Knee osteoarthritis · combination injection
PRP + Hyaluronic Acid for the knee.
One injection into the knee joint that combines two things: PRP made from your own blood, and hyaluronic acid, a gel-like substance similar to natural joint fluid. It's used for mild-to-moderate knee osteoarthritis.
PRP + HA
What is PRP + HA?
PRP made from your own blood carries concentrated platelets and growth factors that may adjust inflammation and support local tissue repair. Hyaluronic acid adds back some of the slipperiness and cushioning of the joint fluid, which thins as osteoarthritis progresses.
The idea behind giving both in one injection is to work on two sides of osteoarthritis symptoms: the biological side (inflammation and signaling) and the mechanical side (thinner joint fluid and more friction at the joint surface).
Autologous PRP
From your blood · two-spin · Lp-PRP
Leukocyte-poor PRP (low in white blood cells), prepared in our on-site lab. We use this lower-inflammation version inside joints. Its concentrated platelets release growth factors and signaling proteins that can start the body's own repair processes.
Hyaluronic acid
Pharmaceutical-grade HA · viscosupplementation
Adds lubrication and cushioning to the joint fluid, which thins as osteoarthritis progresses. The added lubrication is there right away, while the response to PRP builds over several weeks.
FDA regulatory disclosure
PRP is an autologous blood product prepared from the patient's own blood.
Hyaluronic acid products used for viscosupplementation are typically regulated as devices/drug-device combinations depending on the product.
Importantly, PRP has not been approved by the U.S. Food and Drug Administration (FDA) as a drug/biologic for the treatment of knee osteoarthritis, and clinical use is based on physician judgment, current scientific evidence, and individualized patient evaluation. No claims are made regarding guaranteed outcomes, cartilage regeneration, or disease modification.
The procedure
What to expect during a visit.
The procedure is done in our clinic with local anesthesia, and you go home the same day. We prepare the PRP while you're being prepared, then inject both parts in the same session.
Intake & blood draw
Brief intake; venous blood collected for autologous PRP preparation.
PRP preparation
Two-spin centrifugation in our on-site lab, Lp-PRP for intra-articular use.
Image-guided delivery
Both PRP and HA delivered to the joint space under ultrasound guidance, with non-platelet-toxic anesthesia.
Recovery
A short observation period, then guidance on activity and on avoiding anti-inflammatory medicines (NSAIDs) in the early period after the injection.
Evidence base
What the evidence shows.
PRP plus HA has been studied for knee osteoarthritis in clinical studies and a meta-analysis. Most found better pain or function scores with the combination than with HA alone, and one found an early advantage over PRP alone. Results vary between studies, and the evidence is still developing.
Randomized trial of 105 patients with mild-to-moderate knee OA, comparing PRP+HA, PRP alone, and HA alone. The combination did better than HA alone on pain and function at 12 months, and better than PRP alone on physical function at 1 and 3 months.
Retrospective review of 101 knees with grade III–IV OA. At 6 months, knees treated with PRP+HA improved more on function (IKDC) and pain scores than knees treated with HA alone.
Systematic review and meta-analysis of 4 studies (377 patients). PRP+HA did better than HA alone on VAS pain at 3, 6, and 12 months and on 12-month function and stiffness, though not on the 12-month WOMAC pain score.
Talking it through
When PRP + HA is the right combination.
This combination is used most often for mild-to-moderate knee osteoarthritis. For more advanced arthritis, especially when the bone under the cartilage is involved, we usually also talk about cellular therapy (stem cells).
What we look at together
- Mild-to-moderate knee osteoarthritis (grade 2 to 3 on the Kellgren-Lawrence X-ray scale)
- Symptoms that continue despite physical therapy, activity changes, and NSAIDs
- X-ray or MRI of the knee, if you have one
- Wanting both biological and mechanical support in one visit
- Expecting gradual change over 4 to 12 weeks
Frequently asked
Questions about PRP + HA.
Why combine PRP with hyaluronic acid? +
The two work on different parts of knee osteoarthritis. PRP supplies biological signaling that can start the body's own repair and adjust inflammation. HA adds lubrication to joint fluid that has thinned with osteoarthritis. In several studies, the combination did better than HA alone, though results vary between studies.
How is this different from a single PRP injection? +
Standard PRP gives only the biological part. PRP + HA also adds hyaluronic acid, which lubricates the joint right away while the slower response to PRP builds. For mild-to-moderate knee osteoarthritis with mechanical symptoms such as catching or stiffness, the combination is often a better fit.
What's the recovery and timeline? +
Plan for 24–72 hours of soreness at the injection site. Avoid strenuous activity for the first 48 hours; resume PT and normal activity gradually. Skip anti-inflammatory medicines (NSAIDs) in the early period, because they can blunt the response to PRP. When improvement comes, it usually builds over 4 to 12 weeks. We do a full assessment at 12 weeks and a review at 6 months.
Does insurance cover PRP + HA? +
The PRP component is typically not covered by insurance. The hyaluronic acid is not covered either; Boulder Biologics is a patient-pay practice. We discuss the cost with you when you book your service and supply HSA/FSA reimbursement documentation where applicable.
How many injections will I need? +
Most patients receive a single combined PRP+HA injection. Depending on response and OA severity, a repeat injection at 6 months may be considered. We reassess at the 12-week follow-up and individualize the plan from there.
Related therapies
Other options for knee OA.
Schedule a call
Find out if PRP + HA fits your knee.
Dr. Glowney reviews your imaging, prior treatments, and symptom profile, and tells you honestly whether this combination, plain PRP, BMAC, or a different path is the better next step.
720-550-6175