Prospective comparative study of the use prp and viscoelastic sodium hyaluronate gel in patients with grade ii knee osteoarthritis


  • Stella Gulnazarova
  • Tatyana Isakova
  • Aleksey Sverdlov



platelet-rich plasma, hyaluronic acid, knee osteoarthritis, conservative therapy


The development of an effective and safe methods of conservative treatment of knee osteoarthritis of the has a priority in modern orthopaedics.

Objective: to compare results of Platelet-Rich Plasma — PRP and PRP in combination with 2 % viscoelastic sodium hyaluronate gel (proFLEX INTRA) in patients with the II grade knee osteoarthritis.

Methods: from 2018 to 2019 prospective randomized comparative study of the efficiency of using PRP therapy (group I) and PRP in combination with a 2 % viscoelastic sodium hyaluronate gel (proFLEX INTRA) (group II) was conducted in 50 patients with II grade knee osteoarthritis (aged between 48 and 73 years). Patients were assessed before treatment, 1, 3, and 6 months after treatment with the help of VAS while walking, WOMAC, and OKS scales. Laboratory assesment of inflammation markers in serum and synovial fluid were performed before treatment and 4 weeks after. Synovial fluid was examined by using clinical-microscopic and biochemical methods according to the following markers: cytosis, percentage of neutrophils, lymphocytes, synoviocytes and macrophages, protein, hyaluronic acid. In blood serum were determined: total protein, glycoproteins, chondroitin sulfates, alkaline phosphatase activity.

Results: in II group was noted a statistically significant improvement according to VAS and WOMAC scale comparing with I group 6 months after treatment. The content of glycoproteins and chondroitin sulfates in blood serum of patients in the II group, also the protein content in synovial fluid, 4 weeks after treatment was lower (p < 0.05) comparing with the I group. However, the content of HA was higher (p < 0.05) in the II group of patients.

Conclusions: both methods, PRP; PRP and HA allowed to reduce VAS pain score while walking and to improve joint function according to WOMAC and OKS scales in patients with the II stage knee osteoarthritis, six months after treatment. While, in the group of combined use PRP and 2 % viscoelastic sodium hyaluronate gel the results of treatment according to VAS and WOMAC scales were statistically significantly better and the inflammatory-dystrophic degree of changes in the knee was less comparing with the I group.

Author Biographies

Stella Gulnazarova

Ural State medical University of the Ministry of Health of the Russian Federation, Ekaterinburg

MD, Prof. in Traumatology and Orthopaedics

Tatyana Isakova

Ural State medical University of the Ministry of Health of the Russian Federation, Ekaterinburg

PhD in Оncology and Radiation diagnostics

Aleksey Sverdlov

Ural Institute of Traumatology and Orthopaedics named after V. D. Chaklin, Ekaterinburg. Russian Federation


Simenach, B. I., Bondarenko, F. L., & Surkin, N. P. [et al.] (1985). Syndrome of imbalance of the patella of dysplastic origin. Orthopedics, traumatology and prosthetics, 10, 18–23. (in Russian)

Karyakin, A. A. (1992). Outcomes of treatment of a patella fracture and questions of patellofemoral arthrosis: abstract the dissertation of the candidate of medical sciences. St. Petersburg. (in Russian)

Pustovoyt, B. A., Baburkinа, E. P., & Ztyad Tariq Aziz Abdul Rashid (2007). X-ray diagnosis of dysplasia femoropatellyarnogo articulation of the knee. Orthopedics, Traumatology and Prosthetics, 2, 36–41. (in Russian)

Oni J. K., Hochfelder J., & Dayn A. (2014). Isolated patellofemoral arthroplasty. Bulletin of the Hospital for Joint Diseases (2013), 7 2 (1), 97–103.

Van Jonbergen, H. W., Poolman, R. W., & Van Kampen, A. (2010). Isolated patellofemoral osteoarthritis. Acta Orthopaedica, 81 (2), 199–205. doi:10.3109/17453671003628756

Korzh, N. A., Golovakha, M. L., & Orlyansky, V. (2013). Damage to cartilage of the knee joint. Zaporozhye: Enlightenment. (in Russian)

Krych, A. J., Bert, J. M., & Levy, B. A. (2013). Treatment of OA of the knee in the middle-aged athlete. Sports Medicine and Arthroscopy Review, 21 (1), 23–30. doi:10.1097/jsa.0b013e318270d1bd

Movshovich, I. A. (1983). Operative orthopedics. Moscow: Medicine. (in Russian)

Miroshnychenko, V. F., & Izmalkov, S. N. (1991). Method plastics patella. A.S. USSR 1641302. (in Russian)

Kotelnikov, G. P., & Chernov, A. P. (1999). Surgical correction of knee joint deformities. Samara: Samara State Medical University. (in Russian)

Kulyaba, T. A., & Novoselov, K. A. (1992). Treatment of pathology of the knee joint, manifested by pain in its anterior section. Traumatology and orthopedics of Russia, 2, 71–77. (in Russian)

Levitt, R. L. (1973). A long-term evaluation of patellar prostheses. Clinical Orthopaedics and Related Research, 97, 153–157. doi:10.1097/00003086-197311000-00024

Leadbetter, W. B., Seyler, T. M., Rangland, P. S., & Mont, M. A. (2006). Indications, contraindications, and pitfalls of patellofemoral arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 88 (suppl 4), 122. doi:10.2106/jbjs.f.00856

Sisto, D. J., & Sarin, V. K. (2006). Custom patellofemoral arthroplasty of the knee. The Journal of Bone and Joint Surgery. American Volume, 88 (7), 1475–1480. doi: 10.2106/JBJS.E.00382

Lonner, J. H. (2010). Patellofemoral Arthroplasty. Orthopedics, 33 (9), 653. doi:10.3928/01477447-20100722-39

Dejour, D. H. (2013). The patellofemoral joint and its historical roots: the Lyon School of Knee Surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 21 (7), 1482–1494. doi:10.1007/s00167-012-2331-9

Gulnazarova, S. V., & Sverdlov, E. A. (2009). Endoprosthetics in the treatment of osteoarthritis of the patellofemoral joint. Bulletin of Traumatology and Orthopedics V. D. Chaklin, 1, 55–57. (in Russian)

Gulnazarova S. V., Isakova, T. M., & Sverdlov, E. A. (2019, March 01–03). On the feasibility of endoprosthetics of the patellofemoral joint with severe osteoarthritis. Theses of the Intern. Congress [«Spring days of orthopedics»]. Moscow, 57–59. (in Russian)

Akhbari, P., Malak, T., Dawson-Bowling, S., East, D., Miles, K., & Butler-Manuel, P. A. (2015). The Avon patellofemoral joint replacement: mid-term prospective results from an independent centre. Clinics in Orthopedic Surgery, 7 (2), 171. doi:10.4055/cios.2015.7.2.171

Pisanu, G., Rosso, F., Bertolo, C., Dettoni, F., Blonna, D., Bonasia, D., & Rossi, R. (2017). patellofemoral arthroplasty: current concepts and review of the literature. Joints, 05 (04), 237–245. doi:10.1055/s-0037-1606618

Stricland S. M. Bird, M. L., & Chirst, A. B. (2018). Advances in patellofemoral arthroplasty. Current Reviews in Musculoskeletal Medicine, 11 (2), 221–230. doi: 10.1007/s12178-018-9477-0

Godshaw, B., Kolodychuk, N., Williams, G. K., Browning, B., & Jones, D. (2018). Patellofemoral Arthroplasty. Ochsner Journal, 18 (3), 280–287. doi:10.31486/toj.18.0009

Gulnazarova, S. V., & Kazak, L. A. (1994). The method of unloading the femoral-patella joint. Patent 2012259 RF, MKI A61B 17/56. (in Russian)

Ackroyd, C. E., Newman, J. H., Evans, R., Eldridge, J. D., & Joslin, C. C. (2007). The Avon patellofemoral arthroplasty. The Journal of Bone and Joint Surgery. British volume, 89-B (3), 310–315. doi:10.1302/0301-620x.89b3.18062

Van Jonbergen, H. W., Werkman, D. M., & Van Kampen, A. (2009). Conversion of patellofemoral arthroplasty to total knee arthroplasty. Acta Orthopaedica, 80 (1), 62–66. doi:10.1080/17453670902805031

Dahm, D. L., Al-Rayashi, W., Dajani, K., Shah, J. P., Levy, B. A., & Stuart, M. J. (2010). Patellofemoral versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. The American journal of orthopedics, 39 (10), 487–491.

Gupta, R. R., Zywiel, M. G., Leadbetter, W. B., Bonutti, P., & Mont, M. A. (2010). Scientific evidence for the use of modern patellofemoral arthroplasty. Expert Review of Medical Devices, 7 (1), 51–66. doi:10.1586/erd.09.53

Prokhorenko, V. I., Baitov, V. S., & Mamedov, A. A. (2017). Experience of knee replacement. Materials of United All-Russian scientific-educated. conference dedicated to the memory of Professor A. N. Goryachev and VII scientific and educational conferences of traumatologists and orthopedists of the FMBA of Russia, IV Congress of traumatologists and orthopedists of the Siberian Federal District. Omsk: Publishing House Omskblankidat, 230–231. (in Russian)

Nazarov, E. A., Zubov, A. A., & Ryabova, M. N. (2018). Safe operations in the treatment of degenerative joint diseases or how to avoid arthroplasty? Materials XI All-Russian Congress of Orthopedic Traumatologists «Achievements of Russian Traumatology and Orthopedics». St. Petersburg, 1, 238–240. (in Russian)