Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial

  • Gökay Görmeli
  • Cemile Ayşe Görmeli
  • Baybars Ataoglu
  • Cemil Çolak
  • Okan Aslantürk
  • Kadir Ertem



To compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee.


A total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren–Lawrence grade 0 with cartilage degeneration or grade I–III) and advanced OA (Kellgren–Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded.


There was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group. The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups. There was no significant difference in the scores of patients injected with one dose of PRP or HA. In the early OA subgroups, significantly better clinical results were achieved in the patients treated with three PRP injections, but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups.


The clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA. For patients with early OA, multiple (3) PRP injections are useful in achieving better clinical results. For patients with advanced OA, multiple injections do not significantly improve the results of patients in any group.

Level of evidence



Hyaluronic acid Intraarticular injection Knee osteoarthritis Platelet-rich plasma 



We thank Irfan Kuku from Inonu University, Turgut Ozal Medical Center, Department of Haemotology, Malatya, Turkey, and Yusuf Turkoz from Inonu University, Turgut Ozal Medical Center, Department of Biochemistry, Malatya, Turkey.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Gökay Görmeli
    • 1
  • Cemile Ayşe Görmeli
    • 2
  • Baybars Ataoglu
    • 3
  • Cemil Çolak
    • 4
  • Okan Aslantürk
    • 1
  • Kadir Ertem
    • 1
  1. 1.Department of Orthopedics and Traumatology, Turgut Ozal Medical SchoolInonu UniversityMalatyaTurkey
  2. 2.Department of Radiology, Turgut Ozal Medical SchoolInonu UniversityMalatyaTurkey
  3. 3.Department of Orthopedics and TraumatologyGazi UniversityAnkaraTurkey
  4. 4.Department of Biostatistics, Turgut Ozal Medical SchoolInonu UniversityMalatyaTurkey

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