Steve Mora MD
Orange County Knee Specialist
Platelet Rich Plasma (PRP): A Potentially Promising Treatment for Knee Arthritis
For the last few years I have added Platelet-rich Plasma (PRP) injections as a adjunct for the treatment of arthritic conditions. Platelet rich plasm is a simple and minimally invasive treatment that can potentially be used to alleviate symptoms associated with knee arthritis. I find that treatment of knee arthritis in general can be very difficult. It is especially difficult in patients who have early arthritis and who are young. These are tough cases because the arthritis is not severe enough to warrant a knee replacement but significant enough to cause pain that effects one’s life. A cookie cutter approach for everyone with arthritic knee pain does not always work.
What is Knee Arthritis?
Knee arthritis involves the inflammation, degeneration of the joint surface, damage to the meniscus, bowing of the leg, edema of the bone and pathological changes in the joint fluid of the knee joint. Common symptoms include pain, swelling, and stiffness. Often, knee arthritis can interfere with daily activities such as walking and climbing stairs. Arthritis knee pain can also occur simply from sitting in one position for a long time. When severe, symptoms may prevent patients from working and doing the activities which bring them happiness.
Treatment Options
Treatment depends on a multitude of factors including the type of pain, location of pain, presence of deformity such as bowing, presence of bone edema, presence stiffness, presence of loose fragments floating in the joint, age, and other medical problems. Typical treatments for knee arthritis includes lifestyle modifications, physical therapy, steroid injections, Hyaluronate injections, bracing, weight loss, anti-inflammatories and medication. For a detailed discussion about how I treat knee arthritis please go to my blog article-Treatment of Knee Arthritis Its Not Always Easy. Effective treatment needs to be patient specific.
Platelet Rich Plasma Treatment for Knee Arthritis
Recent studies have suggested that PRP can be effective for patients with knee arthritis pain. Platelet rich plasma has become an option for the treatment of specific injuries especially soft tissue injuries such as tennis elbow and plantar fasciitis. Over the last few years PRP has also been used to treat various other injuries and pathologies including rotator cuff tears and knee arthritis. Recently PRP has been used as an alternate treatment for arthritis of the knee. It has shown promise however the number of studies are few and results are mixed. The good news about PRP is that when done properly no harm is done and a benefit may be experienced. Overall it’s a low risk procedure.
How is PRP Done?
The procedure is relatively simple. Platelet Rich Plasma is produced from the patient’s own blood. A sample of the patient’s blood is first drawn, filtered and then platelets are concentrated. Platelets are known to produce a high concentration of essential growth factors which theoretically initiate a natural healing response. I usually use ultrasound to improve the accuracy of my injections. The process is relatively painless. The hope is that the growth factors will repair the degenerative cartilage , reduce inflammation and reduce pain.
Clinical Research on PRP for Knee Arthritis
A recent study by the Hospital for Special Surgery found PRP not only to improved the pain, stiffness and function of the knee in 73% of patients, but also stalled degeneration of the knee joint. Platelet Rich Plasma treatment has also been linked to tissue repair. Researchers have proposed that PRP treatment may stimulate the healing of tissues that have a limited ability to heal on their own. Furthermore, PRP has been utilized as an alternative treatment of professional athlete injuries, which has contributed to the public’s greater enthusiasm for PRP treatment. Although these results seem promising, most scientific studies conducted on PRP and knee arthritis have been no been solid or totally convincing. Thus, although PRP treatment may be effective in some cases, more research utilizing strict scientific methods should be done before PRP is used as a standard form of alternative treatment for knee arthritis.
My Approach
I do not inject everyone with platelet rich plasma. I use it in cases where I think the chance of it helping is high. The truth is that PRP is not covered by insurance therefore patients need to pay for the treatment. Therefore my goal is to first understand what is the cause of pain. It is not always straightforward. Platelet rich plasma is rarely my first recommendation. Once I do recommend PRP I will do 2-3 injections. Its rare for patients to experience magical results after one injection. In addition there are usually concurrent recommendations such as stretching, bracing and other non operative treatments being done.
Conclusion
Platelet Rich Plasma may potentially reduce the symptoms associated with knee arthritis.
Although the effectiveness of PRP seems promising for the treatment of knee arthritis, further research using strict scientific standards are still needed to validate these findings.
In the future, there are many questions that will need to be answered including: How many injections are needed? How far apart should the injections be done? Is there a right concentration? Is it better if mixed with Hyaluronate? Who is the ideal patient? Should it be done for severe bone on bone arthritis?
Platelet Rich Plasma may be the beginning of a new and most effective treatment for knee arthritis, but much more work must be done before it is a standard form of care. Lastly there is no magic bullet for the treatment of knee arthritis. Patients usually do best when a multipronged approach to treatment of arthritis is employed.
References
Foster, T. E., Puskas, B. L., Mandelbaum, B. R., Gerhardt, M. B., & Rodeo, S. A. (2009). Platelet-rich plasma from basic science to clinical applications. The American journal of sports medicine, 37(11), 2259-2272.
Halpern, B., Chaudhury, S., Rodeo, S. A., Hayter, C., Bogner, E., Potter, H. G., & Nguyen, J. (2013). Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clinical Journal of Sport Medicine,23(3), 238-239.
Special thanks to our CSUF pre-med intern Karah Kirby who helped with this article.
Related Articles by Dr. Mora:
Arthritic Knee Pain-it’s not always an easy fix
When Should PRP be used for the Treatment of Arthritis?
About Steve A. Mora MD:
Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He received his medical education at UC Irvine College of Medicine where he finished in the top of his class earning the coveted AOA Medical Society honors. He completed his Orthopedic Surgery training LAC+USC Medical Center and then did a additional Sports Medicine Fellowship at the Santa Monica Orthopaedic and Sports Medicine Group where focused on sports medicine, shoulder, knee, hip arthroscopy. He has published numerous book chapters on the topics of ACL injuries in soccer players, cartilage restoration, and athletic hip injuries. He is currently practicing Orthopedic Surgery in the City of Orange Orange County. He is a founding partner at Restore Orthopedics and Spine Center (www.restoreorthopedics.com). Dr. Mora’s practice focus is on sports related trauma, MMA injury treatment, arthroscopy of the shoulder, hip, knee and elbow, and partial and total knee replacement. He sees athletes of all levels including professional soccer and UFC/MMA patients. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.
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Restore Orthopedics and Spine Center
112o W. La Veta Ave, Third Floor
Orange, CA 92868
Office: (714) 332-5498
Fax: (714) 941-9539
E-mail: smora@restoreorthopedics.com
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