A recently published article concluded that LR-PRP was better than LP-PRP or HA for knee arthritis in a cohort study with 3 treatment groups of 30 patients each.
Interesting because many of us believe that LP-PRP is the better choice for intra-articular applications because of less inflammatory reaction and less potential activation of the catabolic cascade. But there is still lack of consensus on this topic.
Diving into the article I notice that they only drew 25cc per injection and concentrated down to 3cc. The LR-PRP was 4.6X and the LP-PRP was only 1.9X……so maybe that by itself explains why the LR-PRP was better than LP-PRP in this study. Also, the platelet count averages were 1178 platelet count for LR-PRP and 478 platelet count for LP-PRP.
A cleaner study would be to leave the platelet concentration the same and just vary the leukocyte content in my opinion. This is why it is hard to put even good clinical research into widespread practice and why sometimes our studies create more questions than answers!
Based on Level 1 evidence in orthopedics, how much should a clinic charge for a PRP injection for knee osteoarthritis?We already know that PRP has been shown to work better and last longer than steroid or hyaluronic acid injections….that is a fact based on over 25 level 1 studies from around the world. Since PRP is not covered for knee arthritis in the USA, what should the doctor charge the patient?
A level 1 paper published in 2020 evaluated this question and determined that for an insurance company payor…PRP total cost (office visit, procedure, injectable supplies and product) should be less than $1192.08 per year to be cost effective compared to hyaluronic acid.
At the Texas Orthobiologics Institute we charge $650.
The FDA maintains a public website of their letters sent to companies in the orthobiologic field. Every company on this slide has received some form of FDA inquiry. Some of the offenses are more egregious than others with patients blinded or given tainted product resulting in septicemia and life threatening illnesses. The common factor? All used allograft orthobiologics like amniotic fluid, umbilical cord blood, Wharton’s Jelly, exosomes, or adipose (SVF); or delivered the orthobiologic in way (IV, intra-thecal, intra-ocular) or for a medical condition that had no human scientific evidence that it was safe or would work.
The level 1 evidence for using PRP for knee arthritis symptoms is overwhelming at this point. There are over 30 level 1 studies showing that PRP is better than a steroid injection, hyaluronic acid, and placebo with benefits that last at least out to 1 year! Why insurance companies will pay for steroid injections and hyaluronic acid injections but NOT PRP that works better and comes from your own body and lasts longer is anyone’s guess!
The video shows another example of the merging of orthobiologics and orthopedic surgery. Here I repair a troubling lateral meniscal tear with circumferential sutures and then augment the repair with platelet rich plasma injected at the menisco-capsular junction. Total surgery time for these arthroscopic cases is 30-45min. and includes a complete joint assessment. This patient has significant lateral compartment arthritis at a young age so he is likely not done with orthobiologic injections.
Interventional Orthobiologics Foundation is a multi-disciplinary nonprofit with a mission to provide evidence based, fellowship level, hands-on training in the clinical use of orthobiologics….from basic science to imaging guidance. At $400 per year for a physician membership and $300 per year for a non-physician membership, it is an affordable way to learn about the latest evidence based standards. There are beginner, intermediate, and advanced level courses that cover all orthopedic applications of orthobiologics.