Plat

elet
-r
ichplasmat her
apy,someti
mescal l
edPRPt her
apyorautologouscondi
tionedplasma
(ACP)therapy
, att
emptstotakeadvantageoftheblood'
snatur
alheali
ngpropert
iestorepair
damagedcar t
ilage,t
endons,l
igaments,muscl
es,orevenbone.

SeeWhatAr
eSt
em Cel
l
s?

.
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
.

Alt
houghnotconsi der
edstandar
dpr act
ice,agrowi
ngnumberofpeoplearet
urni
ngtoPRP
i
nject
ionstotreatanexpandingl
istoforthopedi
ccondi
ti
ons,
incl
udingost
eoart
hri
ti
s.I
tismost
commonl yusedforkneeosteoar
t hr
it
is,
butmaybeusedonot herjoi
ntsaswel
l.

Kneei
nject
ioni
l
lust
rat
ionSav
e

Thisart
icl
edescri
beshowexpert
sthinkPRPworks,whomightconsiderPRPi nj
ect
ionsf
or
osteoar
thr
iti
s,howtochooseadoctor,
andthei
nject
ionpr
ocedure.Alsodi
scussedisthe
avail
abl
eresearchexami
ningwhet
herPRPisanef f
ecti
vet
reat
mentf orosteoart
hri
ti
s.

Whentreat
ingost
eoart
hri
ti
swit
hpl
atel
et-
ri
chpl
asma,
adoct
ori
nject
sPRPdi
rect
lyi
ntot
he
af
fect
edjoint
.Thegoali
sto:

Reducepai
n

I
mpr
ovej
ointf
unct
ion

Possi
blysl
ow,
hal
t,orev
enr
epai
rdamaget
ocar
ti
lage

Pl
atel
et-r
ichpl
asmaisder
ivedfr
om asampl eofthepat
ient'
sownblood.Thetherapeut
ic
i
nject
ionscont
ainpl
asmawi t
hahigherconcent
rati
onofplatel
etst
hanisfoundinnormalbl
ood.

Whatisplasma?Plasmar ef
erstothel i
qui
dcomponentofblood;
iti
st hemedi
um forr
edand
whit
ebloodcell
sandot hermateri
altravel
i
nginthebloodstr
eam.Plasmaismostl
ywaterbut
al
soincl
udesprotei
ns,nutri
ent
s,glucose,andanti
bodies,
amongothercomponent
s.

Whatarepl
atel
ets?Li
ker
edandwhit
ebloodcell
s,pl
atel
etsareanormalcomponentofbl
ood.
Pl
atel
etsal
onedonothaveanyr
est
orat
iveorheal
ingproper
ti
es;r
ather
,theysecr
ete
substancescalledgrowthfactor
sandot herpr
otei
nsthatr
egulat
ecel
ldivi
sion,st
imulat
etissue
regenerat
ion,andpromot eheali
ng.Pl
atelet
salsohel
pthebloodtocl
ot;
aper sonwithdefecti
ve
plat
eletsortoof ewplat
elet
swi l
lbl
eedexcessivel
yfr
om acut.

Thereisnouniversal
l
yaccept
edmedi
caldefi
nit
ionf
or“pl
atel
et-
ri
chplasma,”soaPRPinj
ect
ion
thatonepati
entrecei
vescanbev
erydi
ff
erentthant
hatofanother
.Vari
ati
onsoccurf
ormany
reasons,
incl
udi
ng:

Pat
ientchar
act
eri
sti
cs.Bl
oodcomposi
ti
on(
e.g.numberofpl
atel
ets)candi
ff
erf
rom pat
ientt
o
pat
ient
.

Pr
ocessi
ngofblood.Howapati
ent'
sbloodsampl
eispr
ocessed(
e.g.centr
ifugedandf
il
ter
ed)
af
fect
stheconcentr
ati
onsofpl
atel
etsandwhi
tebl
oodcel
l
sinaPRPi nject
ion.

Addit
ives.Doct
orsmayaugmentpl
atel
et-
ri
chpl
asmawi
thsubst
ancest
hatar
ethoughtt
o
enhancethePRP'sheal
i
ngproper
ti
es.

HowPRPpr oducti
onandcomposit
ionaf
fectsthet
herapy'
seffecti
venessisnotwel
lunder
stood.
Unt
ilmoreresear
chisdone,
pati
ent
sconsideri
ngplat
elet
-r
ichplasmat her
apyshoul
dtaketi
me
tol
earnwhatisknownaboutPRP.

WhatDoesPl
atel
et-
RichPl
asmaTher
apyDo?

Exper
tsareunsureexact
lyhowPRPther
apymayallevi
atesymptomsf orcer
tainor
thopedic
condi
ti
ons.Doctor
swhousePRPt her
apytot
reatosteoart
hri
ti
stheor
izethatthepl
atel
et-r
ich
pl
asmami ght:

I
nhi
biti
nfl
ammat
ionandsl
owdownt
hepr
ogr
essi
onofost
eoar
thr
it
is1

St
imul
atet
hef
ormat
ionofnewcar
ti
lage2

I
ncr
easethepr
oduct
ionofnat
ural
lubr
icat
ingf
lui
dint
hej
oint
,ther
ebyeasi
ngpai
nful
joi
nt
f
ri
cti
on3

Cont
ainpr
otei
nst
hatal
terapat
ient
'spai
nrecept
orsandr
educepai
nsensat
ion4,
5

I
tcouldbethatplat
elet
-r
ichplasmadoesal
loft
hesethi
ngs,
ornone.
5Mor
elar
ge-
scal
e,hi
gh-
qual
i
tycli
nical
studiesareneededbef
oresci
ent
ist
scanknow.
PRPsol uti
onscanvar
ybecauset heyaremadef rom pat
ients'
blood, andeachpati
ent
'sbloodi
s
alit
tl
edi f
fer
ent.I
naddit
ion,
diff
erentphysi
cianshavedif
ferentapproachesf orf
ormul
ati
ngand
prepar
ingaPRPsol ut
ionforinj
ecti
on.Asoft hedateofthi
sarticl
e,therearenoconsi
stent
guidel
i
nesf oruseoft
hisinj
ecti
ont otr
eatosteoart
hri
ti
s.

SeeOst
eoar
thr
it
isTr
eat
ment

Thefol
l
owingexpl
ainswhati
scur
rent
lyknownabouthowPRPsol
uti
oni
smadeand
component
softheformul
a.

Redbl
oodcel
l
s,appr
oxi
mat
ely45%ofbl
ood,
aref
orcedt
othebot
tom oft
hev
ial
.

Whit
ebloodcel
l
sandplatel
etsf
orm at
hinmi
ddl
elay
er,
cal
l
edabuf
fycoat
,whi
chcompr
ises
l
essthan1%ofthecent
ri
fugedbl
ood.

"
Plat
elet
-poor"plasma,
orplasmawithal
owconcentr
ati
onofpl
atel
ets,
makesupt
her
emai
ning
t
oplayer
, about55%ofthecentr
if
ugedbl
oodsample.

Oncet
hecent
rif
ugeprocessiscomplet
ethedoctorormedicalt
echni
cianwi
l
lremov
ethev
ial
fr
om t
hecent
ri
fugeandpreparethePRPsolut
ionfori
nject
ion.

Centr
if
ugati
onspeedandti
mecanv ar
y.Di
ffer
encesi
ncentr
if
ugati
onspeedandti
meaf fectt
he
composit
ionofPRP.Ther
ei snocl
earconsensusonwhatcent
ri
fugat
ionpr
ocessproducesthe
bestr
esult
sfortr
eat
ingosteoar
thr
it
is.

WhatI
sinaPl
atel
et-
RichPl
asmaI
nject
ion?

All
PRPinjecti
onsarenotthesame.Theexactmake-upofplat
elet
-r
ichpl
asmadependson
sever
alvar
iabl
es,i
ncludi
ngtheconcent
rat
ionofpl
atelet
s,t
heconcentrat
ionofwhi
tebl
oodcel
l
s,
andtheuseofaddit
ives.

Concent
rat
ionofpl
atel
ets

Normalbloodhas150, 000to450,
000plat
elet
spermicrol
i
ter(μL),andtheconcent
rati
onof
pl
atel
etsinplatel
et-
richpl
asmacanvaryfrom 2.
5to9timesthat.1Concentr
ati
onlevelsdepend
ontheindiv
idual'
sblood,howmuchbloodwasdr awn,
thecentri
fugeprocess(e.
g.,
rotati
on
speedanddur
ati
on)
,andot
hercl
i
nical
prepar
ati
onmet
hods.

Whil
ei tmayseem l
ogical
thatplasmawi t
ht hehighestpossi
blepl
ateletconcentr
ati
onwill
get
bet
terresul
tsthanpl
asmawi t
hal owerplateletconcent
rati
on,t
hatisnotnecessaril
ythecase.
Onelabstudysuggest
edthatplasmawi thconcent r
ati
ons2.5ti
mest hatofnormal bl
oodwas
i
deal,andhi
gherconcentr
ati
onsmi ghtactuall
ylimitnewcellgr
owth.2Mor eresear
chisneeded
i
nthisarea.

Whi
tebl
oodcel
lcount

Thei mmunesy stem dependsonwhi tebloodcellstof

ighti
nfect
ion,butthecell
s'roleinPRP
therapyisunclear.Someexper tssuspectthatwhi t
ebl
oodcellsi
nhibitti
ssues'abil
i
tytoheal,
perhapspr omot i
nginfl
ammat i
on,scart
issue,anddamaget onearbytissues.
3Ot herexpert
s
thi
nkt hat,
whilewhi tebloodcell
smaynotai dt i
ssueheali
ng,t
heyhav enonegat i
veef f
ects,
or
mayhav ebeneficial
effects.

SeeSt
em Cel
lTher
apyf
orAr
thr
it
is

Aswit
htheconcent
rat
ionofplat
elets,
theconcentr
ati
onofwhit
ebl
oodcel
l
sisdet
ermi
nedby
ani
ndivi
dual
'
sbloodaswellascli
nicalpr
eparat
ionmethods.

Addi
ti
ves

Somedoct or
smi xadditiv
esintotheplat
elet
-r
ichplasma.Theseaddi
ti
ves,
cal
l
edthrombi
nand
cal
cium chl
ori
de,arti
fi
ciall
yacti
vatethepl
atel
ets,sti
mulat
eclot
ti
ng,andmayenhancepl
atel
et-
ri
chplasma’sregenerat
ivepropert
ies.

Futur
eresearchmayshowt hatthepr
eparati
onandcomposi ti
onofplatel
et-
ri
chpl
asmashoul
d
betai
lor
edf orspeci
fi
cmedicalcondi
ti
ons.Forexample,one"reci
pe"maybebestsui
tedf
or
tr
eati
ngosteoarthr
it
iswhi
l
eanot heri
soptimalf
ortreat
ingtendonit
is.

Unt
ilgui
del
i
nesar
eest
abl
i
shed,
var
iat
ionsi
nPRPpr
epar
ati
onar
eupt
othei
ndi
vi
dual
doct
or.

adv
ert
isement
Cl
assi
fyi
ngPRPf
ormul
as

Becauset hepreparati
onandingredientsofPRPi njecti
onsar esovariabl
e,iti
sdiffi
cultto
evaluatePRP'seffi
cacy.Tothatend, somesci entistshavecal l
edforaclassifi
cati
onsy st
em to
dist
inguishbetweenv ari
ousfor
mul ationsofplatelet-r
ichplasma.4Suchasy stem couldhel
p
researchersf
igureoutwhetherthesedi ff
erencesmat terand,ifso,whatpreparati
onand
formulati
onofplatelet
-ri
chpl
asmawor ksbest.

PRPhasbeenusedi nsurgeri
estopr omotecel l
regenerationsince1987,1,2andagr owingbody
ofevi
denceshowsi tisav i
abletreatmentfortendinosi
s.3-6Notuntilrecently
,though,
have
exper
tsresearchedanddebat edwhet herornotplatel
et-
richplasma( PRP)i nj
ecti
onsarean
eff
ect
ivetreat
mentf orosteoart
hrit
is.

Kneei
nject
ioni
l
lust
rat
ionSav
e

SeeOst
eoar
thr
it
isTr
eat
ment

Nearlyal
loftheresear
chinvest
igat
ingt
heuseofPRPtotr
eatosteoar
thr
iti
sandothercart
il
age
defectshasbeendonesince2000,andthev
astmajor
it
yofresear
charti
clesont
het opi
chave
beenpublishedsi
nce2010.

SeeWhatI
sCar
ti
lage?

NotallstudiessupporttheuseofPRPtotreatosteoart
hri
ti
s;however,
exper
tswhohav
e
r
eviewedt heexisti
ngbodyofr esear
chbel
i
ev etheevidencei
slargel
yencour
agi
ngandmer
it
s
f
urtherinvesti
gati
on.7-9

SeeSt
em Cel
lTher
apyf
orAr
thr
it
is

adv
ert
isement

KneeOst
eoar
thr
it
isTr
eat
edwi
thPRP
Researchersstudyi
ngPRPandost eoar t
hrit
isoft
enworkwithpati
ent
swhohav eknee
osteoart
hri
tis,acondit
iont
hatexpertsestimatewil
laff
ectnear
lyhal
fofallAmericansatsome
pointduri
ngt hei
rli
ves.
10Twocl i
nicalstudi
esthatexaminePRPtotreatkneeart
hrit
isar
e
descri
bedbel ow.

Onest udy,
publi
shedin2013,invol
ved78pat i
entswithosteoart
hrit
isinbot
hknees(156
knees).11Eachkneerecei
vedoneoft hr
eet r
eatments:1PRPi nject
ion,2PRPinj
ect
ions,or1
placebosali
neinj
ecti
on.Researcher
sevaluatedthesubjects'
knees6weeks, 3months,and6
mont hsaft
erinj
ecti
on.Resear
chersfound:

Kneestreat
edwi
th1or2PRPinject
ionssawar
educt
ioni
npai
nandst
if
fnessaswel
las
i
mpr ov
ementinkneef
unct
ionat6weeksand3months.

Att
he6-mont
hmarkposi
ti
ver
esul
tsdecl
i
ned,
thoughpai
nandf
unct
ionwer
est
il
lbet
tert
han
bef
orePRPtr
eat
ment
.

Thegroupthatr
eceiv
edplaceboi
nject
ionssawasmal
li
ncr
easei
npai
nandst
if
fnessanda
decr
easeinkneefuncti
on.

Thepl
atel
et-
ri
chpl
asmausedinthi
scl
i
nical
studyhad3timesthepl
atel
etconcent
rat
ionof
nor
malbloodandhadbeenf
il
ter
edtor
emov ewhit
ebloodcel
l
s.

I
nThi
sAr
ti
cle:

Pl
atel
et-
RichPl
asma(
PRP)Ther
apyf
orAr
thr
it
is

PRPI
nject
ionPr
epar
ati
onandComposi
ti
on

Ef
fi
cacyofPl
atel
et-
RichPl
asmaI
nject
ions

Pot
ent
ial
ProsandConsofPRPI
nject
ions

Choosi
ngaPRPTher
apyDoct
or

WhoI
saCandi
dat
eforPl
atel
et-
RichPl
asmaTher
apy
?

Pl
atel
et-
RichPl
asmaI
nject
ionPr
ocedur
e

Asecond, smallerstudyexaminedpatientswhohadexperiencedmi l
dkneepai nforanav erage
of14mont hs.
12Eachar thri
ti
ckneeunder wentanMRItoev al
uatejointdamageandt hen
recei
vedasi nglePRPi nj
ecti
on.Pati
ents'kneeswereassessedatthe1week, 3mont h,6mont h
and1y earmar ks.Inaddit
ion,eachkneeunderwentasecondMRIaf t
eroney ear.Researchers
f
ound:

Oneyearaf
terr
eceiv
ingaPRPinjecti
on,mostpati
ent
shadl
esspai
nthant
heydi
dthey
ear
bef
ore(t
houghpainhadnotnecessari
lydi
sappear
ed)
.

MRI
sshowedt
hatt
hatt
hedegener
ati
vepr
ocesshadnotpr
ogr
essedi
nthemaj
ori
tyofknees.

Whilekneecar
ti
lagedidnotseem toregener
ateforpat
ient
s,t
hefactt
hatt
hear
thri
ti
sdi
dnot
worsenmaybesi gni
fi
cant.Evi
dencesuggeststhatanaver
ageof4to6%ofcar
ti
lage
di
sappearseachyearinar
t hr
it
icj
oint
s.13,
14

adv
ert
isement

PRPDoesNotWor
kforEv
ery
one

Notall
cli
nicalst
udiesprovi
deevi
dencethatPRPallevi
atesost
eoar
thr
it
issymptoms.I
nseveral
cl
ini
calst
udiesPRPi nj
ecti
onswerenobetterthanaplacebotr
eat
ment.Eveni
nstudi
esthatdo
pr
ovideevi
dencet hatPRPworks,
notall
pat i
entsbenefi
t.

SeeI
sSt
em Cel
lTher
apyf
orAr
thr
it
isSaf
eandEf
fect
ive?

PRPpr oponentsassertthatPRPf ai
lstosuccessfull
ytr
eatsy
mpt omsi nsomecasesbecause
ofdiff
erencesinPRPf or
mul ati
onorinjecti
onadmini
str
ati
on-inotherwords,cer
tai
nchangesi
n
vari
ables,suchasPRPpr eparati
onmet hods,t
heamountofPRPi nject
ed,andthefr
equencyof
i
njecti
ons, canmaket hePRPl esseffectiv
e.Other
ssuggestt
hatPRPt herapymaybeapassing
fadthathasl i
mit
edv alue.
15,16

I
tmaybethatPRPther
apy,l
i
keotherost
eoar
thrit
istr
eatments,worksf
orsomepeoplebutnot
f
orot
her
s,orworksbesti
nconj
uncti
onwithothertr
eatments,suchasphysi
cal
ther
apy.

PRPhasbeenusedi nsurgeri
estopr omotecel l
regenerationsince1987,1,2andagr owingbody
ofevi
denceshowsi tisav i
abletreatmentfortendinosi
s.3-6Notuntilrecently
,though,
have
exper
tsresearchedanddebat edwhet herornotplatel
et-
richplasma( PRP)i nj
ecti
onsarean
eff
ect
ivetreat
mentf orosteoart
hrit
is.

Kneei
nject
ioni
l
lust
rat
ionSav
e
SeeOst
eoar
thr
it
isTr
eat
ment

Nearlyal
loftheresear
chinvest
igat
ingt
heuseofPRPtotr
eatosteoar
thr
iti
sandothercart
il
age
defectshasbeendonesince2000,andthev
astmajor
it
yofresear
charti
clesont
het opi
chave
beenpublishedsi
nce2010.

SeeWhatI
sCar
ti
lage?

NotallstudiessupporttheuseofPRPtotreatosteoart
hri
ti
s;however,
exper
tswhohav
e
r
eviewedt heexisti
ngbodyofr esear
chbel
i
ev etheevidencei
slargel
yencour
agi
ngandmer
it
s
f
urtherinvesti
gati
on.7-9

SeeSt
em Cel
lTher
apyf
orAr
thr
it
is

adv
ert
isement

KneeOst
eoar
thr
it
isTr
eat
edwi
thPRP

Researchersstudyi
ngPRPandost eoar t
hrit
isoft
enworkwithpati
ent
swhohav eknee
osteoart
hri
tis,acondit
iont
hatexpertsestimatewil
laff
ectnear
lyhal
fofallAmericansatsome
pointduri
ngt hei
rli
ves.
10Twocl i
nicalstudi
esthatexaminePRPtotreatkneeart
hrit
isar
e
descri
bedbel ow.

Onest udy,
publi
shedin2013,invol
ved78pat i
entswithosteoart
hrit
isinbot
hknees(156
knees).11Eachkneerecei
vedoneoft hr
eet r
eatments:1PRPi nject
ion,2PRPinj
ect
ions,or1
placebosali
neinj
ecti
on.Researcher
sevaluatedthesubjects'
knees6weeks, 3months,and6
mont hsaft
erinj
ecti
on.Resear
chersfound:

Kneestreat
edwi
th1or2PRPinject
ionssawar
educt
ioni
npai
nandst
if
fnessaswel
las
i
mpr ov
ementinkneef
unct
ionat6weeksand3months.

Att
he6-mont
hmarkposi
ti
ver
esul
tsdecl
i
ned,
thoughpai
nandf
unct
ionwer
est
il
lbet
tert
han
bef
orePRPtr
eat
ment
.
Thegroupthatr
eceiv
edplaceboi
nject
ionssawasmal
li
ncr
easei
npai
nandst
if
fnessanda
decr
easeinkneefuncti
on.

Thepl
atel
et-
ri
chpl
asmausedinthi
scl
i
nical
studyhad3timesthepl
atel
etconcent
rat
ionof
nor
malbloodandhadbeenf
il
ter
edtor
emov ewhit
ebloodcel
l
s.

I
nThi
sAr
ti
cle:

Pl
atel
et-
RichPl
asma(
PRP)Ther
apyf
orAr
thr
it
is

PRPI
nject
ionPr
epar
ati
onandComposi
ti
on

Ef
fi
cacyofPl
atel
et-
RichPl
asmaI
nject
ions

Pot
ent
ial
ProsandConsofPRPI
nject
ions

Choosi
ngaPRPTher
apyDoct
or

WhoI
saCandi
dat
eforPl
atel
et-
RichPl
asmaTher
apy
?

Pl
atel
et-
RichPl
asmaI
nject
ionPr
ocedur
e

Asecond, smallerstudyexaminedpatientswhohadexperiencedmi l
dkneepai nforanav erage
of14mont hs.
12Eachar thri
ti
ckneeunder wentanMRItoev al
uatejointdamageandt hen
recei
vedasi nglePRPi nj
ecti
on.Pati
ents'kneeswereassessedatthe1week, 3mont h,6mont h
and1y earmar ks.Inaddit
ion,eachkneeunderwentasecondMRIaf t
eroney ear.Researchers
found:

Oneyearaf
terr
eceiv
ingaPRPinjecti
on,mostpati
ent
shadl
esspai
nthant
heydi
dthey
ear
bef
ore(t
houghpainhadnotnecessari
lydi
sappear
ed)
.

MRI
sshowedt
hatt
hatt
hedegener
ati
vepr
ocesshadnotpr
ogr
essedi
nthemaj
ori
tyofknees.

Whilekneecar
ti
lagedidnotseem toregener
ateforpat
ient
s,t
hefactt
hatt
hear
thri
ti
sdi
dnot
worsenmaybesi gni
fi
cant.Evi
dencesuggeststhatanaver
ageof4to6%ofcar
ti
lage
di
sappearseachyearinar
t hr
it
icj
oint
s.13,
14

adv
ert
isement

PRPDoesNotWor
kforEv
ery
one
Notall
cli
nicalst
udiesprovi
deevi
dencethatPRPallevi
atesost
eoar
thr
it
issymptoms.I
nseveral
cl
ini
calst
udiesPRPi nj
ecti
onswerenobetterthanaplacebotr
eat
ment.Eveni
nstudi
esthatdo
pr
ovideevi
dencet hatPRPworks,
notall
pat i
entsbenefi
t.

SeeI
sSt
em Cel
lTher
apyf
orAr
thr
it
isSaf
eandEf
fect
ive?

PRPpr oponentsassertthatPRPf ai
lstosuccessfull
ytr
eatsy
mpt omsi nsomecasesbecause
ofdiff
erencesinPRPf or
mul ati
onorinjecti
onadmini
str
ati
on-inotherwords,cer
tai
nchangesi
n
vari
ables,suchasPRPpr eparati
onmet hods,t
heamountofPRPi nject
ed,andthefr
equencyof
i
njecti
ons, canmaket hePRPl esseffectiv
e.Other
ssuggestt
hatPRPt herapymaybeapassing
fadthathasl i
mit
edv alue.
15,16

I
tmaybethatPRPther
apy,l
i
keotherost
eoar
thrit
istr
eatments,worksf
orsomepeoplebutnot
f
orot
her
s,orworksbesti
nconj
uncti
onwithothertr
eatments,suchasphysi
cal
ther
apy.

ManyPRPtreat
mentv ari
abl
esareleftuptoi
ndi
vidual
doctor
s,sodoct
orselect
ionmaypl
aya
l
arger
olei
nwhet herornotpl
atel
et-
ri
chplasma(PRP)ther
apyisef
fect
ive.

Quest
ionst
oask

Ar
thr
it
isSpeci
ali
sts

Rheumat
ologi
st

Phy
siat
ri
st

Or
thopedi
cSur
geon

Ot
herSpeci
alt
ies

Whensel
ect
ingaphy
sici
anf
orpl
atel
et-
ri
chpl
asmat
her
apy
,pat
ient
smaywantt
oask:
Howdoest hedoct
ordiagnoseandassesst heproblem?Adiagnosisofosteoart
hri
ti
sshouldbe
ver
ifi
edwithi
magingtechnol
ogy ,
suchasanX- ray,anyti
mesurgeryorinj
ecti
onsarebeing
consi
dered.I
naddit
iontoaspecificdi
agnosis,
thedoctorshoul
dassesswhet herornotthe
condit
ioni
stooseveretobetreatedwit
hPRPt herapy.

Readmor
eaboutKneeSur
ger
yandI
nject
ions

adv
ert
isement

Whatt
raini
ngdoesthedoctorhaveper f
ormingPRPi nj
ect
ions?TheI nt
ernat
ionalCel
lul
ar
Medi
cineSociet
yrecommendst hatadoct orof
fer
ingPRPt herapyhaseit
herpart
ici
patedina
f
ormaltr
aini
ngcourseorhashadext ensiv
eone-on-onetr
ainingwithanexperi
enceddoctor.

Doest hedoctoruseult
rasound,fl
uoroscopy,
orcomputedt omogr
aphy( CTscan)toguide
i
nject
ions?Mostexper i
encedorthopedicandsportsmedici
nephysi
ciansareabletomake
accurateinj
ecti
onsint
ocer t
ainj
oints(e.
g.knees)wit
houttheneedforimaging;howev
er ,
in
somecasesi magi
ngtechnologi
esmaybeusedt oensurethatt
heinject
ionsaremadepr eci
sel
y
tothejointcapsul
e.

KneeI
nject
ionSav
e

Whatist
hedoctor'
sexperi
enceandsuccessratef
ortr
eatingosteoart
hrit
iswi
thPRPi nj
ecti
ons?
PRPinj
ecti
onsareusedtotreatanumberofdif
fer
entj
ointcondit
ions,andpat
ientsmaywantt o
conf
ir
mt hatt
hephysici
anisfamil
iarwi
thusi
ngPRPspecif i
cal
l
yf ort
reati
ngosteoar
thri
ti
s.

I
nThi
sAr
ti
cle:

Pl
atel
et-
RichPl
asma(
PRP)Ther
apyf
orAr
thr
it
is

PRPI
nject
ionPr
epar
ati
onandComposi
ti
on

Ef
fi
cacyofPl
atel
et-
RichPl
asmaI
nject
ions

Pot
ent
ial
ProsandConsofPRPI
nject
ions

Choosi
ngaPRPTher
apyDoct
or

WhoI
saCandi
dat
eforPl
atel
et-
RichPl
asmaTher
apy
?

Pl
atel
et-
RichPl
asmaI
nject
ionPr
ocedur
e

Bef
oreadmi
nist
eri
ngpl
atel
et-
ri
chpl
asmai
nject
ions,
adoct
orshoul
dal
soexpl
aint
he:
Pot
ent
ial
Risks

Possi
blebenef
it
s

St
epsoft
hepr
ocedur
e

Fol
l
ow-
uppr
otocol
,whi
chshoul
dincl
udeatl
eastonef
oll
ow-
upappoi
ntment

Costoft
hepr
ocedur
e

Adoctormayalsohavethepati
entsi
gnaninf
ormedconsentf
orm st
ati
ngt
hatt
hepati
ent
under
standst
hatplat
elet
-r
ichpl
asmather
apyisanel
ecti
veprocedur
eandt
hatcer
tai
nri
sksand
si
deeffect
sdoexist.

SeeI
sSt
em Cel
lTher
apyf
orAr
thr
it
isSaf
eandEf
fect
ive?

adv
ert
isement

Cost

I
nt r
a-ar
ticul
arinj
ect
ionsofplatel
et-
ri
chplasmatotreatosteoar
thri
ti
sar
econsider
ed
"experi
ment al
"bymostinsurancecompanies.Asingl
et r
eatmentofonejoi
ntcancost$400to
$2,000,paidout-
of-
pocketbythepatient
.1,
2(Ifmorethanonejointi
str
eated,
thecosti
ncreases
buttypicall
ydoesnotdouble.
)

Scient
ist
sarestil
lexplori
ngwhicharthr
it
ispati
entsshoul
dbeeligi
blef
orPRPinj
ect
ions.Whil
e
nodefini
ti
veconclusi
onscanbemade, resear
chsuggeststhatPRPinj
ect
ionsar
eappropri
ate
foryoungerpat
ientsintheear
lystagesofthedisease.
1-3

SeeSt
em Cel
lTher
apyf
orAr
thr
it
is

Thesepati
ent
smayhav eal
readyt
ri
edtreatmentssuchasrestandphy
sical
ther
apybutar
enot
yett
hinki
ngaboutj
ointr
epl
acementsorothersurger
ies.
adv
ert
isement

Suggest
edI
ndi
cat
ionsf
orPRPI
nject
ionsf
orOst
eoar
thr
it
is

Suppl
ement
sKnee

Suppl
ement
sandMedi
cat
ionsf
orKneeOst
eoar
thr
it
isVi
deo

Whi l
etherei
snouni ver
sal
lyadopt
edlistofcr
it
eri
adescr
ibi
ngwhoi sel
igi
blef
orPRPinject
ions,
professi
onalor
ganizati
onssuchastheAmer i
canAcademyofOrthopaedi
cSurgeonsandthe
I
nternati
onalCel
lul
arMedicineSoci
etyhavesuggest
edguidel
i
nes,manyofwhichareincl
uded
below:

Ost
eoar
thr
it
ispai
naf
fect
sdai
l
yact
ivi
ti
es

Ot
hermor
econser
vat
ivet
reat
ment
shav
efai
l
edorbeenel
i
minat
ed:

Phy
sical
ther
apyt
ost
rengt
henj
ointmuscl
eshasnothel
ped

Thepati
enti
ssensi
tiv
etoanti
-i
nfl
ammatorymedi
cat
ions(
NSAI
Ds)suchasi
bupr
ofen,
orf
ind
NSAIDsdonotprov
ideadequat
epainr
eli
ef

Joi
ntaspi
rat
ionsar
enotappr
opr
iat
eordonotpr
ovi
deadequat
epai
nrel
i
ef

St
eroi
dinj
ect
ionshav
enotwor
ked,
ort
hepat
ientwant
stoav
oidst
eroi
dinj
ect
ions

Platel
et-
ri
chplasmai
nject
ionsar
enott
ypi
cal
l
yrecommendedf
ort
hemostsev
erecasesof
osteoart
hri
ti
s.

I
nThi
sAr
ti
cle:

Pl
atel
et-
RichPl
asma(
PRP)Ther
apyf
orAr
thr
it
is

PRPI
nject
ionPr
epar
ati
onandComposi
ti
on

Ef
fi
cacyofPl
atel
et-
RichPl
asmaI
nject
ions

Pot
ent
ial
ProsandConsofPRPI
nject
ions

Choosi
ngaPRPTher
apyDoct
or
WhoI
saCandi
dat
eforPl
atel
et-
RichPl
asmaTher
apy
?

Pl
atel
et-
RichPl
asmaI
nject
ionPr
ocedur
e

adv
ert
isement

Cont
rai
ndi
cat
ionsf
orPl
atel
et-
RichPl
asmaTher
apy

KneeI
nject
ionSav
e

Pl
atel
et-
ri
chpl
asmai
nject
ionsmaynotbeappr
opr
iat
eforost
eoar
thr
it
ispat
ient
swho:

Haveamedical
condi
ti
ont hatcoul
dworsenorspreadwit
hinj
ect
ions,
suchasanact
ive
i
nfect
ion,
ametast
ati
cdisease,orcer
tai
nski
ndiseases

Hav
ecer
tai
nbl
oodandbl
eedi
ngdi
sor
der
s

Ar
eunder
goi
ngant
icoagul
ati
ont
her
apy(
andcannott
empor
ari
l
ysuspendt
reat
ment
)

Ar
eanemi
c

Ar
epr
egnant

SeeI
sSt
em Cel
lTher
apyf
orAr
thr
it
isSaf
eandEf
fect
ive?

Addit
ional
ly
, pat
ientswhohaveanal l
ergyt
ocowpr oductsshoul
dtel
lthei
rdoct
or.These
pati
entscouldexperienceanall
ergi
creact
ioni
ftheplat
elet
-ri
chpl
asmai scombi
nedwi t
han
addi
tivecal
ledbov i
net hr
ombin,whi
chisderi
vedfr
om cows.

Ref
erences

NextPage:
Plat
elet
-Ri
chPl
asmaI
nject
ionPr
ocedur
e

Pl
atel
et-
RichPl
asmaI
nject
ionPr
ocedur
e

SHAREPI
NIT NEWSLETTERSByJohnWi
l
son,
MD

PeerRev
iewed
Pl
atel
et-
ri
chpl
asmai
nject
ionsareoutpati
entpr
ocedur
es.Becausethepat
ient
'sbl
oodmustbe
dr
awnandprepar
edf
orinj
ection,
atypicalpr
ocedur
emayt akeanywher
efrom 45to90mi
nutes.

KneeI
nject
ionSav
e

Whetherthepat
ienthasaone- timeinject
ionoraser i
esofi njecti
onsspacedov erweeksor
monthsisuptothei ndivi
dualpati
entanddoct or
.Ifaser iesofinj
ectionsisplanned, adoct or
mayrecommendasi ngleblooddrawdur ingthefi
rstvisitandusef reshPRPi nt hefirsti
nject
ion
andfreezi
ngandt hawt heremaini
ngPRPasneededf orf ut
ureinjecti
ons.Howev er,
some
exper
tsbeli
evefreezingandthawingPRPnegat i
velyaffectsitsusefulnessandpr ef
ertodoa
separ
ateblooddrawf oreachPRPi njecti
on.1

Pl
atel
et-
RichPl
asmaI
nject
ionsRequi
rePr
eci
sion

Anexper
iencedphysici
anshoul
dperf
ormtheinject
ions.Theuseofi
magi
ngt
echnol
ogy(
e.g.
,
ul
tr
asoundguidance)ensur
esapreci
sei
nject
ion.

Pr
ecisioni
simpor
tantbecause,l
i
kev i
scosupplement
ati
ont
reat
ment
s,pl
atel
et-
ri
chpl
asma
i
nject
ionsmustbemadedi r
ectl
yint
othejointcapsul
e.

adv
ert
isement

Pr
e-I
nject
ionPr
ecaut
ions

I
nject
ionKnee

I
nject
ionsf
orKneeOst
eoar
thr
it
isVi
deo

TheAmer i
canAcademyofOr
thopaedi
cSur
geonsr
ecommendspat
ient
sadher
etot
hef
oll
owi
ng
pre-
inj
ect
iongui
del
ines:

Av
oidcor
ti
cost
eroi
dmedi
cat
ionsf
or2t
o3weekspr
iort
othepr
ocedur
e

St
optaki
ngnon-
ster
oidal
anti
-i
nfl
ammator
ydr
ugs(NSAI
Ds),
suchasaspi
ri
nori
bupr
ofen,
or
ar
thr
it
ismedi
cat
ionssuchasCelebr
ex,
aweekpr
iort
othepr
ocedur
e
Donott
akeant
icoagul
ati
onmedi
cat
ionf
or5day
sbef
oret
hepr
ocedur
e

Dr
inkpl
ent
yoff
lui
dst
hedaybef
oret
hepr
ocedur
e

Somepat
ient
smayr
equi
reant
i-
anxi
etymedi
cat
ioni
mmedi
atel
ybef
oret
hepr
ocedur
e

Alt
hought heAmericanAcademyofOr t
hopaedicSur
geonspubl
ishedthesepre-
inj
ecti
on
gui
delines,t
heorganizat
iondoesnotadvocat
efororagai
nstpl
atel
et-
ri
chplasmat r
eatmentf
or
osteoart
hrit
is.
2

SeeSt
em Cel
lTher
apyf
orAr
thr
it
is

I
nThi
sAr
ti
cle:

Pl
atel
et-
RichPl
asma(
PRP)Ther
apyf
orAr
thr
it
is

PRPI
nject
ionPr
epar
ati
onandComposi
ti
on

Ef
fi
cacyofPl
atel
et-
RichPl
asmaI
nject
ions

Pot
ent
ial
ProsandConsofPRPI
nject
ions

Choosi
ngaPRPTher
apyDoct
or

WhoI
saCandi
dat
eforPl
atel
et-
RichPl
asmaTher
apy
?

Pl
atel
et-
RichPl
asmaI
nject
ionPr
ocedur
e

Pl
atel
et-
RichPl
asmaI
nject
ions,
Step-
by-
Step

Thisi
sanin-
off
icepr
ocedur
ethati
nvol
vesabl
ooddr
aw,
prepar
ati
onoft
hePRP,
andt
he
i
nject
ion:

Bloodi
sdrawnfr
om avei
ninthepat
ient
'sar
mint
oav
ial
(ty
pical
l
y15t
o50mL,
orl
esst
han2
ouncesofbl
oodi
sneeded).

Thebl
oodi
spr
ocessedusi
ngacent
ri
fugemachi
ne.

Adoct
orort
echni
cianpr
epar
est
hecent
ri
fugedpl
atel
et-
ri
chpl
asmaf
ori
nject
ion.

Theaf
fect
edj
ointar
eai
scl
eansedwi
thdi
sinf
ect
antsuchasal
cohol
ori
odi
ne.
I
fultr
asoundisbeingused,aspeci
algel
wi l
lbeappli
edtoanareaofski
nneart
heinj
ect
ionsi
te.
Anultr
asoundprobewillbepr
essedagainstthegel
-cov
eredski
n.Ali
veimageoft
hejoi
ntwil
lbe
pr
ojectedonscr
eenforthedoctort
osee.

Thepati
enti
saskedt
orel
ax;
thi
swi
l
lfaci
l
itat
ethei
nject
ionandal
socanmaket
hei
nject
ionl
ess
pai
nful
.

Usingasyr
ingeandneedl
e,thedoctori
nject
sasmal
lamount(
oft
enj
ust3t
o6mL)ofpl
atel
et-
ri
chplasmaint
othejoi
ntcapsul
e.3

Thei
nject
ionar
eai
scl
eansedandbandaged.

Thepl
atel
et-
ri
chpl
asmatypical
l
ysti
mulatesaseri
esofbi
ologi
cal
responses,
andt
hei
nject
ion
si
temaybeswoll
enandpainfulf
orabout3days.

adv
ert
isement

Af
tert
hePRPI
nject
ion:
Immedi
ateFol
l
ow-
upCar
e

Pat
ient
sar
eadv
isedt
otakei
teasyf
oraf
ewday
sandav
oidput
ti
ngst
rai
nont
heaf
fect
edj
oint
.

Doct
orsmayr
equi
reorsuggestt
hatapat
ient
:

Doesnottakeant
i-
inf
lammat
orypai
nmedi
cat
ion;
anot
herpai
nmedi
cat
ionmaybepr
escr
ibed
bythedoctor

Wearabraceorsl
ingtoprotectandi
mmobil
i
zetheaf
fect
edjoi
nt;
apat
ientwhor
ecei
vesan
i
nject
ionatt
heankle,
knee,orhipmaybeadvi
sedt
ousecrut
ches

Useacoldcompressafewt
imesadayf
or10t
o20mi
nut
esatat
imet
ohel
pdecr
easepost
-
i
nject
ionpai
nandswell
i
ng

SeeWhenandWhyt
oAppl
yCol
dtoanAr
thr
it
icJoi
nt

Pati
entswhodonothav ephy si
cal
lydemandingjobscanusuall
ygobacktoworkthenextday.
Pati
entscanresumenor malacti
vi
tieswhenswelli
ngandpaindecr
ease,t
ypi
cal
l
yaf ewday s
aft
ertheinj
ecti
ons.Pat
ient
sshoul dnotbegi
ntakingant
i-
inf
lammator
ymedicat
ionsunti
l
approvedbythedoctor
.
Phy
sical
ther
apy

Ift
heinjecti
on(s)i
ssuccessfuli
nreducingthepati
ent
'spai
n,t
hepati
entwil
lli
kel
ybeprescri
bed
physi
cal t
herapy.Doi
ngsimpleexerci
sest obuil
dandmaint
ainmuscl
estrengthar
oundthe
aff
ectedjointserv
estodecreaseosteoart
hrit
issympt
omsandcanslowdownorhal tf
urther
j
ointdegenerati
on.

SeeExer
cisef
orAr
thr
it
is.
..
..

Thanky
ou.
..
S.S.
Sur
yawanshi
!!.
.