Osteoarthritis (OA) is one of the most prevalent degenerative joint disorders worldwide and a leading cause of chronic pain, functional limitation, and disability, particularly among the elderly population [1]. It is a progressive, multifactorial disorder characterised by articular cartilage degradation, subchondral bone remodelling, osteophyte formation, and synovial inflammation [2]. Rather than being merely a consequence of wear and tear, OA involves complex interactions between mechanical, biochemical, and inflammatory processes affecting the entire joint [3]. Pro-inflammatory mediators and matrix-degrading enzymes contribute to progressive cartilage deterioration, resulting in pain, stiffness, deformity, and restricted mobility [4,5].Knee OA is among the most common forms of osteoarthritis and represents a substantial global public health concern due to its association with disability and reduced quality of life [6,7]. Its prevalence continues to increase with population ageing, obesity, and sedentary lifestyles [8]. In India, Aakash et al. highlighted the considerable burden of OA among individuals above 40 years, emphasising its clinical and socioeconomic importance [9]. Besides physical disability, knee OA contributes to increased healthcare expenditure, reduced productivity, and long-term functional dependence [10].The characteristic manifestations of knee OA include pain, stiffness, crepitus, reduced range of motion, and progressive functional impairment [1]. Cartilage degeneration results from an imbalance between matrix synthesis and degradation, leading to the loss of type II collagen and proteoglycans, reduced elasticity, and diminished load-bearing capacity [2]. Progressive cartilage thinning, subchondral bone exposure, and synovial inflammation further aggravate symptoms [3,4]. Therefore, early therapeutic intervention is essential to alleviate symptoms and preserve joint function.Management of knee OA primarily aims to relieve pain, reduce inflammation, and improve functional capacity. Non-pharmacological measures, including patient education, weight reduction, physiotherapy, strengthening exercises, and lifestyle modification, form the foundation of treatment [5,11]. Pharmacological options include non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and other analgesics; however, prolonged systemic medication use may cause gastrointestinal, renal, and cardiovascular complications [5,12]. In patients with persistent symptoms despite conservative management, intra-articular injections, including corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP), offer targeted nonsurgical treatment options [7,13,14].Intra-articular corticosteroids are widely used because of their potent anti-inflammatory action and rapid symptomatic relief [13]. They suppress inflammatory pathways by inhibiting cytokine production, neutrophil migration, and the synthesis of prostaglandins and leukotrienes, thereby reducing joint pain, swelling, and tenderness [15,16]. Although corticosteroid injections provide effective short-term relief, their benefits are generally transient, lasting from several weeks to a few months [7,17]. Moreover, repeated administration may be associated with cartilage volume loss under certain treatment regimens and adverse effects such as transient hyperglycaemia and rare joint infections, limiting their long-term therapeutic utility [17,18].Platelet-rich plasma has emerged as a biological alternative for the management of knee OA. It is an autologous blood-derived preparation obtained through centrifugation, resulting in plasma containing concentrated platelets [11]. Upon activation, platelets release bioactive growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), which participate in tissue repair and cellular signalling [19]. These factors may modulate inflammation, inhibit cartilage-degrading enzymes, reduce chondrocyte apoptosis, and promote extracellular matrix synthesis, suggesting potential chondroprotective effects [11,19,20]. However, definitive structural cartilage regeneration following PRP administration in humans remains unestablished.Several clinical studies have demonstrated promising results with PRP in reducing pain and improving functional outcomes in knee OA [16,21]. Nevertheless, variations in PRP preparation, platelet concentration, injection frequency, patient selection, and follow-up duration have contributed to inconsistent findings [20]. Although corticosteroids provide rapid anti-inflammatory effects, PRP may offer more sustained symptomatic improvement in selected patients. However, evidence directly comparing these interventions, particularly in early-stage knee OA, remains variable [8,21,22].Early knee OA provides an important opportunity for nonsurgical intervention while substantial native cartilage and joint function are preserved. Considering the distinct mechanisms, duration of action, and therapeutic profiles of PRP and corticosteroids, further comparative evaluation is warranted to identify appropriate treatment strategies and optimise clinical outcomes [17,19,20].Therefore, the present study aims to compare the efficacy of intra-articular platelet-rich plasma (PRP) versus corticosteroid injections in the treatment of early knee osteoarthritis, with particular emphasis on pain relief and improvement in functional outcomes.

This interventional, randomized controlled trial was conducted in the Department of Orthopaedics, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru, Karnataka, over 18 months (August 2024–January 2026) to compare intra-articular platelet-rich plasma (PRP) and corticosteroid injections in patients with early primary knee osteoarthritis (OA).A total of 60 patients of either sex, aged 45 years and above, presenting with symptomatic early primary knee OA were recruited from the orthopaedic outpatient and inpatient departments using purposive sampling. Diagnosis was confirmed through clinical and radiological assessment using the Kellgren–Lawrence (KL) grading system.The sample size was based on Finogejevs et al. (2020) [23], who reported mean pain scores of 2.9 ± 1.5 in the PRP group and 5.1 ± 1.9 in the corticosteroid group at 58 weeks. A total of 60 patients (30 per group) were included in the study. Eligibility Criteria Inclusion Criteria: Patients aged 45 years and above with symptomatic early primary knee OA diagnosed using the KL grading system who provided written informed consent were included. Exclusion Criteria: Patients with severe anaemia, haematological disorders, rheumatoid arthritis or other inflammatory arthropathies, oral corticosteroid use exceeding four weeks, previous intra-articular knee injections, bilateral lower-limb fractures or injuries, or local skin pathology at the proposed injection site were excluded. Randomization and Group Allocation Eligible participants were randomized using Randomizer for Clinical Trial software into two equal groups: • Group A (n=30): Intra-articular PRP injection. • Group B (n=30): Intra-articular corticosteroid injection. No blinding was employed. Baseline Assessment All participants underwent detailed clinical examination and weight-bearing knee radiography. Baseline pain intensity and functional disability were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. Intervention Protocol Group A – PRP Injection: Approximately 30 mL of autologous venous blood was collected under aseptic precautions and subjected to double centrifugation (3000 rpm for 5–10 minutes, followed by 3000 rpm for 15–20 minutes). The prepared PRP was administered within eight hours through the classical lateral suprapatellar approach without activation using calcium chloride or thrombin. No local anaesthetic or corticosteroid was mixed with PRP, and post-injection analgesics/NSAIDs were avoided. Group B – Corticosteroid Injection: Triamcinolone acetonide (40 mg/mL) mixed with 1 mL of 2% lignocaine (following a test dose) was administered intra-articularly through the classical lateral suprapatellar approach under strict aseptic precautions. Outcome Measures Treatment efficacy was assessed using the following parameters: • Visual Analogue Scale (VAS): Pain intensity was measured on a 10-cm scale ranging from 0 (no pain) to 10 (worst possible pain). • WOMAC Index: Pain (5 items), stiffness (2 items), and physical function (17 items) were evaluated using a total score of 0–96, with higher scores indicating greater disability. • Radiological Assessment: Weight-bearing knee radiographs were used to evaluate osteoarthritic changes. Follow-up Assessment Patients were evaluated at baseline and at 1, 4, 8, and 12 weeks following injection, with follow-up continued up to six months. Changes in VAS and WOMAC scores and treatment-related adverse events were documented. Statistical Analysis Data were analysed using IBM SPSS Statistics version 25. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), while categorical variables were presented as frequencies and percentages. Between-group comparisons were performed using the independent Student's t-test or Mann–Whitney U test, as appropriate, while categorical variables were compared using the Chi-square test. VAS and WOMAC scores were compared between groups at each follow-up interval. All tests were two-tailed, with p<0.05 considered statistically significant and p<0.001 considered highly significant.

A total of 60 patients diagnosed with early knee osteoarthritis (Kellgren–Lawrence Grade I–II) were enrolled in this randomized interventional study and allocated equally into two groups: the platelet-rich plasma (PRP) group (n=30) and the corticosteroid group (n=30). Baseline demographic, clinical, radiological, pain, and functional characteristics were comparable between the groups. Patients were evaluated over a six-month follow-up period to assess changes in pain intensity, functional outcomes, and post-injection adverse events.The mean age of participants was 58.4 ± 6.8 years in the PRP group and 57.9 ± 7.1 years in the steroid group, with no statistically significant difference (p=0.78). The majority of participants belonged to the 56–60 years and above 60 years age categories. Males constituted 60.0% of the PRP group and 56.7% of the steroid group (p=0.79). The mean BMI was also comparable between groups (27.1 ± 3.2 vs. 27.4 ± 3.4 kg/m²; p=0.71), with most participants classified as overweight or obese. No significant differences were observed in age-group distribution, sex distribution, or BMI categories (Table 1).Right-sided knee involvement was observed in 40.0% of patients in the PRP group and 36.7% in the steroid group, followed by left-sided (33.3% vs. 40.0%) and bilateral involvement (26.7% vs. 23.3%), without a significant difference (p=0.84). Kellgren–Lawrence Grade II osteoarthritis was more frequent in both groups (53.3% vs. 56.7%), with comparable radiological severity (p=0.79).Baseline pain and functional scores were also comparable. The mean VAS score was 7.2 ± 0.9 in the PRP group and 7.1 ± 1.0 in the steroid group (p=0.68), while the corresponding WOMAC scores were 62.3 ± 8.5 and 61.8 ± 9.1 (p=0.84). These findings demonstrated similar baseline pain intensity and functional impairment between the two treatment groups (Table 2). At one week, the steroid group demonstrated significantly lower mean VAS scores than the PRP group (4.8 ± 0.9 vs. 5.6 ± 0.8; p=0.010), indicating greater early pain relief following corticosteroid administration. At four weeks, VAS scores were comparable between the groups (4.2 ± 0.9 vs. 4.5 ± 1.0; p=0.290).However, from eight weeks onwards, significantly lower VAS scores were observed in the PRP group compared with the steroid group. At eight weeks, mean scores were 3.4 ± 0.8 versus 4.9 ± 1.1, decreasing further to 2.9 ± 0.7 versus 5.2 ± 1.2 at 12 weeks and 2.6 ± 0.6 versus 5.5 ± 1.3 at six months (p<0.001 at all three intervals). Thus, corticosteroids provided greater initial pain relief, whereas PRP demonstrated more sustained pain reduction throughout subsequent follow-up (Table 3, Figure 1).At four weeks, mean WOMAC scores were comparable between the PRP and steroid groups (45.2 ± 7.4 vs. 47.6 ± 8.1; p=0.270). Subsequently, significantly lower WOMAC scores were observed in the PRP group at eight weeks (36.1 ± 6.9 vs. 48.9 ± 9.4), 12 weeks (31.4 ± 6.2 vs. 52.1 ± 10.2), and six months (28.7 ± 5.8 vs. 55.3 ± 11.5), with p<0.001 at all three intervals. These findings indicated sustained improvement in pain, stiffness, and physical function following PRP administration, whereas the initial functional improvement in the steroid group diminished during later follow-up (Table 4, Figure 2).At six months, the mean VAS score decreased from 7.2 to 2.6 in the PRP group, corresponding to an absolute reduction of 4.6 points (63.9%), compared with a reduction from 7.1 to 5.5 in the steroid group, corresponding to 1.6 points (22.5%). Similarly, the mean WOMAC score decreased from 62.3 to 28.7 in the PRP group, representing an absolute reduction of 33.6 points (54.0%), compared with a reduction from 61.8 to 55.3 in the steroid group, representing 6.5 points (10.5%). The reported differences in percentage improvement were statistically significant for both VAS and WOMAC outcomes (p<0.001), demonstrating greater sustained clinical improvement following PRP administration (Table 5).Post-injection pain or swelling was reported in six patients (20.0%) in the PRP group and three patients (10.0%) in the steroid group, with no statistically significant difference (p=0.29). No major complications were observed in either group during the six-month study period (Table 6, Figure 3). Table 1. Comparison of baseline demographic and anthropometric characteristics between study groups (N=60) Characteristic PRP Group (n=30) Steroid Group (n=30) p-value Statistical Test Age (years) Mean ± SD 58.4 ± 6.8 57.9 ± 7.1 0.78 Unpaired t-test Median (IQR) 58 (53–63) 57 (52–64) 0.81 Mann–Whitney U test Range 46–72 45–74 – – Age group, n (%) 45–50 years 6 (20.0) 5 (16.7) 51–55 years 7 (23.3) 8 (26.7) 56–60 years 9 (30.0) 8 (26.7) Above 60 years 8 (26.7) 9 (30.0) 0.89 Chi-square test Sex, n (%) Male 18 (60.0) 17 (56.7) Female 12 (40.0) 13 (43.3) 0.79 Chi-square test BMI (kg/m²) Mean ± SD 27.1 ± 3.2 27.4 ± 3.4 0.71 Unpaired t-test BMI category, n (%) Normal 6 (20.0) 5 (16.7) Overweight 14 (46.7) 15 (50.0) Obese 10 (33.3) 10 (33.3) 0.93 Chi-square test Table 2. Comparison of baseline clinical, radiological, and functional characteristics between study groups (N=60) Parameter PRP Group (n=30) Steroid Group (n=30) p-value Statistical Test Side of knee involvement, n (%) Right 12 (40.0) 11 (36.7) Left 10 (33.3) 12 (40.0) Bilateral 8 (26.7) 7 (23.3) 0.84 Chi-square test Kellgren–Lawrence grade, n (%) Grade I 14 (46.7) 13 (43.3) Grade II 16 (53.3) 17 (56.7) 0.79 Chi-square test Baseline VAS score Mean ± SD 7.2 ± 0.9 7.1 ± 1.0 0.68 Mann–Whitney U test Median (IQR) 7 (6–8) 7 (6–8) 0.74 Mann–Whitney U test Range 5–9 5–9 – – Baseline WOMAC score Mean ± SD 62.3 ± 8.5 61.8 ± 9.1 0.84 Unpaired t-test Median (IQR) 62 (56–68) 61 (55–69) 0.88 Mann–Whitney U test Range 48–78 47–80 – – Table 3. Comparison of VAS scores between PRP and steroid groups at different follow-up intervals Follow-up interval PRP Group (n=30) Mean ± SD Steroid Group (n=30) Mean ± SD p-value Statistical Test Baseline 7.2 ± 0.9 7.1 ± 1.0 0.68 Mann–Whitney U test 1 week 5.6 ± 0.8 4.8 ± 0.9 0.010 4 weeks 4.2 ± 0.9 4.5 ± 1.0 0.290 8 weeks 3.4 ± 0.8 4.9 ± 1.1 <0.001 12 weeks 2.9 ± 0.7 5.2 ± 1.2 <0.001 6 months 2.6 ± 0.6 5.5 ± 1.3 <0.001 Table 4. Comparison of WOMAC scores between PRP and steroid groups at different follow-up intervals Follow-up interval PRP Group (n=30) Mean ± SD Steroid Group (n=30) Mean ± SD p-value Statistical Test Baseline 62.3 ± 8.5 61.8 ± 9.1 0.84 Unpaired t-test 4 weeks 45.2 ± 7.4 47.6 ± 8.1 0.270 8 weeks 36.1 ± 6.9 48.9 ± 9.4 <0.001 12 weeks 31.4 ± 6.2 52.1 ± 10.2 <0.001 6 months 28.7 ± 5.8 55.3 ± 11.5 <0.001 Table 5. Comparison of improvement in VAS and WOMAC scores at six months between study groups Outcome parameter PRP Group (n=30) Steroid Group (n=30) p-value Statistical Test VAS score Baseline (Mean ± SD) 7.2 ± 0.9 7.1 ± 1.0 0.68 Mann–Whitney U test At 6 months (Mean ± SD) 2.6 ± 0.6 5.5 ± 1.3 <0.001 Mann–Whitney U test Absolute reduction in group mean 4.6 1.6 – – Percentage improvement (%) 63.9 22.5 <0.001 Unpaired t-test WOMAC score Baseline (Mean ± SD) 62.3 ± 8.5 61.8 ± 9.1 0.84 Unpaired t-test At 6 months (Mean ± SD) 28.7 ± 5.8 55.3 ± 11.5 <0.001 Unpaired t-test Absolute reduction in group mean 33.6 6.5 – – Percentage improvement (%) 54.0 10.5 <0.001 Unpaired t-test Table 6. Comparison of post-injection adverse events between PRP and steroid groups (N=60) Adverse event PRP Group (n=30), n (%) Steroid Group (n=30), n (%) p-value Statistical Test Post-injection pain/swelling 6 (20.0) 3 (10.0) 0.29 Chi-square test No adverse event 24 (80.0) 27 (90.0) Major complications 0 (0.0) 0 (0.0) Total 30 (100.0) 30 (100.0)

The present randomized controlled trial compared the efficacy and safety of intra-articular platelet-rich plasma (PRP) and corticosteroid injections in 60 patients with early knee osteoarthritis (Kellgren– Lawrence Grade I–II) over six months. The findings demonstrated that corticosteroids provided greater immediate pain relief, whereas PRP resulted in significantly greater and sustained improvement in pain and functional outcomes from eight weeks onwards.The mean age was 58.4 ± 6.8 years in the PRP group and 57.9 ± 7.1 years in the steroid group (p=0.78), with most participants aged above 55 years. Comparable findings were reported by Elksniņš-Finogejevs et al. (2020) [23], who observed a mean age of approximately 57–59 years, Arjun et al. (2020) [24] (56.2 ± 7.4 vs. 55.8 ± 6.9 years), and Pretorius et al. (2022) [25] (59.1 ± 6.3 years). McLarnon and Heron (2021) [22] reported a pooled mean age of 59 years, while Khalid et al. (2023) [26], Qiao et al. (2023) [27], and Khalilizad et al. (2025) [28] also reported predominantly middle-aged and elderly populations. Jaiswal et al. (2021) [29] observed a knee OA prevalence of 64.3% among individuals aged ≥55 years, while Ayhan et al. (2014) [7] similarly highlighted the predominance of OA treatment among older individuals.Males constituted 60.0% of the PRP group and 56.7% of the steroid group (p=0.79), comparable to Elksniņš-Finogejevs et al. [23] and Pretorius et al. [25], who reported approximately 55–60% and 62% male participants, respectively. However, McLarnon and Heron [22] reported female predominance (68%) in their pooled analysis, indicating demographic variation across study populations.The mean BMI was 27.1 ± 3.2 kg/m² in the PRP group and 27.4 ± 3.4 kg/m² in the steroid group (p=0.71), with most participants being overweight or obese. These findings were comparable to Elksniņš-Finogejevs et al. [23] (approximately 28.0 kg/m²), Pretorius et al. [25] (27.9 ± 3.6 kg/m²), and McLarnon and Heron [22] (28.4 kg/m²). Similar BMI profiles were described by Aakash et al. [8], Khalid et al. [26], Qiao et al. [27], and Khalilizad et al. [28].Right-sided knee involvement was observed in 40.0% and 36.7% of the PRP and steroid groups, respectively, with no significant difference in laterality (p=0.84). Pretorius et al. [25] adopted a bilateral-knee design involving 29 patients (58 knees), administering PRP and corticosteroids to opposite knees.KL Grade I OA was present in 46.7% of PRP patients and 43.3% of steroid patients, whereas Grade II disease was observed in 53.3% and 56.7%, respectively (p=0.79). Elksniņš-Finogejevs et al. [23] and Arjun et al. [24] included patients with KL Grade II–III disease, while McLarnon and Heron [22] evaluated studies predominantly involving KL Grade I–III OA.Baseline VAS scores were comparable between the PRP and steroid groups (7.2 ± 0.9 vs. 7.1 ± 1.0; p=0.68), as were WOMAC scores (62.3 ± 8.5 vs. 61.8 ± 9.1; p=0.84). Similar baseline comparability was reported by Elksniņš-Finogejevs et al. [23], Pretorius et al. [25], and Arjun et al. [24]. McLarnon and Heron [22] also reported baseline VAS scores generally ranging between 6 and 8 across the included trials. At one week, corticosteroids provided significantly greater pain relief than PRP, with mean VAS scores of 4.8 ± 0.9 versus 5.6 ± 0.8 (p=0.01). Scores were comparable at four weeks (4.5 ± 1.0 vs. 4.2 ± 0.9; p=0.29). However, PRP demonstrated significantly lower VAS scores at eight weeks (3.4 ± 0.8 vs. 4.9 ± 1.1), 12 weeks (2.9 ± 0.7 vs. 5.2 ± 1.2), and six months (2.6 ± 0.6 vs. 5.5 ± 1.3), with p<0.001 at all three intervals. Similarly, Elksniņš-Finogejevs et al. [23] observed comparable initial improvement with both interventions, followed by significantly greater pain reduction with PRP from 15 weeks to one year. Arjun et al. [24] reported greater VAS improvement with PRP at 24 weeks (32.9 ± 12.1 vs. 12.9 ± 5.9; p<0.0001). Khalid et al. [26], in their meta-analysis of 42 trials involving 3,696 patients, also demonstrated greater pain reduction with PRP at six months (mean difference: −1.11; 95% CI: −1.64 to −0.59).At four weeks, WOMAC scores were comparable between the PRP and steroid groups (45.2 ± 7.4 vs. 47.6 ± 8.1; p=0.27). However, PRP demonstrated significantly greater functional improvement at eight weeks (36.1 ± 6.9 vs. 48.9 ± 9.4), 12 weeks (31.4 ± 6.2 vs. 52.1 ± 10.2), and six months (28.7 ± 5.8 vs. 55.3 ± 11.5), with p<0.001 at all three intervals.These findings were consistent with Arjun et al. [24], who reported greater WOMAC improvement with PRP than corticosteroids at 24 weeks (31.8 ± 14.7 vs. 7.5 ± 5.5; p<0.0001). Elksniņš-Finogejevs et al. [23] similarly demonstrated sustained functional improvement with PRP from 15 weeks onwards. McLarnon and Heron [22] reported an additional WOMAC improvement of 9.51 points with PRP at six months, while Bensa et al. (2024) [88] observed clinically meaningful functional improvement with PRP at mid- and long-term follow-up.Post-injection pain or swelling occurred in 20.0% of PRP patients and 10.0% of steroid patients (p=0.29), with no major complications in either group. Elksniņš-Finogejevs et al. [23] similarly reported no serious adverse events, although transient synovitis occurred in 75% of PRP-treated patients. Pretorius et al. [25] reported comparable safety between both interventions. McLarnon and Heron [22] observed predominantly mild local reactions, while Qiao et al. [27], in their network meta-analysis involving 3,104 participants, reported no significant increase in treatment-related adverse events across the evaluated injection therapies.

The present study demonstrated that intra-articular corticosteroid injections provided greater immediate pain relief, whereas platelet-rich plasma (PRP) produced significantly greater and sustained improvement in pain and functional outcomes from eight weeks to six months. At six months, PRP achieved 63.9% improvement in VAS and 54.0% improvement in WOMAC scores, compared with 22.5% and 10.5%, respectively, in the steroid group (p<0.001). Both interventions were well tolerated, suggesting that PRP may be an effective nonsurgical treatment option for early knee osteoarthritis. LIMITATIONS The study was limited by its relatively small sample size (n=60), single-centre design, absence of blinding, and six-month follow-up period. Additionally, the lack of platelet concentration analysis and long-term structural assessment limits conclusions regarding the regenerative potential and sustained efficacy of PRP.

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