PRP for Joints - USA (2022)

PRP injections treat a list of orthopedic conditions including knee osteoarthritis but may be used on other joints as well.

Platelet-rich plasma therapy, sometimes called PRP therapy or autologous conditioned plasma (ACP) therapy, attempts to take advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles, or even bone.

Although not considered standard practice, a growing number of people are turning to PRP injections to treat an expanding list of orthopedic conditions, including osteoarthritis. It is most commonly used for knee osteoarthritis but may beused on other jointsas well.

Treating Osteoarthritis with PRP

When treating osteoarthritis with platelet-rich plasma, a doctor injects PRP directly into the affected joint. The goal is to:

  • reduce pain;
  • improve joint function;
  • possibly slow, halt, or even repair damage to the cartilage.

Platelet-rich plasma is derived from a sample of the patient’s own blood. The therapeutic injections contain plasma with a higher concentration of platelets than is found in normal blood.

What is plasma? Plasma refers to the liquid component of blood; it is the medium for red and white blood cells and other material traveling in the bloodstream. Plasma is mostly water but also includes proteins, nutrients, glucose, and antibodies, among other components.

What are platelets?

Like red and white blood cells, platelets are a normal component of blood. Platelets alone do not have any restorative or healing properties; rather, they secrete substances called growth factors and other proteins that regulate cell division, stimulate tissue regeneration, and promote healing. Platelets also help the blood to clot; a person with defective platelets or too few platelets will bleed excessively from a cut.

Platelet-Rich Plasma Injection Procedure

There is no universally accepted medical definition for “platelet-rich plasma,” so a PRP injection that one patient receives can be very different from that of another. Variations occur for many reasons, including:

Patient characteristics.Blood composition (e.g. number of platelets) can differ from patient to patient.

Processing of blood.How a patient’s blood sample is processed (e.g. centrifuged and filtered) affects the concentrations of platelets and white blood cells in a PRP injection.

(Video) Platelet-Rich Plasma (PRP) Injections | Q&A

Additives.Doctors may augment platelet-rich plasma with substances that are thought to enhance the PRP’s healing properties.

What does platelet-rich plasma therapy do?

Doctors who use PRP therapy to treat osteoarthritis suppose that the platelet-rich plasma might:

  • inhibit inflammation and slow down the progression of osteoarthritis;
  • stimulate the formation of new cartilage;
  • increase the production of natural lubricating fluid in the joints, thereby easing painful joint friction;
  • contain proteins that alter a patient’s pain receptors and reduce pain sensation.

PRP solutions can vary because they are made from patients’ blood, and each patient’s blood is a little different. In addition, different physicians have different approaches for formulating and preparing a PRP solution for injection.

How is platelet-rich plasma made?

The most common way to prepare PRP involves centrifuging a patient’s blood sample. A vial of blood is placed in a centrifuge, where it is spun at intensely high speeds. The spinning causes the blood to separate into layers:

  • Red blood cells, approximately 45% of blood, are forced to the bottom of the vial.
  • White blood cells and platelets form a thin middle layer, called a buffy coat, which comprises less than 1% of the centrifuged blood.
  • “Platelet-poor” plasma, or plasma with a low concentration of platelets, makes up the remaining top layer, about 55% of the centrifuged blood sample.

Once the centrifuge process is complete the doctor or medical technician will remove the vial from the centrifuge and prepare the PRP solution for injection.

Centrifugation speed and time can vary. Differences in centrifugation speed and time affect the composition of PRP. There is no clear consensus on what the centrifugation process produces the best results for treating osteoarthritis.

What is in a platelet-rich plasma injection?

All PRP injections are not the same. The exact make-up of platelet-rich plasma depends on several variables, including the concentration of platelets, the concentration of white blood cells, and the use of additives.

Concentration of Platelets

Normal blood has 150,000 to 450,000 platelets per microliter (μL), and the concentration of platelets in platelet-rich plasma can vary from 2.5 to 9 times that. Concentration levels depend on the individual’s blood, how much blood was drawn, the centrifuge process (e.g., rotation speed and duration), and other clinical preparation methods.

While it may seem logical that plasma with the highest possible platelet concentration will get better results than plasma with a lower platelet concentration, that is not necessarily the case. One lab study suggested that plasma with concentrations 2.5 times that of normal blood was ideal, and higher concentrations might actually limit new cell growth.

White Blood Cell Count

The immune system depends on white blood cells to fight infection, so experts suspect that white blood cells inhibit tissues’ ability to heal, promoting inflammation, scar tissue, and damage to nearby tissues.

(Video) PRP Price for Knee Osteoarthritis Research Paper Summary - Drew A. Lansdown, MD

As with the concentration of platelets, the concentration of white blood cells is determined by an individual’s blood as well as clinical preparation methods.

Additives

Some doctors mix additives into the platelet-rich plasma. These additives, called thrombin and calcium chloride, artificially activate the platelets, stimulate clotting, and may enhance platelet-rich plasma’s regenerative properties.

PRP for Joints - USA (1)

Platelet-Rich Plasma Injection Procedure

Researchers studying PRP and osteoarthritis often work with patients who have knee osteoarthritis, a condition that experts estimate will affect nearly half of all Americans at some point during their lives. Two clinical studies that examine PRP to treat knee arthritis are described below.

One study, published in 2013, involved 78 patients with osteoarthritis in both knees (156 knees). Each knee received one of three treatments: 1 PRP injection, 2 PRP injections, or 1 placebo saline injection. Researchers evaluated the subjects’ knees 6 weeks, 3 months, and 6 months after injection. Researchers found:

Knees treated with 1 or 2 PRP injections saw a reduction in pain and stiffness as well as improvement in knee function at 6 weeks and 3 months.

At the 6-month mark, positive results declined, though pain and function were still better than before PRP treatment.

The group that received placebo injections saw a small increase in pain and stiffness and a decrease in knee function.

The platelet-rich plasma used in this clinical study had 3 times the platelet concentration of normal blood and had been filtered to remove white blood cells.

A second, smaller study examined patients who had experienced mild knee pain for an average of 14 months. Each arthritic knee underwent an MRI to evaluate joint damage and then received a single PRP injection. Patients’ knees were assessed at the 1 week, 3 month, 6 month, and 1-year marks. In addition, each knee underwent a second MRI after one year. Researchers found:

(Video) MoraMD: Platelet Rich Plasma (PRP) for Knee Arthritis: Live injection with Dr Steve Mora

One year after receiving a PRP injection, most patients had less pain than they did the year before (though the pain had not necessarily disappeared).

MRIs showed that the degenerative process had not progressed in the majority of knees.

While knee cartilage did not seem to regenerate for patients, the fact that arthritis did not worsen may be significant. Evidence suggests that an average of 4 to 6% of cartilage disappears each year in arthritic joints.

Platelet-rich plasma injections are outpatient procedures. Because the patient’s blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.

Knee Injection

Whether the patient has a one-time injection or a series of injections spaced over weeks or months is up to the individual patient and doctor. If a series of injections is planned, a doctor may recommend single blood draw during the first visit and use fresh PRP in the first injection and freezing and thaw the remaining PRP as needed for future injections. However, some experts believe freezing and thawing PRP negatively affects its usefulness and prefer to do a separate blood draw for each PRP injection.

Pre-Injection Precautions

The American Academy of Orthopaedic Surgeons recommends patients adhere to the following pre-injection guidelines:

  • avoid corticosteroid medications for 2 to 3 weeks prior to the procedure;
  • stop taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or arthritis medications such as Celebrex, a week prior to the procedure;
  • do not take anticoagulation medication for 5 days before the procedure;
  • drink plenty of fluids the day before the procedure;
  • some patients may require anti-anxiety medication immediately before the procedure.

Platelet-Rich Plasma Injections, Step-by-Step

This is an in-office procedure that involves a blood draw, preparation of the PRP, and the injection:
Blood is drawn from a vein in the patient’s arm into a vial (typically 15 to 50 mL or less than 2 ounces of blood is needed).

The blood is processed using a centrifuge machine.

A doctor or technician prepares the centrifuged platelet-rich plasma for injection.

The affected joint area is cleansed with disinfectants such as alcohol or iodine.

(Video) Do PRP Injections For Arthritis Actually Work. What Does The Science Say

If ultrasound is being used, a special gel will be applied to an area of skin near the injection site. An ultrasound probe will be pressed against the gel-covered skin. A live image of the joint will be projected on-screen for the doctor to see.

The patient is asked to relax; this will facilitate the injection and also can make the injection less painful.

Using a syringe and needle, the doctor injects a small amount (often just 3 to 6 mL) of platelet-rich plasma into the joint capsule.

The injection area is cleaned and bandaged.

The platelet-rich plasma typically stimulates a series of biological responses, and the injection site may be swollen and painful for about 3 days.

After the PRP Injection: Immediate Follow-up Care

Patients are advised to take it easy for a few days and avoid putting a strain on the affected joint.
Doctors may require or suggest that a patient:

does not take anti-inflammatory pain medication; another pain medication may be prescribed by the doctor;
wears a brace or sling to protect and immobilize the affected joint; a patient who receives an injection at the ankle, knee, or hip may be advised to use crutches;
uses a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling.

See When and Why to Apply Cold to an Arthritic Joint

Patients who do not have physically demanding jobs can usually go back to work the next day. Patients can resume normal activities when swelling and pain decreases, typically a few days after the injections. Patients should not begin taking anti-inflammatory medications until approved by the doctor.

If there are some additional questions still left pleaseget in touchwith us to get a free qualified consultation!

FAQs

PRP for Joints - USA? ›

Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient's own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient's own healing system to improve musculoskeletal problems.

Is PRP effective for joints? ›

Researchers found: Knees treated with 1 or 2 PRP injections saw a reduction in pain and stiffness as well as improvement in knee function at 6 weeks and 3 months. At the 6-month mark positive results declined, though pain and function were still better than before PRP treatment.

Is PRP FDA approved 2020? ›

PRP is not FDA-approved but it can be legally offered 'off-label' for musculoskeletal conditions including muscle strains and soft tissue injuries. Texas Orthopedics physicians may recommend PRP injections for certain injuries, arthritis, or after surgery to aid in your recovery.

Is PRP worth the money? ›

In our experience, PRP micro-needling has been worth it for most of our patients. Although it is not as effective as hair transplants, and you can save a bit of money trying less intrusive treatments like Rogaine and Propecia, PRP can still help reverse the devastating effects of premature hair loss.

How long does it take for PRP to work on joints? ›

PRP can be injected deep into joints to reach ligaments and attachment points on tendons with no immobilization required. This improves patient outcomes considerably, with most patients finding results within 4 weeks.

Can PRP regenerate cartilage? ›

The PRP accelerates and boosts healing, so your body can actually repair significant amounts of damage that it can't handle by itself. Research has shown that PRP can actually help you regenerate cartilage that's been degraded by osteoarthritis or rheumatoid arthritis.

Can PRP reverse arthritis? ›

PRP injections might preserve the cartilage that you have left within your knee. PRP injections appear to improve your quality of life and may enable you to put off further consideration of surgery as an alternative treatment. BUT, PRP injections have NOT been shown to reverse or cure the arthritis, yet.

Is PRP legal in USA? ›

Summary. While PRP is not 'FDA-approved', it can be legally offered in the clinic 'off-label' in the USA for a myriad of musculoskeletal indications.

Is PRP covered by insurance 2021? ›

Most insurance providers do not cover it at all. Clinics that offer PRP consider it a “fee for service” type of treatment. The main reason insurance companies are reluctant, at the present time anyway, to cover the treatment is that there has not been enough testing.

Does PRP help arthritic knees? ›

Platelet-rich plasma (PRP) is a concentrate of autologous blood growth factors. PRP has been shown to provide some symptomatic relief in knee osteoarthritis. To date, this intervention has been largely delivered in hospital settings. This study has shown that it is feasible to deliver PRP therapy in primary care.

Who should not get PRP? ›

While PRP is considered safe for most people, it's not recommended for anyone who has one of the following medical conditions: Hepatitis C. HIV or AIDS. Any type of blood cancer.

Is PRP better than cortisone? ›

Cortisone Injections have immediate pain relief but is primarily a temporary solution. With PRP on the other hand, it offers not only pain relief but also tissue regeneration and healing but has a longer healing and pain relief time.

How many times can you have PRP injections? ›

You may require up to three PRP injections within a six-month period, usually performed two to three weeks apart, but you may be able to achieve significant to complete relief after the first or second shot. Symptom improvement is said to gradually increase as your healing progresses.

What is the success rate of PRP injections? ›

While there is no consensus on the exact success rate of PRP injections for hair restoration, it sits between 70-90% for the average patient. It tends to work better in younger patients beginning to experience the effects of genetic hair loss and thinning.

Why is PRP so painful? ›

PRP therapy takes time to work. It is not like a steroid shot that will make you feel better right away. You may feel more pain at first, since we are causing swelling in the area that was already sore. The swelling is needed for the blood cells to start helping you heal for the long term.

Does PRP last forever? ›

The effects of PRP are not permanent but effects can last up to 18 months in an average with a maximum of 2years as the longest reported effect. However, most may resort to a re-touch of the treatment once a year.

How can I rebuild my knee cartilage naturally? ›

Stretch as often as possible. A simple stretch can help prevent stiffness in your joints and lubricate and nourish the cartilage with synovial fluid. Stretch exercises like yoga and pilates can help alleviate the symptoms of osteoarthritis and also strengthen your muscles to prevent further joint injury.

Can I regrow cartilage in my knee? ›

Cartilage Regeneration Options

MACI is a surgical procedure that uses cartilage-forming cells from your body to restore damaged cartilage in the knees. It involves a biopsy to harvest chondrocytes (cartilage-forming cells), which are allowed to multiply in a lab, and surgery to implant them into the damaged area.

Can PRP regrow knee cartilage? ›

PRP takes advantage of the bloods natural healing properties to repair damaged cartilage in the knee and reduces pain, inflammation, and improve joint function.

Do PRP injections work for cartilage? ›

Lab studies have shown that PRP can modulate the repair and regeneration of repaired cartilage within the joint. It causes stem cells to migrate to the area of damage where they can proliferate (increase in number) and differentiate (change into cartilage cells).

Is PRP good for osteoarthritis? ›

Recent research into the applications of PRP for KOA has further indicated both the efficacy and safety of PRP treatment. Although research has shown a tendency toward better efficacy at earlier stages of osteoarthritis (OA), evidence exists to indicate positive effects at all stages of OA.

How many PRP injections are needed for knee? ›

For most applications, I recommend starting with a series of three injections and usually spread those out by a week or a week and a half. We do that because most of the studies for treating arthritis with PRP were done with a series of three injections. These studies show that to be the most effective protocol.

Why is PRP not FDA approved? ›

Since PRP is a substance derived from one's own blood, it is not considered a drug. FDA clearance means that doctors can prescribe and administer PRP if they believe it's in the best interest of the patient. However, lack of the FDA approval means that PRP treatments may not be covered by insurance.

When was PRP approved by the FDA? ›

The processes are very similar and each one combines the whole blood with an anti-coagulant before placing it in a centrifuge. It is important to note that both the buffy coat” and the PRP method have been FDA-approved ways of preparing PRP since 2009.

Is PRP covered by Medicare 2022? ›

Platelet-Rich Plasma Injection is not covered under Medicare.

Is Prolotherapy a hoax? ›

Prolotherapy is an alternative treatment, which means it's not regulated by the U.S. Food and Drug Administration (FDA). Experts have found that it can benefit some people in certain situations, but it's still not universally accepted because research has found inconclusive results.

Can PRP cause blood clots? ›

Blood Clot

Because a PRP injection uses a needle (guided by a sonogram) there is a chance that a artery or vein could be damaged. If that happens a blood clot occurs and is treated like any normal clot.

Does Medicare pay for PRP? ›

Currently, the Centers for Medicare & Medicaid Services (CMS) reimburses autologous PRP only for patients who have chronic nonhealing diabetic, pressure, and/or venous wounds when the patient is enrolled in an approved clinical research study.

Is stem cell therapy better than PRP? ›

Stem Cell Therapy is a more advanced treatment compared to PRP Therapy. PRP Therapy recruits growth factors in the injured area to aid in healing. Stem Cell Therapy not only does the same thing that PRP offers, which is initiating the body's repair response, it also enhances stem cell activity for regeneration.

Can I walk after PRP injection? ›

Rest for the first 24-48 hours, but do not lie sedentary. We encourage light movement and range of motion after your injections. Use crutches or a walker for a lower extremity joint, and a sling if necessary for shoulders. You should gradually increase activities using discomfort as a guideline.

Can PRP replace knee replacement? ›

While it doesn't regrow new cartilage, researchers say that the use of PRP might delay its loss, raising the prospect that patients might be able to avoid knee replacement surgery if they are treated early enough.

What can go wrong with PRP? ›

The main risks include local infection (< 1% chance) and pain at the site of injection. Injection of non-buffered PRP (which is acidic) tends to be very painful, thus we add a small amount of sodium bicarbonate to the solution to neutralize the pH, which seems to alleviate much of the pain associated with injection.

Who is good candidate for PRP? ›

James Nassiri may recommend PRP to patients who experience chronic pain associated with the joint degeneration caused by osteoarthritis or those who have recurring soft-tissue injuries. Some of the most common ailments our office treats with PRP include: Knee pain caused by arthritis.

What is PRP treatment for arthritis? ›

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge machine to separate the platelets from the red blood cells. In the case of knee OA, the collected platelets are then injected into the knee to stimulate healing and regeneration.

What is the best injection for knee pain? ›

Cortisone and hyaluronic injections are commonly used for fast, temporary relief from knee osteoarthritis pain. Cortisone injections may begin working within 24 hours of the injection, and the effects of a cortisone injection typically last between 6 weeks to 6 months.

What is the new injection for knee pain? ›

The FDA has approved a single-injection hyaluronic acid gel (Durolane – Bioventus) and an extended-release (ER) formulation of the synthetic corticosteroid triamcinolone acetonide (Zilretta – Flexion) for intra-articular (IA) treatment of osteoarthritic knee pain.

Is a PRP injection a steroid? ›

Yes, they're a form of steroids, and no, they won't get you suspended for half an MLB season if you're caught using them as they are not anabolic steroids. They're used due to the extremely potent anti-inflammatory properties they possess, and are commonly recommended to patients who have severe joint pain.

How long does PRP stay in your system? ›

How long does platelet-plasma last? Platelet-rich plasma lasts anywhere from six and nine months, during which time it will continue to aid in healing the soft-tissue injury.

Can I drink coffee after PRP? ›

Do not use any lotions, creams, or make-up for at last 24 hours after your treatment. AVOID: vigorous exercise, sun and heat exposure for 5 days post treatment. MINIMIZE: Alcohol, caffeine, and cigarettes for 2 days before and after treatment.

Does PRP help shoulder arthritis? ›

Using PRP for shoulder arthritis, like in the knee, can be very effective and help mitigate the symptoms, including the pain, inflammation, swelling. PRP shoulder treatments can help slow down the progression of arthritis by protecting the cartilage still there.

How many PRP sessions are needed? ›

PRP therapy is a three-step process. Most PRP therapy requires three treatments 4–6 weeks apart. Maintenance treatments are required every 4–6 months.

What should I avoid after PRP? ›

Avoid applying ice or heat at the site for three days after your injection. Do not apply lotions, oils, or makeup to the injection site for six hours. Avoid strenuous activities and exercise for three days after. Do not smoke or consume alcohol for at least three days post-procedure.

Do knee PRP injections hurt? ›

In general, PRP injections are not painful. This may vary by the patient or by the area of the body in which the injection is being made. Your doctor may recommend a local anesthetic to manage this discomfort. General anesthesia typically is not used in conjunction with PRP therapy.

Does PRP reduce inflammation? ›

PRP has anti-inflammatory properties; it decreases the inflammation and accelerates the healing process.

Does PRP need to be repeated? ›

PRP, as performed in my office, is usually successful after one procedure and is repeated every 9-15 months.

Does PRP help hip arthritis? ›

Platelet-rich plasma (PRP) can be an excellent choice for treating hip arthritis. PRP can stop cartilage degeneration in its tracks, and enhance your body's natural regenerative capabilities to create new cartilage tissue, improve function, and reduce pain.

Is a PRP injection painful? ›

Generally speaking PRP injections are not painful; however, the discomfort level depends on the part of the body being treated. Injections into the joint are of minimal discomfort.

Does PRP help with bone on bone? ›

Osteoarthritis: Also known as the wear-and-tear disease, osteoarthritis gradually deteriorates the cartilage in your joints. This results in inflammation, damaged tissues, and painful bone-on-bone contact. PRP reduces the swelling, regenerates tissues, lubricates the joint, and alleviates your pain.

Is PRP worth it for knee arthritis? ›

Overall, 60% of patients had good outcomes with PRP and less knee pain. Another study suggests a 70% improvement in knee pain after PRP treatments. In one paper – long-term meaningful results were seen in 85% of patients in knee pain after PRP treatments.

Does PRP work for knee cartilage? ›

PRP injections reduce inflammation and provide a local healing of the knee cartilage. Thus, PRP can reduce knee pain and increase activity level of the patient. PRP has been praised by professional athletes like Tiger Woods, who have gone through PRP injection therapy to help him recover from an injured knee.

How many PRP injections are needed for knee? ›

PRP can be effective in relieving pain and function in patients with early osteoarthritis by decreasing the inflammation in the knee and by promoting restoration of damaged cartilage. If PRP treatment is being administered, three consecutive PRP injections spaced two weeks apart gives the best results.

Is PRP covered by insurance 2021? ›

Most insurance providers do not cover it at all. Clinics that offer PRP consider it a “fee for service” type of treatment. The main reason insurance companies are reluctant, at the present time anyway, to cover the treatment is that there has not been enough testing.

Why is PRP so painful? ›

PRP therapy takes time to work. It is not like a steroid shot that will make you feel better right away. You may feel more pain at first, since we are causing swelling in the area that was already sore. The swelling is needed for the blood cells to start helping you heal for the long term.

Can PRP regenerate bone? ›

Furthermore, platelet-rich plasma (PRP), which can be easily isolated from whole blood, is often used for bone regeneration, wound healing and bone defect repair. When stem cells are combined with PRP in the presence of GFs, they are able to promote osteogenesis.

Videos

1. PRP injection Knee Arthritis: why platelet rich plasma treatment works
(Jeffrey Peng MD)
2. How Many PRP Injection for KNEE Pain Due to Arthritis?
(Jeffrey Peng MD)
3. Why one shot of PRP may not help knee pain - Comprehensive vs. one-shot methods
(Caring Medical)
4. How PRP Therapy Can Help Treat Knee Pain & Arthritis
(Warner Orthopedics & Wellness)
5. Do PRP and stem cell injections work?
(Talking With Docs)
6. PRP for Hip Arthritis - A Run-down with Dr. John Pitts
(Chris Centeno, M.D.)

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