Efficacy of Combined Platelet-Rich Plasma and Ozone Injections in Advanced Knee Osteoarthritis: A Retrospective Clinical Study

Objective: Knee osteoarthritis (KOA) is a major cause of pain and disability, particularly in the advanced stages, where treatment options are limited. Platelet-rich plasma (PRP) and ozone therapy have individually demonstrated beneficial effects. However, evidence regarding their combined use, especially in severe KOA, remains scarce. Therefore, with this study, we aimed to evaluate the efficacy of combined intra-articular PRP and ozone injections in patients with advanced knee osteoarthritis.Methods: This study included 61 patients with advanced KOA who were treated with three ultrasound-guided intraarticular injections of PRP, followed by ozone at two-week intervals. Pain and function were assessed using the Numerical Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 1month, and 3 months.Results: Significant improvements were observed in both pain and functional scores over time (P < 0.001). The mean NRS decreased from 7.70 ± 1.37 at baseline to 4.54 ± 1.15 at 1 month, increasing to 6.33 ± 1.29 at 3 months. WOMAC scores improved from 73.61 ± 12.64 to 54.44 ± 11.67 at 1 month but returned to near baseline (73.21 ± 12.33) at 3 months. At 1 month, 90.2% of patients achieved ≥30% pain reduction, decreasing to 9.8% at 3 months.Conclusion: Combined PRP and ozone therapy provides substantial short-term improvements in advanced KOA in terms of pain and function. Yet, these benefits decrease notably within 3 months. This treatment may be considered a short-term or adjunctive option rather than a durable, long-term solution.