Although we cannot use cultured stem cells in the USA currently, studies like this one suggest that the future of orthobiologics as a disease modifying (ie. restoring cartilage) therapy lies in much higher cell dosing than we can do in the same day procedures. With our same day procedures, most of our success is with symptom modifying (ie. decreasing pain).
We have an increasing volume of clinical evidence that PRP injections can offer some hope of pain relief even to patients with advanced knee arthritis.
It is up to the patient to decide on this treatment modality after discussing relevant surgical and nonsurgical treatment options with their orthopedic trained doctor.
What do you do when your doctor says surgery is the only way to relieve your knee pain? Or when physical therapy, painkillers, and ice don’t seem to be helping? You may want to consider orthobiologics.
You may have been told that knee replacement surgery is the only option available to you for the management of severe arthritis, or to handle the joint pain you are subjected to every day. Before settling for knee replacement, however, you should explore other options that may give you what you need with less risk, downtime, and cost.
Today I saw a middle aged patient with middle aged knee arthritis and he was looking for another option for arthritis pain relief. He had been to two seminars discussing umbilical cord blood, Wharton’s Jelly, Exosomes, and other regenerative medicine injections. His question for me: “How much cartilage will YOUR procedure grow back” Seems that he had been told that he would grow 1 inch of cartilage back at one seminar and about 0.5 inches at the other seminar. I found this funny and interesting and probably a bald faced lie…. because the upper range of normal human cartilage thickness in the knee is 3-4mm…….FAR less than the 25mm promised in one seminar and still far less that the 12mm promised in the other seminar.
Every patient wants to know the answer to this question. My answer is partly based on this publication by 4 authors including friend Aaron Calodney, MD. They published a comprehensive analysis in 2015 based on the best evidence currently available. After crunching the data from 24 included studies with a total of 2315 patients...the answer is....pain and function improved for 6 months and at 12 months pain and function scores were still better than preinjection scores. There was a wide range of products injected across these studies. Ongoing research since 2015 suggests that platelet counts above 1000 and total platelet doses above 5 billion give longer and better clinical outcomes.
The low concentration/lower doses of PRP still seem to help too, but for a shorter time.
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.
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.
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!
We are now enrolling patients with symptomatic knee arthritis into a clinical, nonsurgical study.
Please call the study coordinator if you are interested at 877-211-4471
There is no cost to be in the study!
