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Is Platelet-Rich Plasma (PRP) a Safe and Effective Treatment for Osteoarthritis of the Knee?

Overview

Key points

  1. Platelet-rich plasma (PRP) is an experimental treatment that may reduce pain from osteoarthritis.
  2. It involves using your own blood to treat damaged tissues.
  3. Early trials have shown promising results, but more research is needed.

Traditional methods of managing knee pain caused by osteoarthritis (OA) include anti-inflammatories, physical therapy, cortisone injections, and surgery. In the past decade, researchers have examined whether injections of platelet-rich plasma (PRP) can be used to manage OA of the knee.

Growth factors are found in platelets in your blood. PRP operates under the theory that injecting growth factors from the blood into an injured area will cause new tissues to form. That is supposed to reduce inflammation in the tissue. When growth factors interact with local cells, they signal them to initiate cell division and migration. This promotes tissue formation.

Keep reading to learn more about the PRP procedure, its effectiveness, and other treatment options you can use with or instead of PRP.

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Efficacy

How effective is PRP?

Despite its use, there has been conflicting evidence about the effectiveness of PRP in treating knee OA. A recent meta-analysis from 2017 reviewed 14 randomized controlled trials with a total of 1,423 participants. It found that PRP appears to be effective in managing pain associated with knee OA. Researchers noted that, compared with placeboes, PRP injections significantly reduced pain scores at 3-, 6-, and 12-month follow-ups. And compared with controls, PRP significantly improved physical function at these follow-ups. The study did not see a significant improvement in postinjection adverse events.

While those results are promising, 10 of the 14 studies in the meta-analysis were at high risk of bias and 4 were at moderate risk of bias. More studies are needed to determine the efficacy of using RPR to manage pain from OA of the knee.

Candidate

Who is a good candidate for this treatment?

You may be a good candidate for PRP if your symptoms of OA of the knee are not manageable through conventional methods such as anti-inflammatories, cortisone injections, and physical therapy.

PRP injections are considered experimental, however. That means that they may not be covered by insurance. It also means that there is limited research around the safety and effectiveness of this treatment. Work closely with your doctor before starting any experimental treatments.

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Preparation

How can someone prepare for PRP?

Ask your doctor about anything you should do or avoid doing prior to the treatment. Follow their guidelines. You will likely need to:

  • avoid taking anti-inflammatory medications seven days prior to PRP
  • have an MRI of your knee so your doctor can determine the extent of the damage
  • arrange to use crutches up to two days after the injection
  • have somebody drive you home

You should also contact your insurance provider before the procedure to see if they will cover any of the expenses. Because this is considered an experimental procedure, your insurance provider may not provide any coverage. Be aware of the costs beforehand so that you aren’t surprised. If your insurance provider won’t cover the costs, or if you are uninsured, talk to your doctor about arranging a payment plan.

Procedure

What happens during the procedure?

As part of the procedure, your doctor will draw blood from your arm. Then, they’ll put the blood sample into a centrifuge for 15 minutes. The centrifuge will separate your blood into:

  • red blood cells
  • white blood cells
  • plasma
  • platelets

Your doctor will use that sample to extract PRP. They will numb your knee and inject the RPR into the area. You’ll then rest about 15 minutes before being discharged.

The procedure will take about one hour.

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Recovery

What happens after the procedure?

After the procedure, ice your knee every 2 to 3 hours for 20 minutes each time. Continue this for three days. You may also need to take pain medication if you have significant pain. You’ll want to limit your physical activity and avoid activities that put weight on your knee. Your doctor may recommend using crutches for a few days to keep weight off of your knee.

Follow up with your physician 6 to 8 weeks after the procedure to assess the effectiveness. You can discuss possible next steps, as well.

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Risks

Are there risks?

PRP uses your own blood, so there’s a low risk of complications. However, there are some rare risks, including:

  • local infection
  • pain at the site of injection
  • nerve damage, most likely at the site of injection

Ask your doctor about symptoms that may signal a complication and what to do if you notice any signs.

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Other treatments

What are my other treatment options?

There are several other methods orthopedists recommend to manage pain associated with osteoarthritis. Most of these methods can be used with PRP.

Decrease OA pain
  • Apply ice and heat to the knee.
  • Work with a physical therapist to create a home exercise program. Follow your home exercise program as recommended.
  • Take over-the-counter anti-inflammatories, such as ibuprofen (Advil, Motrin), and pain-relieving medication, such as acetaminophen (Tylenol).
  • Consider using medical devices such as canes, braces, and shock-absorbing shoes.
  • Apply ointments prescribed by your doctor.
  • Talk to your doctor about corticosteroid (cortisone) injections or viscosupplementation.
  • In the most severe cases or ones with minimal improvement of symptoms, consider surgery.

Outlook

What’s the outlook?

PRP is a relatively low-pain, low-risk procedure that uses your own blood to stimulate growth in injured tissues. Recent evidence suggests that PRP may be an effective treatment in managing pain associated with knee osteoarthritis. However, better research is needed to show its benefits. You can use PRP with other pain management methods for knee OA. However, be aware that insurance companies vary in terms of coverage for PRP.

Article resources
  • Marx, R. E., Carlson, E. R., Eichstaedt, R. M., Schimmele, S. R., Strauss, J. E., & Georgeff, K. R. (1998, June). Platelet-rich plasma: Growth factor enhancement for bone grafts [Abstract]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology85(6), 638–646. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9638695
  • Pal, U. S., Mohammad, S., Singh, R. K., Das, S., Singh, N., & Singh, M. (2012, July-December). Platelet-rich growth factor in oral and maxillofacial surgery. National Journal of Maxillofacial Surgery, 3(2), 118–123. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700143/
  • Shen, L., Yuan, T., Chen, S., Xie, X., & Zhang, C. (2017, January 23). The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research12, 16. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260061/
  • Zhou, Y., Zhang, J., Wu, H., Hogan, M. V., & Wang, J. H-C. (2015). The differential effects of leukocyte-containing and pure platelet-rich plasma (PRP) on tendon stem/progenitor cells —Implications of PRP application for the clinical treatment of tendon injuries. Stem Cell Research & Therapy6(1), 173. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572462/
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