By: Dr. Brent Mollon
On behalf of Simcoe-Muskoka Orthopaedics
A new series of so-called ‘regenerative’ treatments are evolving in an attempt to stimulate the body’s natural healing process. Although we are frequently asked about ‘stem-cell’ therapies, most treatments designed to inject stem cells (bone marrow aspiration or adipose tissue harvest) remain clinically unproven and thus not recommended by our department.
In contrast, Platelet Rich Plasma (PRP) is a biologically active substance with increasing clinical evidence to support its use for several diseases of the musculoskeletal system.
What is PRP?
PRP is harvested from a patient’s own blood just prior to an injection. Through commercially available technology, blood is spun in a centrifuge to isolate the platelet layer. Platelets are a liquid substance found within the blood that contain many substances and growth factors required for healing of injury.1 Once isolated, the biologically active platelet layer is injected into the site of arthritis or injury to incite or augment a healing response.
Is PRP Treatment Effective?
The rationale behind PRP injections is supported by basic science research on cellular regeneration following injury.1,2 High quality clinical evidence continues to emerge to help determine which orthopaedic conditions may benefit from PRP. To date, available evidence suggests PRP injections may be beneficial in patients with mild to moderate osteoarthritis of the knee, as well as lateral epicondylitis of the elbow.3 PRP appears to be more effective than hyaluronic acid injections for osteoarthritis of the knee.4,5 Although PRP has been tried in muscular injuries, medial epicondylitis, ACL reconstructions, Achilles tendon injuries and rotator cuff injuries, available data does not support the use of these injections in these diseases.3
- Every Patient is Different: We see many patients seeking PRP therapy for diseases in which these injections have not been proven to work, or for cases with the arthritis is too severe to have any chance of success. Simply because someone you know benefited from these injections does not necessarily mean they will be helpful for you.
- Hydration: Prior to any injection, it is important that you are adequately hydrate and avoid excessive caffeine use so the maximal amount of blood (and thus PRP) can be extracted.
- Anti-Inflammatory Medications: some experts believe that anti-inflammatory medications will negatively impact the healing response. We believe the data behind this notion is poor, but still recommend that our patients avoid anti-inflammatory medications as a precaution.
- WADA: PRP is not prohibited by the World Anti-Doping Agency, as it is designed to return an athlete to their prior level of sport. However, the addition of substances to PRP that may be considered to produce ‘performance-enhancing’ benefits would be prohibited. Athletes considering PRP should consult with their team physician or coach prior to treatment.
As a newer therapy, PRP treatments are not covered by the Ontario Health Insurance Plan (OHIP) and are often not covered by independent insurance plans. The cost of most PRP injections ranges from $500-800 per injection depending on location and treating provider. As best available evidence suggests 2 or 3 injections (performed once a week) may be more effective than a single injection,5 this should be factored into treatment cost. As an example, we are able to provide PRP injections at $500 per injection to our patients, and recommend two injections separated by 7-10 days for a total treatment cost of $1000. As a patient, it is important that you are informed of total cost and your available insurance benefits when considering the investment in this treatment, should it be offered to you.
Anything Else I Should Know?
Although PRP injections are safe, any injection comes with it a small risk of infection. It is possible that the additional fluid injected into your knee joint or soft tissues causes local irritation, so an increase in pain may be anticipated for a few days following any injection. Redness, warmth, heat, and/or excessive swelling is not normal and should prompt a call to your doctor and/or a trip to the emergency room.
The field of regenerative injections or ‘orthobiologics’ will continue to expand at a fast pace. Often newer treatments are made available when high-quality clinical data is lacking. It is important that you are as informed as possible about any proposed treatment. Ask questions! Seek clarification if you do not understand! Being as involved as possible in the decision-making processes will go far in ensuring you get the best result possible – regardless of what ails you and what treatment is decided.
- Mollon B, Kandel R, Chahal J, Theodoropoulos J. The clinical status of cartilage tissue regeneration in humans. Osteoarthritis Cartilage. 2013;21(12):1824-1833.
- Sheth U, Simunovic N, Klein G, et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am. 2012;94(4):298-307.
- Hussain N, Johal H, Bhandari M. An evidence-based evaluation on the use of platelet rich plasma in orthopedics – a review of the literature. SICOT J. 2017;3:57.
- Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2015;49(10):657-672.
- Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):958-965.