title: Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.
abstract: OBJECTIVE
  This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas.
  
  
  METHODS
  A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP × 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone × four doses. Weight-bearing anteroposterior-lateral and Merchant's radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months.
  
  
  RESULTS
  At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p < 0.001). At the 6th month, while the clinical efficacies of PRP and HA were similar and continued, the clinical effect of ozone had disappeared (p < 0.001). At the end of the 12th month, PRP was determined to be both statistically and clinically superior to HA (p < 0.001).
  
  
  CONCLUSIONS
  In the treatment of mild-moderate knee OA, PRP was more successful than HA and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities.
  
  
  METHODS
  Therapeutic study, Level I.
authors.affiliation: Department of Orthopaedics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey. dr.tahirmutlu@gmail.com.
authors.forename: Tahir Mutlu
authors.initials: TM
authors.lastname: Duymus
authors.affiliation: Department of Orthopaedics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Mutlu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Dernek
authors.affiliation: Department of Orthopaedics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303, Küçükçekmece, Istanbul, Turkey.
authors.forename: Baran
authors.initials: B
authors.lastname: Komur
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Haydarpaşa Numune Education and Research Hospital, 34668, Üsküdar, Istanbul, Turkey.
authors.forename: Suavi
authors.initials: S
authors.lastname: Aydogmus
authors.affiliation: Physical Medicine and Rehabilitation Education and Research Hospital, Kocasinan Merkez Mah. Karadeniz Cad.No 48, 34147, Bahcelievler, Istanbul, Turkey.
authors.forename: Fatma Nur
authors.initials: FN
authors.lastname: Kesiktas
mesh_terms: D000368:Aged; D002755:Choice Behavior; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010126:Ozone / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D011859:Radiography; D016896:Treatment Outcome; D016474:Weight-Bearing
chemical_list: D010126:Ozone; D006820:Hyaluronic Acid
keywords: Hyaluronic acid; Intra-articular injection options; Knee osteoarthritis; Ozone; Platelet-rich plasma