New hope for arthritic knees; PRP and other effective options.
PRP (Platelet Rich Plasma) is being wildly promoted to help heal and reduce pain in damaged muscle and tissue much more efficiently than with other methods. A recent study suggests that it is an effective treatment for knee pain in a mildly arthritic joint.
According to Wikipedia; “Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.”
Our office has had patients who claimed varying levels of success with this method after other methods of treatment failed to offer relief.
Is PRP cost effective and safe?
As with many medical procedures, PRP is expensive and is likely not covered by insurance, with many considering it investigational. While it is difficult to say how much it will cost you, one web site said the average cost per injection is between $500 and $700 per injection, with the high end being around $1000 (1). They justify the cost when compared to surgery which is more invasive and has been disproven as an effective way to manage arthritic knees, yet there is no guarantee of success. The method, since it uses elements from your own body has a good record of safety.
How does the procedure work?
According to a 2012 article in Kevin MD, a popular medical information site, “Platelets are part of your blood that are critical for clotting, but they also contain high levels of growth factors. It is thought that these growth factors are important in the healing process, which is why platelets are used. The procedure goes like this: the blood is taken from a vein (usually from the arm as if you’re giving blood) and placed into a centrifuge machine. The blood is spun in the machine until the platelets separate out from the other components of the blood. This layer of platelets is then injected into the injured tissue, preferably with ultrasound guidance.” (2)
As far as cost is concerned for the healthcare provider, they are minimal since the provider only needs to have a centrifuge, and should use an ultrasound when guiding in the platelet mixture to the injured area in question. The benefit of this procedure is that as long as guidelines are followed, the platelets are from your body and should not cause a problem of rejection.
The question is; what should you pay, how many injections do you need and is it worth the high price, considering the doctors markup is very high (A bad American tradition with most healthcare services). My suggestion is to not pay any more than you need to, since the method is basically the same from provider to provider. The diagnostic skill and appropriateness of where and when to recommend PRP may be the key to your success using this treatment.
Recent study showing effectiveness for the arthritic knee
A recent study from the O.A.S.I. Bioresearch Foundation, based in Italy shows that Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option. There is a significant reduction in pain and improvement in function after 12 months, which can be further improved at 18 months by annual repetition of the treatment. Although the beneficial effects are ill sustained at 2 years, the results are encouraging when compared to the pre-treatment function. (3)
In summary, if you have a mildly arthritic knee, a series of yearly injections using PRP has shown effectiveness in reducing knee pain and improving function. The question is of course, are you willing to spend $1500 or more for an expensive treatment that may not offer a long term solution to your knee pain?
Other more cost effective and reliable options you may wish to consider first.
Typically, patients respond to pain according to the where they feel it often visit providers who will look at the painful area, evaluate, diagnose and then offer a treatment option that may or may not relieve the problem based on your symptoms. Rarely, do most healthcare providers look beyond your symptoms because of the type of training they receive and their belief systems. This is why treatment is usually directed to relieving the pain rather than trying to find out what is stressing and damaging the joint. Most medical injections and medications work by offering relief only or affecting the pain only, and do not improve the mechanism that caused the problem in the first place. Most patients do not know the difference and just want the pain relieved, so when it is, they are satisfied without realizing that it increases the likelihood of a future knee or hip replacement as further damage ultimately is the end result. This author believes based on 30 years experience that most hip and knee replacements could be avoided with proper education, advice and biomechanical management by screening people mechanically when they are younger and by better evaluation processes at the primary care level.
In the case of the knee; a knee becomes arthritic or is damaged because something in the fascio kinetic chain (series of joints from the foot to the hip) is malfunctioning and needs to be properly evaluated first, before recommending a treatment. While treating the area of pain is what most people are comfortable with and accustomed to, treatment to the mechanism of knee pain is far more effective and may preserve and improve the way your knee feels and functions for years to come.
The book, Cheating Mother Nature, what you need to know to beat chronic pain is a great guide to understanding the malfunction that created and likely caused your knee to become arthritic (4). Often, the problem involves the feet, pelvis, hip joint and other parts of the body you wouldn’t regularly consider, yet, when the mechanism causing the stress to the knee is addressed, patients report they can do more, with less pain and have far fewer episodes of pain. Also, many of these same mechanisms are responsible for back pain, foot pain, plantar fasciitis and many other problems that are often considered normal by many patients (based on life experiences), even though in reality, there is no true normal, but a huge variety of body mechanics from the different gene pools we have descended from. Most people mistakenly believe conditions like these are the problem, although they are really the symptoms of poor mechanisms of movement within the body itself, which can be markedly improved with the appropriate approach to diagnosis and management.
A huge warning sign that the cause of your problem is being ignored is having many different conditions that come and go such as back pain, then knee pain, then foot, pain, then stiff necks as well as other musculoskeletal complaints. A more holistic approach to looking at why you are in pain will likely reduce the incidence of these occurrences of pain as the mechanism is properly addressed.
Normal for most of us is just what we are used to, since we are familiar with what our own bodies feel like when we do not hurt, which we consider normal. This may be confusing but consider this; by the age of 6 years old, we are walking the way we will and are likely feeling the way we will in the future. From here we get taller, womens hips get wider as they get taller (which is likely why they have more Fibromyalgia and other chronic pain and knee problems than men) and we consider the way we feel to be norm, without having anything else to compare this to.
Most sports chiropractors are experts at understanding the mechanisms behind why your knee hurts, since they are most likely to look beyond the obvious symptom of knee pain and stiffness and have a culture of holistic evaluation and care. If you had a lifetime history of many injuries including muscle pulls, knee pain, foot pain, strains and other problems, have you ever considered there may be a connection between your body style, inherited traits and all those painful injuries?
Should you consider PRP for yourself?
The real question is, do I treat the symptom or the problem? Since knee pain is a mechanical problem, doing stuff to it is likely not to be a satisfactory long term solution to resolving the knee problem of improving its function. While PRP is a relief option, you should consider seeing someone who will look beyond your symptoms and fix the mechanical problem behind your pain. Basically, you need a body mechanic. Most sports chiropractors are body mechanics, and are likely your best first option.
3. Gobbi A1, Lad D, Karnatzikos G. The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee.
Knee Surg Sports Traumatol Arthrosc. 2015 Aug;23(8):2170-7. doi: 10.1007/s00167-014-2987-4. Epub 2014 Apr 20.