Here is a great question from “T Hand” that prompted me to write about Platelet Rich Plasma:
“What is the expectation of PRP injections for those of us who have had knee problems for a number of years?” - T Hand
There are some exciting developments with the field of biologic treatments including PRP. To answer T Hand’s question, results are encouraging but vary. Please read on to learn more and find out how PRP injections went for me.
To start with, the application of any treatment depends on the problem in the knee, and, as always, you should consult with your doctor. I’ll assume that we are talking about general knee pain that comes with osteoarthritis (OA) or “it just hurts.”
First, I want to clarify some terms that get tossed about so that we are all talking about the same things.
Prolotherapy is short for “proliferation therapy” or “proliferative therapy” and is thought to stimulate the body’s natural healing response through an injection to the injury site causing a mild inflammatory response to encourage the repair to damaged tissue and regrowth of healthy tissue.
Science has used a variety of injection therapy since the 1800’s. In fact, methods of prolotherapy can be dated back to 400 BC, but Alfred A.L.M. Velpeau, MD is considered the father of prolotherapy with his work in 1835 (1). The methods and solutions for Prolotherapy injections have varied over time and currently use natural substances such as dextrose-based solutions (2), saline, sarapin, procain, lidocaine (3) - and now PRP - mixed with local anesthetic agents to ease the pain of the injection.
Prolotherapy was first widely used to treat hernias and moved into joint therapy in the 1930’s after Dr. Earl Gedney tested it on himself after he caught his own thumb in a door, stretching the joint and causing instability. Dr. George Stuart Hackett, in the 1950’s, continued the injection research and coined the term “proliferation therapy.”
PRP, or Platelet Rich Plasma, is the hot “new” treatment to reduce pain and possibly slow the advancement of OA. PRP has actually been in use since 1987 (4) and is used to treat tendinosis, ligament damage, and for joint pain.
PRP is prepared from the patient’s own blood which is spun in a centrifuge to obtain a highly concentrated sample of platelets. This concentrated platelet solution is rich in growth factors and bio active molecules. An injection of PRP in the affected area results in an inflammatory reaction (Inflammatory Phase - this is good!) which causes a cascade of effects: release of growth factors set the stage for the next three phases of healing: to lay down the scaffolding for repair (Proliferative Phase), collagen rebuilding (Maturation and Remodeling phase), and healing of open wound or connective tissue fascia (Re-epithelialization Phase).
With healing comes a reduction in pain and inflammation, and often improved function. PRP is a relatively new generation of bio active treatments and is not yet widely used and generally not accepted by insurance as a reimbursable treatment. So you’ll probably pay out of pocket for this.
The good news it that positive results are rolling in.
According to Arthritis-Health, it’s only been since 2000 that PRP has been used to treat OA and other cartilage defects. Most of the research articles have been published since 2010 (5). Two studies cited regarding PRP knee injections for OA showed that after one year there was a reduction of pain and that the degenerative process had not progressed in a majority of the knees. WOW!
Not all studies show that PRP works to alleviate symptoms of OA and of course individual results will vary. Not all PRP injections are equal. There are different PRP preparation methods, injection frequencies (one injection vs. multiple injections), and injection methods (ultrasound guided or not).
My orthopaedic surgeon did not recommend it for me because he believed there wasn’t yet enough science backing the efficacy of PRP. Yet I proceeded anyway and saw Dr. Kim Harmon at the UW Sports Medicine Center, in Seattle, WA. I first had a consultation visit to review my knee history to see if I was a good candidate. She explained the procedure and thought my right knee may benefit well but was not so optimistic about my severely arthritic left knee.
She explained that there are different concentrations of PRP for different applications. She also said that the according to the research at the time, one injection in the knee joint for OA had the same efficacy as two injections and so we settled on one injection in each knee for me. I scheduled the appointment for the injections which were $600 each.
Good news is that I had great relief in both knees that lasted for a little more than a year. At 16 months I had another set of injections (one in each knee) and now, 10 months later am feeling like I’m ready for more, or something else. I figure that PRP injections are better than surgery and if I can gain a year or so of reduced pain, they are definitely worth the cost.
I haven’t done an exhaustive survey of prices, but a quick internet search revealed a range mostly from $500 to $1000 per injection. If you no longer get relief from cortisone, have tried hyaluronic acid, and are looking for the next step, PRP injections may be for you.
Coming Soon - What’s the difference between Cortisone, Hyaluronic Acid, PRP, and Stem Cells
(1) Velpeau ALM. IEW Elements of Operative Surgery. Townsend PS, trans-ed. New York, NY: Samuel S & William Wood; 1847. http://collections.nlm.nih.gov/ocr/nlm:nlmuid-66921050RX1-mvpart. Accessed April 23, 2015.
(2) Andersen, Arden, DO. The History of Prolotherapy. https://www.practicalpainmanagement.com/treatments/complementary/prolotherapy/history-prolotherapy
(3) The American Osteopathic Association of Prolotherapy Regenerative Medicine. What is Prolotherapy? http://prolotherapycollege.org/what-is-prolotherapy/
(4) Two studies reference PRP use: Ferrari M, Zia S, Valbonesi M. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery. Int J Artif Organs. 1987;10:47–50; Marx R, Garg A. Dental and craniofacial applications of platelet- rich plasma. Carol Stream: Quintessence Publishing Co, Inc.; 2005.
(5) Wilson, John. J MD, MS. Arthritis-Health. Efficacy of Platelet-Rich Plasma Injections. https://www.arthritis-health.com/treatment/injections/efficacy-platelet-rich-plasma-injections
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