Globally, osteoarthritis (OA) is considered the most prevalent joint condition, which commonly affects the hands, knees, hip, and the foot ^[1]. It is a slowly progressive chronic condition that was termed as degenerative disorder primarily causing cartilage loss. Previously considered a natural sign of aging, it is now being understood from various literature studies that multiple etiological factors, including age, occupational cause, obesity, and hereditary reasons, contribute to its occurrence, primarily affecting the whole joint, which includes the ligaments, menisci, synovium, cartilage, and subchondral bone [2, 3]. Worldwide epidemiological studies have estimated that the prevalence of OA has a stronger correlation with both age and gender with 5.3 women affected for every 3.6 men affected [4, 5]. OA is caused by a pathologic imbalance between the synthesis and breakdown of the cartilaginous matrix ^[6]. High amounts of proinflammatory cytokines, including interleukin (IL)-1 and tumor necrosis factor-alpha, are produced by chondrocytes and synovial cells in these patients, which in turn triggers IL-6 and IL-8, nitric oxide, prostaglandins E2, and metalloproteinases, which are further triggered by mechanical stress ^[7]. The primary cause of nocturnal discomfort, stiffness, edema, and impaired joint mobility is the advancement of articular chondral lesions, which have a detrimental impact on the patient’s overall health, quality of life, and emotional stability, particularly among the geriatric population ^[8]. Since the knee joint is the most commonly impacted main joint, it causes incapacitating symptoms among 10% of adults over 55 years of age, lowering their quality of life and also causing serious immobility issues among one-quarter of this population ^[9]. At present, with the advanced treatment modality available, there is no disease-modifying therapy being approved which points to joint replacement as the possible solution. Non-pharmacological therapy such as weight reduction, exercises, walking supports, bracings, heating, cooling, acupuncture, electromagnetic therapy, patient education, and self-management is only minimal and temporary benefits to the patients [10, 11]. Pharmacological therapy, which includes topical and oral non-steroidal anti-inflammatory drugs, provides initial benefits for the early stages of the disease ^[12]. However, as pharmacological therapy is insufficient for the desired control of OA, treatment should always be multimodal. Patients who do not respond well to oral regimens have found improvement using infiltration therapies. Intra-articular corticosteroid (IA) injections and platelet-rich plasma (PRP) have been found to provide short-term pain relief for OA patients and have been considered a supplement to core therapy [13, 14]. PRP is now implicated as a potential treatment in enhancing the clinical condition of OA patients [15-17]. Literature are limited in PRP, where it is compared with IA in treatment for OA patients [18-20]. To throw further light on this topic, this study was designed to compare the functional outcomes between intra-articular injection of PRP and intra-corticosteroid injection for the treatment of OA patients.

This prospective randomized controlled study was conducted at the orthopedics outpatient department at Chettìnad Hospital and Research Institute, Kelambakkam. A total of 40 patients who were symptomatic with radiologically confirmed OA of the knee (Kellgren–Lawrence grade 1–3) were enrolled in the study. The study was conducted for a duration of 6 months from January 2024 to June 2024. The inclusion criteria included an age group between 40 and 70 years, symptomatic patients with more than 3-month duration, and confirmatory X-ray diagnosis using Kellgren and Lawrence grading – Grade 1–3. The patient exclusion criteria were infection or active wound of the knee joint, a recent history of trauma to the knee, oncological diseases, endocrine diseases, autoimmune or platelet disorders, previous intervention on the knee joint, and previous non-steroidal inflammatory drug or hormonal therapy treatment within 10 days before the intervention. The patients who were potentially eligible for the study with knee pain were pre-screened, and those who had signed informed consent and met the inclusion criteria were randomized into two groups, the control group, and the interventional group, using a computer-generated randomized list, that is, individuals are selected completely randomly, typically using random number generators. Those patients assigned to receive PRP constituted the interventional group whereas patients assigned for corticosteroid injection were the control group. A flow chart of the patients involved in this study has been given in (Chart 1). A total of 40 patients were enrolled in the study, and they were randomized into interventional and control groups each 20 in number. The variables analyzed in each group included age, gender, the mean age of diagnosis, which side of the knee involved, and complications. Therapeutic outcomes were evaluated using the Western Ontario and McMaster Universities OA index score (WOMAC) and LEQUESNE index score both validated and standardized for the Tamil language. Graph shows WOMAC index score among study participants shown in (Fig. 1). The patients were evaluated with these questionnaires before the intervention and at 1^st month, 3^rd month, and 6^th month after infiltration.

The collected study data were entered in “Microsoft Office Excel 2013” and analyzed using the Statistical Packages for the Social Sciences 24 software. Continuous variables such as age, baseline, 1^st, 3^rd, and 6^th months. WOMAC and LEQUESNE index scores were expressed as mean and standard deviation. A description of categorical data such as gender, side of OA involvement, and complications was expressed as frequency and proportions. An independent sample t-test was used to compare the two means. The Chi-square test and Fisher’s exact test were employed to compare the distribution of qualitative variables between the groups. All tests were two-tailed, with results considered statistically significant if the P = 0.05.

The mean age of the study participants was 54.69 ± 2.15 and the majority of them were more than 50–60 years old, which is 16 (40%) participants. Out of 40 participants, 30 (75%) were female and 10 (18.3%) were males. All the patients had OA; 22 (55%) patients had right-side OA, and 18 (45%) patients had left-side OA, as described in (Table 1). IA and PRP injections were given to 20 patients in each group.

(Table 2) shows the mean WOMAC index scoring for the participants in both the IA and PRP groups calculated at the time before the procedure was done (baseline) and consecutive reviews done during 1^st month, 3^rd month, and during 6^th month visits. There was no significant difference in the mean scoring between the groups during baseline reading but during the 1^st, 3^rd, and during 6^th-month readings. The mean WOMAC index scoring had a significant difference, with the P-value being significant (P < 0.05) measuring at 1^st month, 3^rd months, and during 6^th months as 0.011, 0.026, and 0.002.

(Table 3) shows the mean LEQUESNE index scoring for the participants in both the IA and PRP groups calculated at the time before the procedure was done (baseline) and consecutive reviews done during 1^st month, 3^rd month, and during 6^th-month visits. There was no significant difference in the mean scoring between the groups during baseline reading but during the 1^st, 3^rd, and during 6^th month readings. The mean LEQUESNE index scoring had a significant difference with the P-value being highly significant (P < 0.005) for the 1^st month, 3^rd month, and during 6^th month (P < 0.005).

Management of knee OA usually commences with a conservative approach starting with the use of analgesic agents, non-steroidal anti-inflammatory agents, and physical therapy. As the intensity and intricacy of the symptoms increase other therapeutic modalities such as injectable intra-articular corticosteroids, hyaluronic acid, and PRP infiltrations are considered. In contrast to placebo, analgesic agents and non-steroidal anti-inflammatory agents provide better therapeutic responses to the patients, but their utility is restricted only to mild-to-moderate cases as per various literature ^[21]. Physical therapy’s role is primarily based on the patient’s fitness, core strength of the quadriceps muscle, and flexibility which only provide assist to drug therapy ^[22]. Infiltration therapy is considered when oral medication fails to provide better relief to the patients. Intra-articular corticosteroid injections are widely being deployed for symptomatic treatment in OA but fail to provide long-term relief to patients, which warrant repeated procedures for a minimum of 3 times a year for the same condition ^[23]. in the treatment modality for OA and has also gained noteworthiness in the fields of sports medicine, rehabilitation, and primary care. PRP has been found to be safe in administration since it is prepared from autologous blood ^[24]. Various studies have demonstrated that the administration of intra-articular PRP has amplified the quality of life beyond 1 year of treatment [25, 26]. The present study, in comparison to corticosteroids, showed PRP to have better significant values for betterment. Few researchers have questioned the effectiveness of PRP because of its variability on specific indications [27, 28]. Patel et al. ^[25] concluded that there was no significant difference in WOMAC score between single and double administration PRP injections at 6 weeks, 3, and 6 months for early OA. Costa et al. ^[29] conducted a systemic review and meta-analysis of 40 randomized controlled trials and concluded that PRP is an effective therapy in reducing pain, stiffness, and functions up to 6-month follow-up. Anil et al. ^[30] in their network meta-analysis of 79 randomized controlled trials indicated that a significant P-value was appreciated at 6-month post-administration of PRP for WOMAC score in comparison with intra-articular corticosteroid and hyaluronic acid injections. Singh et al. [31] in their systemic review and network analysis demonstrated that except corticosteroids all other injectable agents showed significant outcome improvements compared to placebo. He also stated that PRP showed clinically significant differences in functional outcomes compared to placebo and corticosteroids. Another systemic review and meta-analysis of eight studies conducted by McLarnon and Heron [32] indicated that PRP had better outcomes in terms of pain, stiffness, and functionality at 3, 6, and 9-month post-intervention. The present study revealed a decrease in pain scale, such as the WOMAC index, and an increase in functional scale score such as the LEQUESNE index which was more appreciated in the long-term follow-up of 6-month duration.

This study shows that intra-articular PRP injection is considered safe, found to have more potential in alleviating pain and joint stiffness, and also provides better functional outcomes of the knee joint in patients with OA. They when compared to corticosteroids tend to improve the short-term scores of pain and knee function with significant differences.

Intra-articular injections of PRP and corticosteroids are commonly employed treatments for managing OA. This study evaluates and compares the functional outcomes of these two interventions, highlighting their respective efficacy in alleviating symptoms and improving joint function. While corticosteroids are effective in providing short-term pain relief, PRP may offer superior and longer-lasting improvements in joint function and symptom control by promoting tissue repair and reducing inflammation. These findings underscore the importance of tailoring treatment strategies to patient needs, balancing immediate symptom relief with long-term joint health.