions of corticosteroids (CSI), hyaluronic acid (HA), and platelet-rich plasma (PRP) treatments for knee osteoarthritis (OA).<br /><br />Corticosteroids offer quick and effective pain relief but their benefits are short-lived and come with potential flare-ups in 2–25% of cases. HA injections are controversial but show some anti-inflammatory effects and possibly longer duration of symptom relief; however, insurance coverage issues affect accessibility. PRP, representing an orthobiologic approach, is growing in popularity due to its biological rationale and promising evidence.<br /><br />Research indicates that high molecular weight (HMW) HA products tend to be more effective and safe compared to low molecular weight (LMW) versions. Corticosteroids are better at pain relief at 4 weeks, but HA has stronger longer-term benefits at 6 months, potentially delaying the need for total knee replacement. Patient satisfaction surveys suggest HA injections have higher levels of perceived effectiveness and satisfaction than steroid injections and other common treatments.<br /><br />PRP shows promise with improved function and pain scores at 6 to 12 months compared to HA and saline controls. However, PRP treatment protocols vary widely in preparation methods, number of injections, and composition (leukocyte-rich vs. poor), creating confusion and the need for standardization. Evidence suggests leukocyte-poor PRP is more beneficial intra-articularly for OA, while leukocyte-rich PRP may be better for soft tissue injuries.<br /><br />While all three modalities appear effective to some degree, clinicians should individualize treatment choices, counsel patients on realistic expectations, and be transparent about the limited data for advanced (KL4) osteoarthritis. The speaker encourages offering patients a range of options: corticosteroids for quick relief, HA for safety and moderate efficacy, and PRP as a cutting-edge option with growing evidence but higher cost and variability.<br /><br />In conclusion, corticosteroids, HA, and PRP all have roles in managing knee OA symptoms, with PRP representing an evolving frontier promising improved outcomes but requiring further research and consensus on optimal use.

Keywords

knee osteoarthritis

corticosteroids

hyaluronic acid

platelet-rich plasma

PRP treatment protocols

high molecular weight HA

patient satisfaction

pain relief duration

orthobiologic therapies

treatment individualization