Comparative Efficacy of Intra-Articular PRP vs. Placebo Injections for Pain Management in Patients with Osteoarthritis of the Lower Limbs: A Systematic Review and Meta-Analysis

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease that causes pain, disability, and a reduced quality of life. Traditional management strategies often provide limited relief, prompting the exploration of alternative therapies such as platelet-rich plasma (PRP). PRP has gained attention for its potential to reduce pain and improve functional outcomes in OA patients. This review aimed to compare the efficacy of intra-articular PRP versus placebo for pain management in OA patients. Methods: This study conducted a systematic review and meta-analysis to evaluate the clinical outcomes of PRP compared to placebo in OA treatment. A total of 10 randomized controlled trials (RCTs) were included, involving 1323 patients. The primary outcomes assessed were pain reduction (Visual Analog Scale, VAS), functional improvement (WOMAC and KOOS scores), and quality of life (SF-36). Data were extracted from studies that used different PRP preparation techniques, including leukocyte-rich and leukocyte-poor formulations. Statistical analyses were performed using a random-effects model to calculate the pooled effects including effect sizes (e.g., mean differences or confidence intervals). Results: PRP treatment demonstrated significant improvements in pain relief and functional outcomes. At 3 months, VAS scores showed better reduction in pain for PRP-treated patients compared to placebo. WOMAC scores also favored PRP at 3 months. Quality of life, assessed by SF-36, improved significantly in the PRP group, particularly in physical function (p<0.01). However, while PRP provided significant early improvements, the benefits were less pronounced at 6 months, and some variability was observed depending on PRP preparation and administration protocols. Considering safety profile, PRP has a significant higher incidence of mild side effects. Conclusion: PRP has gained attention for its potential to reduce pain and improve functional outcomes in OA patients. While results suggest PRP is more effective than placebo in the short term, the long-term efficacy remains uncertain due to varying study protocols and follow-up durations.