Platelet Rich Plasma
The goal of treatment for your arthritis is to reduce pain and restore function to that joint. There are two basic pathways we can take to achieve these goals:
- Surgical treatments
- Non-surgical treatments
We will review each option with a brief description of how each treatment works and how it is administered. We will also review the efficacy, safety, amount of time and effort involved (convenience). We rate each section on a scale of (+) to (++++) with each (+) indicating less pain, more convenience, better safety, and higher efficacy. A maximum score of (++++) indicates that this procedure has the least amount of pain, is the most convenient, has the best safety, and the highest efficacy. So, in summary, the more (+) next each segment, the better the rating.
What are they?
This is a therapy based on your own cells and thus is in a class called Cell Based Therapies. When you have a cut or scratch, the scab that forms is filled with platelets. These are special cells in your blood that cause the blood to clot. This clot helps heal an injury by releasing special growth factors (insulin-like growth factor, transforming growth factor b-I, platelet derived growth factor). In addition, the platelets can also help reduce some harmful chemicals released by a trauma (Matrix Metalloproteinase). Your joint or injured tissue can benefit from the release of these growth factors in a concentrated form.
Although this is not a complete list, it is a general guideline to help you understand whom may be the ideal candidate for this procedure. You and your surgeon will always find exceptions since not every patient responds the same to each treatment:
• Patients looking for mid-term pain relief of 3 months to 2 years.
• Patients searching for improved pain relief and improved function above and beyond what is found in hyaluronic acid injections.
• No or limited instability symptoms of the joint (Not more than 2 events per week).
• Not currently taking blood thinners such as warfarin, or Pradaxa™.
• Ability to stop anti-inflammatory medications (i.e. Motrin™) for 2 weeks prior and 2 weeks after the procedure.
• Willing to participate in additional therapies to improve the health of the joint.
• Age under 80
How does this work?
A small amount of your own blood (anywhere from 10 to 40cc) is drawn, as would be done in a typical lab test, and then centrifuged (spun at a very high speed) to separate out your blood cells from your plasma and platelets. A concentration of anywhere from 3 to 9 times your normal amount of platelets is than formed into a solution called platelet rich plasma. This is packed with growth factors as well as cytokines, chemokines, arachidonic acid metabolites, extracellular matrix proteins, nucleotides, and even ascorbic acid which help heal damaged tissue. This is all done in our office setting within 20 to 30 minutes. There are different protocols for these injections; depending on the specifics of your problem, your surgeon may recommend 1-5 treatments. You may notice some improvement within weeks, but some patients do not see the full benefit of the treatments until 3 months after the last injection in the series.
Safety of This Procedure: Score: ++++
In clinical studies to date, PRP is safe, with no serious complications reported. Minor adverse events associated with repeated injections have been moderate pain, swelling and mild effusion that lasted a few days. In a double blinded randomized study conducted by Sanchez12 of PRP vs. Hyaluronic Acid injections, found a 14.1% improvement in the reduction of pain in the PRP group with a report of adverse events that were mild and evenly distributed between the groups. In another study entitled “Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial.” 13 the authors evaluated the use of a single PRP injection vs. two injections of PRP vs. a simple saline injection. The result revealed similar improvements of pain relief of one injection and two PRP injections over saline injections and there were very transient, brief experiences of dizziness, and nausea noted in the treatment groups. However, in a study conducted by Sampson et al in the American Journal of Physical Medicine and Rehabilitation in 2010 there were no adverse reactions reported. 14
Efficacy of the Treatment:Score: +++
There have been numerous studies evaluating the positive effects of this treatment for arthritis of the knee. A few worth reviewing include “Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions.” by Kon and colleagues15 They looked at 115 patients treated with 3 PRP injections and followed up at 6 and 12 months. A statistically significant improvement of all clinical scores was obtained from the base line evaluation to the end of the therapy and at 6-12 months follow-up (P < 0.0005). They concluded “ The preliminary results indicate that the treatment with PRP injections is safe and has the potential to reduce pain and improve knee function and quality of live in younger patients with low degree of articular degeneration.” One other study by Filardo 16 was a retrospective study of 90 patients treated with three injections of PRP into arthritic knees at 24 month follow up.
All of the parameters at the 24-month period improved including the IKDC subjective and objective parameters for a median length of improvement for over 9 months. If we compare PRP to hyaluronic injections (ie Supartz), PRP patients tend to have better pain and function scores. A great review article entitled “The effects of platelet rich plasma in the treatment of large-joint osteoarthritis: a systemic review.”17 compared 13 studies of hyaluronic acid to PRP. Most (12) were for knee arthritis. All of the studies revealed that PRP had statistically significant benefit in knee osteoarthritis compared to hyaluronic acid. Although most of these studies utilized 3 separate PRP injections, a few have shown that one injection is effective. One study conducted by Torreo in 2012 found that one injection of PRP was effective in reducing pain. 18
Convenience of this procedure: Score: ++++
This is all done in one simple 30 minute or less office visit. The blood is drawn and processed within 15 minutes and injected into the affected area. You can resume your normal activities the day of the injections within reason. It is not necessary to have someone drive you home or stay during this treatment.
Pain Associated with this Procedure: Score : ++++
You may experience some pain with the drawing of the blood but not usually more than any other blood draw. The injection into the joint is not any more painful than other types of joint injections and if pain occurs, it is normally for just a few minutes.
No insurance plans currently cover these injections. Please contact us for current pricing. These expenses may be reimbursable through qualified Health Spending Accounts (HSA), Flexible Spending Account (FSA), Medical Savings Account (MSA), or Health Reimbursement Arrangement (HRA). Please contact your plan administrator for details.
12 Sanchez M. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Journal of Arthroscopy 2012 Aug;28(8):1070-8.
13 Patel et al. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. American Journal of Sports Medicine 2013 Feb;41(2):356-64.
14 Sampson S et al.Injection of platelet-rich-plasma in patients with primary and secondary knee arthritis: a pilot study. American Journal of Physical Medicine and Rehabiliation (2010 Dec;89(12):961-9.
15 Kon et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surgery Sports Traumatology and Arthroscopy, 2010, April; 18(4):472-9.
16 Filardo G et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis; Knee Surgery, Sports, Traumatology, and Arthroscopy; 2010 Aug 26
17 Teitze DC et al The effects of platelet rich plasma in the treatment of large-joint osteoarthritis: a systemic review. Physiology and Sports Medicine 2014, May; 42(2) 27-37.
18 Torrel JL. Treatment of knee chondropathy with platelet rich plasma. Preliminary results at 6 month follow up with only one injection. J Biolo Regul Homeost agents. 2012 June 26 (2 Suppl) 71s-78s.