Platelet-rich plasma (PRP) is a therapy which uses a component of a persons own blood to treat their osteoarthritis. PRP is a safe treatment which often gives significant benefit to people suffering from osteoarthritis including improvements in stiffness, pain and mobility.
PRP injections contain a high concentration of your own platelets. These platelets contain a large amount of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-), insulin-like growth factor (IGF), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF)1.
Table 1. Growth factors involved in tissue repair2.
These growth factors trigger tissue repair in our natural healing and recovery process. When a high concentration of these growth factors is introduced into the area of an injured or arthritic joint the healing process is jump-started.
Some research has suggested that PRP improves the integrity of the joint cartilage by increasing the amount of cartilage producing cells (chondrocytes) and by decreasing their rate of cell death (apoptosis)3. This would conceivably lead to a larger number of chondrocytes actively producing healthy cartilage within the joint and a healthier joint as a result.
PRP is prepared by drawing and centrifuging a small sample of your own blood on the day of treatment. A centrifuge is a device which rapidly rotates, spinning a blood sample at a high speed causing it to separate into layers based on weight. After centrifugation the blood sample separates into a top layer of plasma which is transparent yellow in color (mostly water with some dissolved proteins) and a bottom thick, red layer (red blood cells). At the junction of the plasma and red blood cell layers sits a dense concentration of platelets. This platelet-rich layer of the plasma is the portion of the blood which is collected and used for injection.
PRP is given by injection into the affected site or the site of injury. For example, in cases of tennis elbow the PRP injection is made at the site of the affected common extensor tendon on the elbow and in plantar fasciitis the injection is given at the site of the damaged plantar fascia insertion on the heel of the foot. In the case of osteoarthritis the injury includes two entire joint surfaces. An osteoarthritic joint is treated by injecting PRP into an affected joint space. Since a joint is a closed compartment the PRP fluid stays within the joint, coating the affected joint surfaces and exerting its effect on them through its rich concentration of growth factors.
Many studies have been performed on PRP injections for osteoarthritis and the results have been near-unanimously positive, showing a reduction in pain and improvement in mobility among the people receiving the treatment. In total, 54 studies have investigated PRP as a treatment for osteoarthritis and all 54 of these studies have found that this treatment was beneficial4-57.
Some research has found that 3 PRP injections, with 1 month between each injection, is more effective and gives longer lasting results than only one or two injections33.
Platelet-rich plasma vs hyaluronic acid
Most PRP for osteoarthritis research has been on the knee. To date 44 studies have examined PRPs effect on knee osteoarthritis while the hip has 4 studies, the temporomandibular joint has 3 studies, the ankle has 2 studies and the thumb has 1 study.
Figure 1. Number of studies (by joint) examining platelet-rich plasma for osteoarthritis. Most research performed on knee joint. Although the studies have yet to be done I have also seen good results with osteoarthritis of other joints including the shoulder, wrist and other hand joints.
PRP injection treatments are quite safe, having very little in the way of reported adverse effects58. While most treatments for pain involve a synthetic medication-based therapy, PRP simply uses a component of a persons blood. PRP therefore carries very little risk of causing an allergic reaction. The most common adverse effect of PRP is discomfort at the site of treatment for 1-3 days. This is a common reaction as the mechanism of action of PRP involves a short-term inflammatory phase after treatment which can contribute to discomfort temporarily. As with any injection there is a small chance of infection. There is also a small chance of allergic reaction to the local anesthetic (numbing agent) which is used at the site of the injection.
PRP treatment can provide lasting results for people with osteoarthritis including reduced pain and improved mobility. Typically 3 treatments will be required to attain maximum benefit from PRP. PRP injections can be done 2-4 weeks apart without issue.
PRP injections are a long-term solution for osteoarthritis. While this treatment gives long term benefit some people may experience discomfort following treatment for 1-3 days. In order to deal with this possible discomfort it is best to reduce physical activity after a PRP injection to avoid additional discomfort of the region which was treated. Applying ice to the affected area will not inhibit the effectiveness of the PRP treatment and may help if the treated area is achy or sore.
The treated body part should be rested on the day of treatment and if discomfort remains then 2-3 days of avoiding heavy activity may be required to assist in recovering. Anti-inflammatories such as aspirin, ibuprofen and naproxen in general should not be taken for 2-7 days after a PRP treatment as they could theoretically dampen its effectiveness. Generally acetaminophen (Tylenol) is preferable to anti-inflammatories in this short term to manage any discomfort or pain which may be present.
People with active cancer or active infection are not candidates for PRP treatment. People with thrombocytopenia (low platelets) and people on blood thinners can have PRP treatment but some changes to the treatment may be required.
Naturopathic Doctor at MacLeod Naturopathic
Dr. Colin is a naturopathic doctor practicing in Upper Tantallon in the Halifax Area. He was born and raised in rural Cape Breton and returned to Nova Scotia to practice after finishing his naturopathic education in Toronto. His practice focuses on pain management and maintaining health through physical activity and diet. He utilizes platelet-rich plasma, neural prolotherapy and acupuncture to keep his patients pain-free so that they can stay physically active, social and healthy.
Last updated October 9, 2018
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Platelet-Rich Plasma For Arthritis | Dr. Colin MacLeod ND
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