As joint wear increases, many people are faced with the decision of whether to improve their quality of life with an endoprosthesis (joint replacement). Hyaluronic acid and autologous blood therapy (also known as ACP and PRP) have come into focus in recent years as potential alternatives. These therapies utilize the body's own healing forces and biologically active substances to alleviate pain and improve joint function. But how effective are they really? Can they delay or prevent an endoprosthesis in advanced cases?

How do hyaluronic acid and autologous blood therapy work?

• Hyaluronic acid is injected directly into the joint, where it acts as a lubricant and shock absorber. It can improve joint glide and reduce inflammation, especially in so‑called "dry" arthroses, where the joint is painful due to friction.
• Autologous blood therapy (ACP/PRP) is based on concentrated platelets, which are rich in growth factors. These stimulate tissue regeneration, alleviate inflammation and promote cell renewal, which can be helpful for pain relief.

Areas of application and effectiveness in advanced osteoarthritis

The two treatment modalities show promising results in mild to moderate osteoarthritis. In advanced stages, however, the successes are often limited:

• Knee osteoarthritis: Studies have shown that hyaluronic acid and PRP slow the progression of osteoarthritis and relieve symptoms in moderate osteoarthritis. In severely damaged cartilage, the effectiveness, however, declines.
• Hip osteoarthritis: Because the hip joint is anatomically deeper and has more sensitive structures nearby, the application of hyaluronic acid or PRP is more complex and carries some risk. In advanced hip osteoarthritis, the success chances decrease, as the tissue is often already too severely damaged.

When is an endoprosthesis a better solution?

In cases where cartilage wear is already far advanced, hyaluronic acid and autologous blood therapy can usually only alleviate pain in the short term. Signs that an endoprosthesis might be more useful include:

• Persistent pain that occurs at night and disrupts sleep.
• Limited mobility that restricts daily activities.
• No or only minor improvement in symptoms after hyaluronic acid or PRP treatments.

Study situation on efficacy and sustainability

• Long-term studies on hyaluronic acid show that patients with moderate osteoarthritis benefit the most from it. The positive effect is usually limited to about 6–12 months, after which the efficacy declines.
• PRP studies have shown a slightly stronger and longer‑lasting effect in moderate osteoarthritis, especially in the knee joint. The pain‑relieving effects can last up to one year, but are strongly dependent on the severity of the osteoarthritis.

Benefits and risks of the individual methods

• Hyaluronic acid: Easy to apply and well tolerated, but only limited effect in severely advanced osteoarthritis.
• ACP/PRP: Stronger effect in mild to moderate osteoarthritis, but more complex in execution and more expensive. In advanced stages the effectiveness is reduced.

When is combination therapy useful?

For patients in the intermediate stages of osteoarthritis, a combination therapy of hyaluronic acid and PRP or other approaches such as physiotherapy and exercise training can achieve the best results. In advanced stages, however, often only an endoprosthesis can provide long-term relief and mobility.

Conclusion: Hyaluronic acid and PRP as an option before endoprosthesis



Hyaluronic acid and ACP/PRP offer a valuable, yet limited, alternative to endoprosthesis for patients in the early to moderate stages of osteoarthritis. In advanced osteoarthritis, patients should weigh, after comprehensive consultation at ENDOPROTHETICUM, whether joint replacement is ultimately not the more sustainable solution.