Leon E. Popovitz, MD
Top-Rated Orthopedic Surgeon
Specializing in Arthroscopic Surgery of the Shoulder & Knee.
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PRP Blog Post NY Bone and Joint

The TRUTH about PRP Injections

There has been rapidly growing interest in PRP (Platelet Rich Plasma) injections. In particular, more and more patients are interested in these novel injections for alternative, non-surgical treatment of their osteoarthritis. After all, there are so many claims from so many different health care providers about PRP. What can a patient believe? What patients can truly benefit? This review of the most relevant, true data and evidence should reveal the most vital information.

Osteoarthritis of a joint, whether it be the knee or the hip, etc., is the result of the joint’s inability to withstand the bio-mechanical overload; the joint cannot hold up the forces upon it. Subsequently, damage to the cells occur. Often, the body is able to provide some restoration and remodeling (repair), but eventually the balance may be comprised from overload (excessive wear and tear, trauma, or heavy body weight). That is when osteoarthritis develops.

There is a wide array of treatments available to patients with osteoarthritis that include medications, vitamin supplements, physical therapy, cortisone injections, lubricating injections, arthroscopic surgery and total joint replacement surgery. Nonetheless, a true cure, outside of surgically resecting the arthritis and replacing it with metal and plastic, has been the target of countless research. 

Most recently, PRP injections have provided hope as a minimally invasive option to improve the condition of a joint that is afflicted with arthritis. The platelet rich plasma (PRP) is obtained from the patient’s own blood and has a higher concentration of platelets than whole blood. These platelets can release biological proteins that bind to receptors that promote cell recruitment and growth. At the same time (according to a study by Anitua in 2010) these cells can decrease inflammation. Therefore, PRP has become an attractive option to treat osteoarthritis (OA) where there is hope that cells actually experience healing. 

All of this is very promising but, as interest has skyrocketed in recent years, the true indications and benefits have not been standardized yet. This review of the most relevant scientific data should help clear up many of the questions.

Among the studies performed in the laboratory, 13 studies showed an increase in the chondrocyte (cartilage cells) growth. Muraglia et al, in 2013, actually showed that PRP promoted cell growth in fetal calf serum that have no stimulating ability (much like the cartilage cells in the older patient population). Park et al, in 2012, revealed an increase in cellular viability in a dose-dependent manner. 

Moreover,  Akeda in 2006 and and Yin in 2013, have shown evidence of matrix (microscopic cartilage construct) production with PRP. More practically, Lee et al, in 2012, showed that PRP has a pain relief effect by increasing the function of analgesic cell receptors.

Mifune et al, in 2013, noticed that PRP stimulates the growth, migration and configuration of cartilage cells in OA. Ishida et al, in 2007, and Gonzalez et al, in 2013, actually showed potential benefits of PRP in meniscus cell growth.

Subsequently, pre-clinical studies (animal models) also have revealed promising data. Kwon, et al, in 2012 showed cartilage regeneration in all degrees of osteoarthritis severity with the most benefit in moderate OA. Saito et al, in 2009, revealed that PRP suppressed the progression of osteoarthritis. 

Clinical studies though, have not been completely promising. Still, there is some very useful data. Sanchez, et al, in 2008, was the first significant study. It was a retrospective study and revealed that PRP was more effective in pain control (comparing to injection of hyaluronic acid eg.Synvisc, Orthovisc, etc). Kon et al, in 2011, published a prospective study (a higher level of proof) that showed better results in PRP patients, but only in the patients with less severe osteoarthritis and under the age of 50. Patients with severe OA had no difference in outcome.  

Sanchez, in 2012, revealed significant pain relief with PRP injections, but less effective for patients with moderate and severe OA. Filardo et al, in 2012, also noted better results in patients with earlier degree of OA. Patel et al, in 2013,  compared PRP to saline and found a significant difference with PRP. 

Therefore, Platelet Rich Plasma (PRP) injections have become a valid option in the treatment of osteoarthritis. The basic concept is that growth factors are extremely important in the tissue healing process and PRP injections provide high concentrations of these natural, patient’s own growth factors directly to the damaged area. Moreover, there have been no major adverse reactions reported aside from some swelling. There are still many aspects that need to be understood in order to maximize the benefits and provide even better treatment. 

Right now, there is a consensus that Platelet Rich Plasma (PRP) has clinical benefits in providing pain relief for patients with osteoarthritis (OA). There are laboratory and pre-clinical evidence that PRP promotes cell growth, increases cellular viability, and cartilage regeneration. Preliminary, it appears that it is the younger patients with early osteoarthritis (OA), that would benefit the most.

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