REGENERATIVE OUTCOMES OF INTRA-ARTICULAR STEROID AND SEQUENTIAL PRP INJECTIONS FOR PAIN MANAGEMENT IN KNEE OSTEOARTHRITIS PATIENTS

Abstract

Background: Knee osteoarthritis is a common chronic musculoskeletal disorder characterized by persistent pain, functional limitation, and reduced mobility. Intra-articular corticosteroid injections are widely used for short-term symptom relief, while platelet-rich plasma has emerged as a minimally invasive biological treatment intended to provide more sustained clinical improvement. However, evidence regarding the clinical outcomes of sequential platelet-rich plasma following corticosteroid treatment in routine clinical practice remains limited.

Objective: To compare the post-treatment pain relief, functional recovery, duration of pain relief, and local safety outcomes of corticosteroid monotherapy with corticosteroid followed by sequential platelet-rich plasma injections in patients with symptomatic knee osteoarthritis.

Methods: A retrospective comparative cohort study was conducted using clinical records from two pain-management settings in Lower Dir, Khyber Pakhtunkhwa, Pakistan, covering the study period from January 2025 to January 2026. A total of 56 eligible patients with symptomatic knee osteoarthritis were included, with 28 patients receiving intra-articular corticosteroid monotherapy and 28 receiving corticosteroid followed by three sequential platelet-rich plasma injections at approximately three-week intervals. Patients had symptomatic Kellgren–Lawrence Grade I–III knee osteoarthritis. Demographic and clinical characteristics, pain outcomes, functional limitations, duration of pain relief, and post-injection local adverse effects were evaluated. Pain was assessed using the Visual Analog Scale, while functional limitations were assessed using selected Western Ontario and McMaster Universities Osteoarthritis Index activities. Between-group categorical outcomes were assessed using the Chi-square or Fisher–Freeman–Halton test, while non-parametric continuous outcomes were compared using the Mann–Whitney U test, with statistical significance defined as p < 0.05.

Results: The study showed a slight female predominance (57.1%), with 50.0% of patients being overweight and 53.6% classified as overweight or obese. Most patients had Kellgren–Lawrence Grade II or III osteoarthritis, with 42.9% in Grade III and 41.1% in Grade II. Symptoms were chronic in most patients, with 66.1% reporting symptoms for more than three years, and 80.4% had bilateral knee involvement. Baseline characteristics were comparable between the treatment groups, with no significant differences observed (all p > 0.05).

Both groups showed significant improvement in pain after treatment; however, corticosteroid followed by sequential PRP produced significantly better outcomes for pain at rest (p = 0.0018), walking pain (p < 0.001), night pain (p = 0.032), rising from a chair (p < 0.001), walking (p = 0.0026), and stair climbing/descending (p < 0.001). The sequential PRP group also reported longer-lasting pain relief, with 85.7% experiencing relief for at least three months and 46.4% beyond six months, whereas 92.9% of the corticosteroid-only group reported relief lasting less than one month (significant (p = 1.000).

Both treatments demonstrated a favorable safety profile. No adverse effects were reported by 82.1% of the corticosteroid-only group and 85.7% of the sequential PRP group, while the remaining patients experienced only mild pain or swelling. The difference in adverse effects between groups was not statistically (p = 1.000).

Conclusion: In this retrospective cohort, corticosteroid followed by sequential platelet-rich plasma was associated with greater post-treatment improvement in pain and everyday functional mobility and a substantially longer duration of perceived pain relief than corticosteroid monotherapy, without an observed increase in local adverse effects. These findings support further prospective, adequately powered randomized studies to evaluate the effectiveness, durability, and standardized clinical application of sequential platelet-rich plasma therapy in knee osteoarthritis.