PRP + Hyaluronic Acid for Knee Osteoarthritis | Ludhiana
PRP / Autologous Growth Factors Alone or in Combination with Hyaluronic Acid in Knee Osteoarthritis
Knee osteoarthritis is associated with pain, stiffness, inflammation and progressive changes in the joint environment. In daily practice, patients commonly present with pain while walking or climbing stairs, stiffness after sitting, difficulty with prolonged standing and gradual reduction in their normal activities.It has now been established that OA knee is a local manifestation of a low grade systemic inflammation, which is immune mediated and slowly progressive.
At N K Aggarwal Joints & Spine Centre, Ludhiana, we use Platelet-Rich Plasma (PRP) and Autologous Growth Factor Concentrate (GFC) as important biological components of our multimodal knee-preservation approach. This is used in combination with High Molecular Weight Hyaluronic Acid (HA). The rationale for combining them is that they address different aspects of the osteoarthritic joint. PRP/GFC provides the biological component, while HA supports the lubrication and viscoelastic properties of the joint environment.
What Are PRP and Autologous Growth Factors?
PRP is prepared from the patient’s own blood and contains a concentrated fraction of platelets and biologically active substances, including growth factors. These substances are involved in pathways associated with inflammation, tissue repair and cellular responses. Autologous Growth Factor Concentrate is derived from platelets from the patient’s own blood, with the objective of concentrating biologically active growth-factor components for intra-articular use. Because these preparations are autologous, the treatment uses the patient’s own biological material rather than introducing an external drug into the joint.
PRP / GFC as a Stand-Alone Treatment
PRP can be used on its own as an intra-articular biological treatment for knee osteoarthritis. Clinical research has consistently investigated PRP for improvement in pain and function. Meta-analyses of randomized controlled trials have reported beneficial clinical outcomes with PRP in knee osteoarthritis, including improvements in pain and WOMAC functional measures.[1][2] A 2025 critical overview of systematic reviews and meta-analyses also found that PRP generally provides better pain and functional outcomes than HA, particularly during longer follow-up periods.[2]
Growth Factor Concentrate (also considered as activated PRP) is another autologous biological preparation that has been studied separately. A placebo-controlled randomized study of serial GFC injections reported significant clinical improvement in patients with knee osteoarthritis.[3] A more recent randomized controlled trial involving patients with Kellgren-Lawrence Grade II and III osteoarthritis also reported improvements in VAS pain and WOMAC outcomes following intra-articular GFC treatment.[4]
Why Combine PRP / GFC With Hyaluronic Acid?
PRP/GFC and HA have different properties.
HA is a natural component of synovial fluid and contributes to lubrication and viscoelasticity within the knee. PRP/GFC is used for its biological properties and growth-factor content. This provides the clinical rationale for combining the two rather than treating them as competing injections. When both are used, the intention is to provide biological support together with lubrication and improvement of the joint environment.
What Does the Research Show About PRP + HA?
The combination has now been evaluated in multiple randomized controlled trials.
A 2024 systematic review and meta-analysis included 10 randomized controlled trials involving 943 patients. Compared with HA alone, PRP + HA produced greater improvement in pain at 1, 6 and 12 months, as well as better WOMAC total scores at 12 months. The combination also had a lower incidence of adverse events than either HA or PRP alone in that analysis.[5] A 2025 meta-analysis of 11 randomized controlled trials involving 1,023 patients similarly reported better WOMAC, VAS, Lequesne and IKDC outcomes with PRP + HA compared with PRP alone.[6] Another 2025 systematic review of nine studies involving 868 knees found that PRP + HA produced statistically better WOMAC physical-function and total scores compared with PRP alone, with fewer minor adverse events.[7]
Taken together, these studies provide a clinical rationale for combining PRP with HA when both the biological and joint-environmental components of treatment need to be addressed..
How We Use It in the Ludhiana Protocol
At N K Aggarwal Joints & Spine Centre, Ludhiana, we assess the patient’s symptoms, clinical examination, X-rays or MRI, severity of osteoarthritis, alignment, activity level and general health before planning treatment. The multimodal knee preservation treatment “Ludhiana Protocol” includes both local and systemic treatment.
For local treatment, PRP or Autologous Growth Factor Concentrate is combined with High Molecular Weight HA. This forms part of a broader sequence that also includes knee lavage, Oxygen-Ozone therapy, correction of abnormal mechanical loading, rehabilitation and also systemic treatment. The purpose is to address the different factors contributing to symptoms rather than relying on a single injection.
Who May Be Considered?
PRP and GFC-based treatment is mainly considered when knee preservation remains a reasonable clinical objective.
Patients with early or moderate osteoarthritis, and selected patients with early Grade III disease, may be considered for biological treatment. Severe bone-on-bone Grade IV disease with major deformity and extensive structural damage requires a different treatment strategy. Even in many of these patients with advanced disease who are unfit for surgical treatment and want to avoid major surgery, we have been able to achieve good results.
Age alone does not determine suitability. We consider the condition of the knee, symptoms, imaging findings, alignment, functional requirements and general health before deciding the treatment plan which is customized for every patient.
PRP / GFC Within the Ludhiana Protocol
PRP and Autologous Growth Factor Concentrate form an important biological component of Dr. N. K. Aggarwal’s “Ludhiana Protocol for Multimodal Knee Preservation.”
The advantage of this approach is that treatment can be adapted to the individual knee. PRP/GFC is not simply being used as another pain-relieving injection. It is being incorporated as a biological component of a structured knee-preservation strategy, with other modalities added when clinically indicated.
Medical References
[1] Kaye AD, et al. Efficacy of intra-articular platelet-rich plasma injections in treatment of knee osteoarthritis: A systematic review and meta-analysis. Curr Pain Headache Rep. 2025. PubMed: https://pubmed.ncbi.nlm.nih.gov/39760984/
[2] Zhou Q, et al. A critical overview of systematic reviews and meta-analyses of intra-articular injection of platelet rich plasma versus hyaluronic acid for knee osteoarthritis. Clin Rheumatol. 2025;44(2):547-571. PubMed: https://pubmed.ncbi.nlm.nih.gov/39738804/
[3] Saraf A, Hussain A, Bishnoi S, et al. Serial intraarticular injections of growth factor concentrate in knee osteoarthritis: A placebo controlled randomized study. J Orthop. 2023;37:46-52. PubMed: https://pubmed.ncbi.nlm.nih.gov/36974096/
[4] Shah S, Chincholi S, Saraf A, et al. Efficacy of intra-articular Growth Factor Concentrate in Knee Osteoarthritis: A Randomized Controlled Trial. J Orthop Case Rep. 2026;16(7):528-535. PubMed: https://pubmed.ncbi.nlm.nih.gov/42428370/
[5] Gao J, et al. Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2024;144(9):3947-3967. PubMed: https://pubmed.ncbi.nlm.nih.gov/38972025/
[6] Du D, Liang Y. A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA). J Orthop Surg Res. 2025;20(1):57. PubMed: https://pubmed.ncbi.nlm.nih.gov/39819683/
[7] Yudtanahiran N, Piyapanyamongkhon P, Rojpalakorn W, et al. Intra-articular injections of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2025;35(1):241. PubMed: https://pubmed.ncbi.nlm.nih.gov/40498171/