PRP therapy is an effective modern means of treating joints

What is PRP therapy? You may not be familiar with the acronym PRP - it is one of the new techniques for treating sports injuries. PRP, or platelet-rich plasma, is a revolutionary blood plasma treatment for chronic sports and musculoskeletal injuries. Professional athletes and active lifestyle enthusiasts trust PRP therapy to help them return to sports, while patients with arthrosis of the joints experience less pain, allowing them to move more freely.

Why does PRP work?

Platelets are a special type of blood cell. Blood is made up of 93% red cells (erythrocytes), 6% platelets, 1% white blood cells (leukocytes) and plasma. The goal of PRP therapy is to increase platelet concentration while minimizing the number of red blood cells. Simply put, the higher the platelet concentration, the better.

Platelets are responsible for blood clotting and stopping bleeding. This is certainly an important function of platelets, but they are also actively involved in healing injury. These blood cells are extremely rich in growth factors, the introduction of which into damaged ligaments, tendons and joints stimulates the natural healing process. But in order to benefit from these natural healing proteins, the platelet concentration must be high enough. In other words, the infused platelet-rich plasma (PRP) repairs damaged tissue by stimulating the body's natural healing process.

How does platelet rich plasma work?

The essence of PRP therapy is the injection of one’s own growth factors, secretory proteins and platelets in high concentrations to enhance healing processes.

In addition to reducing pain, the use of platelet-rich plasma is widespread for bone fractures, plastic surgery, dentistry, and for improved wound healing. The first successes in the use of PRP therapy for bone fractures contributed to the spread of the new method to other areas of traumatology and orthopedics.

How is the procedure done?

In the patient's office, blood is taken from the patient (as for analysis) and placed in a special centrifuge, which separates the red blood cells, as a result of which the remaining platelets and plasma are significantly condensed. The red blood cells are removed and the resulting platelet concentrate is used for treatment.

Then, after treating the skin with antiseptic solutions, platelet-rich plasma is injected into the problem area, onto which an aseptic bandage is applied after the procedure. If necessary, local anesthesia may be used to numb the skin and deeper tissues. The introduction of the solution (if necessary) can be performed under the control of an ultrasound machine. The entire procedure - from drawing blood, preparing a solution and injection - lasts 10-15 minutes.

Features of the sessions

The treatment is based on autoplasma therapy methods: using specialized equipment, platelets are extracted from human blood. Blood cells are mixed with plasma and injected into the damaged area of the body. Sometimes, for better accuracy, injections are controlled by ultrasound. The entire treatment process takes about 20 minutes.

The PRP technique is also effective in the presence of degenerative processes and acute pain syndromes. This treatment activates the regeneration of affected tissues and quickly stops inflammatory processes. High therapeutic rates are ensured due to the action of platelets - the main sources of growth factors. Once in the lesion, blood cells begin to rapidly attract stem cells there, accelerating the regeneration process.

If necessary, platelets can be converted into bone, cartilage or muscle fibers. When exposed to them, the internal structures of the body actively produce elastin and collagen. The innovative technique effectively stimulates such a unique ability of the human body as self-healing.

When a patient develops arthrosis of any kind, the cartilage of the joint loses its ability to recover and absorb nutrition. Enriched bioplasma helps accelerate the natural reanimation of the damaged area. Thanks to the innovative technique, patients can do without painful and dangerous surgery.

Be careful: not all plasma is created equal!

Currently, there are more than a dozen companies in the world specializing in the manufacture and sale of PRP preparation systems. Of course, every company claims that their PRP is the best!

PRP production can vary greatly depending on the concentration of platelets, the presence or absence of red blood cells (RBCs), the presence/absence of white blood cells (WBCs), and the volume of PRP created.

Some types of plasma obtained will not be much more effective than whole blood or platelet-poor plasma, which has a very low platelet concentration. Using poorly prepared plasma containing large numbers of “inflammatory” white blood cells will result in increased pain after administration.

In my practice, I use equipment from Arthrex, which allows me to prepare high-quality plasma containing an average of 1.5 million platelets per microliter, essentially free of red blood cells and containing beneficial, proportionately growing white blood cells, despite the removal of inflammatory white blood cells. Therefore, you can be confident that the plasma I use in my practice is of the highest quality, purity and potency currently available.

When you spend money on treatment, you need to be sure that you are getting the best product!

Are there any side effects of autoplasma therapy for joints?

The side effects of this procedure are minimized if the instructions are strictly followed, high-quality equipment and consumables are available, and the duration of treatment and plasma volume are correctly selected.

Usually, when preparing a substance for administration, the patient’s own cells are used, not treated with preservatives or other chemicals, so allergic reactions are practically impossible. Individual reactions may occur when heparin or other additives are added.

After injection, small bruises may occur at the injection sites caused by mechanical damage to the capillaries. This is not a complication, and after a few days all traces will disappear.

You should keep the bandage clean and do not scratch the injection site to avoid infection.

What diseases does PRP help with?

PRP treatment is most effective for chronic ligament and tendon injuries when other treatments have failed. Also, such treatment may be needed in the following cases:

Rotator cuff tendon injuries, including incomplete and complete tendon ruptures
Shoulder pain
Tennis elbow and golfer's elbow (epicondylitis)
Hip and knee sprains
Patellofemoral syndrome and patellar tendinitis
Ankle sprains and ruptures
Tendinitis (inflammation) of the Achilles tendon and plantar fasciitis (heel spur)
Osteoarthritis of the knee, hip and other joints
Other chronic diseases of tendons and ligaments

Additionally, PRP therapy can be very helpful in many cases of osteoarthritis (“wear and tear” of the articular cartilage). PRP can stimulate the “repair” of damaged cartilage, reducing pain and increasing quality of life. For example:

Osteoarthritis of the knee joint
Arthrosis of the ankle joint
Osteoarthritis of the hip joint
Arthrosis of the shoulder joint
And arthrosis of other joints

Does Platelet Rich Plasma Therapy Treat Plantar Fasciitis?

As already mentioned, PRP therapy is one of the best and proven methods for treating plantar fasciitis.

Plantar fasciitis is a common condition that causes significant pain, affecting 1 in 10 adults. The connective tissue on the bottom of the foot (plantar fascia) can become damaged or stretched by excessive walking, leading to inflammation and pain. PRP therapy for plantar fasciitis mobilizes the body's natural repair processes, thereby reducing inflammation.

Does PRP injections hurt?

The level of discomfort from treatment depends on the area being treated. For example, injections into the joint cause minimal discomfort, and in some cases are completely painless. Tendon injections tend to be more unpleasant. If necessary, local anesthesia can be used. Typically, pain persists for the next few days.

During the first week after the injection, it is necessary to avoid taking anti-inflammatory drugs, such as, for example, Diclofinac, Nimesil, Xefocam, Ketorol, Ibuprofen, Celebrex, etc. They will significantly reduce the effectiveness of the procedure.

How to prepare for autoplasmotherapy of joints

The necessary course of autoplasmotherapy can only be prescribed by a doctor of appropriate qualifications. The specialist will conduct a detailed examination of the affected area, do the necessary research, and study the medical history. Only after this, if necessary, will a course of such therapy be prescribed.

The procedure does not require special preparation, but it is better to follow some recommendations:

stop taking antithrombic agents 14 days before the procedure;
refrain from smoking and drinking alcohol for 24 hours before the procedure;
avoid physical activity and do not play sports before starting treatment;
get a good night's sleep the night before;
there should be no emotional experiences;
drink up to two glasses of warm plain water immediately before the session.

Read material on the topic: Plasmolifting of the face - a breakthrough in domestic cosmetology

Are there risks associated with PRP?

Any time a needle is in a person's body, even when drawing blood, there is a risk of infection, bleeding and nerve damage. However, in appropriate medical conditions the risk is minimal.

There are other rare complications that may occur depending on the characteristics of the treated area. All risks will be assessed by your doctor before starting treatment.

Due to the fact that PRP therapy uses your own blood, there cannot be an allergic reaction to it.

Advantages and disadvantages of autoplasmotherapy of joints

Like any medical procedure, autoplasma therapy has its advantages and disadvantages. Therefore, before turning to this method of treatment, you should carefully familiarize yourself with the technique.

Pros:

Almost complete absence of side effects.
Minimal risk of allergic reaction or intolerance. The patient's own plasma, obtained from his blood, is ideally combined with the tissues of his body.
Significant reduction of the drug load on the body. After a course of treatment, it becomes possible to reduce the doses of medications taken, and in some cases, to completely cancel some of the prescriptions
There are a large number of diseases and injuries for which autoplasma therapy can achieve complete cure or long-term remission.
Impact on the causes of the disease and their elimination.
Relieving inflammation, effective tissue restoration.
A small number of contraindications.
There is no rehabilitation period - the procedure does not require changes to your usual lifestyle.
Possibility of use in complex therapy together with other treatment methods.

Minuses:

The likelihood of post-injection complications.
Quite a high cost.

Read material on the topic: Manual therapy of the spine: its essence, basic techniques, patient reviews

What is the probability of success?

Studies show that improvement occurs in 80-85% of cases, although in some joints, namely the hips, the results are worse. Some patients experience complete relief from pain. In the case of treatment of tendon and ligament injuries, the positive effect lasts for a long time. In the case of joint arthritis, the duration of treatment depends on the severity of the disease. In the case of early stage osteoarthritis, one course of treatment is often sufficient. With a more severe degree of the disease, several courses of treatment are usually required - usually over 1-3 years.

How much does autoplasma therapy of joints cost?

The price of autoplasmotherapy of joints depends on both objective factors (which include the cost of consumables, the use of a patent for the technique, training of doctors), and on subjective ones, for example, on the prestige of the clinic. The price of this treatment process is comparable to cosmetic skin treatments with a similar name.

In Moscow, the average price of one plasma lifting procedure ranges from 3,500 to 6,000 rubles . In regions, the cost may be slightly lower. In addition, you will need to pay for a pre-procedure examination.

Many private clinics offer favorable discounts if you pay in full for the entire course in advance.

Read material on the topic:

Myostimulation of body muscles: indications, contraindications and features of the procedure

Will PRP therapy help grow new cartilage in my joint?

The goal of PRP treatment is to reduce pain and improve function. Although there is some weak evidence that treatment sometimes results in increased cartilage thickness, it is important to keep in mind that the cartilage covering the surfaces of the joint does not have nerve endings! For example, we often see patients with osteoarthritis of the knee or hip joints, when the joint does not hurt, but signs of pronounced changes are visible on radiographs. Pain due to arthrosis is not always associated only with damage to the cartilage; often the source of pain is the surrounding soft tissue structures.

It is not safe to say that PRP therapy will help grow cartilage tissue, but it can relieve pain.

Effects obtained after the procedure

After PRP therapy sessions, the blood supply is activated at the site of the lesion. The damaged cartilage receives the necessary nutrients and restores the ability to produce joint fluid. As a result, muscle spasm is relieved, and the muscle tissue surrounding the diseased joint is strengthened and restored. The pressure on the surface of the joints drops significantly, which leads to an increase in the distance between them. This increases motor activity and reduces the rehabilitation period after surgery and injuries of any complexity.

Will PRP Help Avoid Joint Replacement?

This is a frequently asked question. In cases of early arthrosis, PRP treatment can stop further joint destruction. However, in advanced stages of the disease, as noted above, the goal of treatment is to reduce pain and improve function. In some severe cases, PRP therapy is ineffective. The use of PRP therapy may delay possible joint replacement for a while, but does not completely eliminate this need. In some patients, surgery cannot be performed due to concomitant diseases. Other patients simply do not want joint replacement surgery under any circumstances. In these cases, PRP may be a viable treatment option.

Who should not undergo PRP plasma treatment?

The technique is safe, which is why it attracts the attention of orthopedists, traumatologists, cosmetologists, and clinicians. There are no absolute contraindications to it. Contraindications to PRP therapy are relative, that is, those that can be eliminated and the prescribed treatment carried out.

The procedure should be used with caution in the following cases:

low platelet count in the patient (thrombocytopenia, when there are less than 100 thousand in 1 μl of blood);
abnormalities in the structure of platelets - thrombocytopathies (there are congenital and acquired, for example, due to vitamin deficiency);
anemia, moderate and severe anemia, hemoglobin below 90 g/l;
treatment with drugs that interfere with blood clotting (prescribed for serious heart problems);
acute infectious inflammation in the joint area or systemic infection (flu, acute respiratory infections, COVID-19, pneumonia, etc.);
oncological diseases;
the body's reaction to the anticoagulants used;
pregnancy.

As you can see, most of the listed contraindications to PRP can be corrected: cure the infection, replenish hemoglobin levels, take vitamins, etc.

What do the studies say?

The past 10 years have seen an explosion of research examining the potential benefits of PRP therapy. However, one of the problems with PRP therapy research is that often researchers do not indicate the characteristics and properties of the plasma used. See discussion above, “Not all PRP is created equal!”

Below are brief excerpts from several scientific articles:

"Tennis Elbow"

Peerbooms et al in 2010 compared a single PRP injection with a cortisone injection (Diprospan) for the treatment of chronic tennis elbow. 51 patients received PRP injections, while 49 patients received cortisone injections. Over the follow-up year, 73% of PRP subjects had significant improvements, compared with only 51% of cortisone (Diprospan) injection subjects. The observations noted that those patients who received cortisone injections initially felt better than the PRP group, while the PRP group showed gradual improvements.

Their conclusion: “Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injections.” (Pearbooms et al. Beneficial effect of autogenous platelet concentrate in the treatment of lateral epicondylitis in a double-controlled, randomized study. American Journal of Sports Medicine. 2010;38(2):255-262).

In a 2011 study, Hechman et al found 30 patients (31 elbows) with epicondylitis unresponsive to conservative treatment (including steroid injections) receiving a single PRP injection for >6 months. Results: Patient satisfaction scores improved from 5.1±2.5 at 1 month to 9.1±1.9 (on a scale of 1-10) at one year follow-up. Only 1 patient reported no improvement after 6 months.

The results suggest that a single injection of platelet-rich plasma may reduce pain and improve function, thereby avoiding surgery. (Hechman et al. Platelet-rich plasma injections reduce pain in patients with treatment-resistant epicondylitis. Orthopedics.2011 Jan 1;34(2):92.

Rotator cuff

In 2012, Ra and associates compared PRP treatment with Diprospan injection for the treatment of chronic rotator cuff tendinitis. 39 patients were randomized to receive either 2 PRP injections over 4 weeks or 2 Diprospan injections over 4 weeks. All procedures were performed under ultrasound guidance. Conclusions: “Injections of autogenous platelet-rich plasma lead to a gradual reduction in pain and limitation of movements compared with Diprospan injections.

This benefit is, of course, still present six months after treatment. These results indicate that treatment with platelet-rich plasma injections is safe and beneficial for rotator cuff disease.” (Ra et al. Comparison of therapeutic effects with ultrasound guidance of platelet-rich plasma injection and Diprospan administration for rotator cuff disease: a randomized controlled trial. Clinical Rehabilitation. 2012;27(2):113-122.)

Chronic plantar fasciitis (heel spur)

Monto in 2014 observed the effectiveness of PRP for chronic plantar fasciitis. Forty patients (23 women and 17 men) with unilateral chronic plantar fasciitis who had failed additional conservative treatments for at least 4 months were randomized as expected to receive either a single ultrasound-guided PRP injection (3 cc) or 40 mg hydrocortisone (Diprospan).

The patients' condition was assessed 3, 6, 12 and 24 months after treatment. Those who received a hydrocortisone injection initially felt better than the PRP group, but their improvement waned and pain returned completely to baseline after 12 months. On the other hand, those in the PRP group still experienced gradual improvement, and there were noticeable improvements at 12 and 24 months.

Conclusion: “For the treatment of chronic intractable plantar fasciitis, PRP was more effective and long-lasting than hydrocortisone injections. (Monto, Research Report. Efficacy of platelet-rich plasma versus treatment with corticosteroid injections for severe chronic plantar fasciitis. Foot & Ankle International, 2014;35(40):313-318.)

Tendonitis (inflammation) of the patellar tendon

Volpi et al treated the affected knees of 8 athletes (10 knees) with chronic patellar tendinitis who had failed conservative treatment and were considering surgery. Patients received one ultrasound-guided PRP injection into the injured patellar tendon.

Subsequently, within 120 days, all subjects reported a 91% improvement, and an MRI procedure showed healed areas. (Volpi et al. Treatment of chronic patellar tendinosis with buffered platelet-rich plasma: a pilot study. Medsport. 2007;60:595-603.)

Osteoarthritis of the knee joint

Cerza and associates in 2012 compared PRP injections and hyaluronic acid (HA) injections for the treatment of knee osteoarthritis. 120 patients were randomly divided into 2 groups. One group received 4 weekly PRP injections, while the other group received 4 weekly HA injections. Patients were assessed at 4, 12 and 24 weeks after the first injection.

Results: Treatment with PRP showed statistically significantly better clinical outcome than treatment with GC. It should be noted that patients with more severe arthritis (grades III and IV) did not show improvement with HA injections, while the severity of the disease does not matter relative to improvement with PRP. (Cerza et al. Comparison between hyaluronic acid and platelet-rich plasma intra-articular infiltration in the treatment of gonarthrosis. American Journal of Sports Medicine.. 2012;40(12):2822-2827.)

Gobbi et al also investigated the effectiveness of PRP for the knee joint. 50 patients received 2 PRP injections per month. 25 patients had previously been operated on due to damage to cartilage tissue. Results: All patients showed significant improvement in all measures assessed at 6 and 12 months and returned to their previous activities. There was no difference in improvement among different subgroups (surgery, disease severity, age). (Gobbi et al. Platelet-rich plasma treatment for symptomatic patients with knee arthrosis: preliminary results in a group of active patients. Health Sports. 2012;4(2):162-172.)

Osteoarthritis of the hip joint

Sanchez and co. in 2012 studied PRP for hip arthrosis. 40 patients with severe forms were included. Each subject received PRP injections into the affected thigh once a week for 3 weeks. The patients' condition was analyzed after 7 weeks and after 6 months. 60% of subjects reported a positive reaction (defined as at least a 30% improvement in symptoms). 40% of those with a positive result were classified as “excellent responders.” Conclusions: “This preliminary, uncontrolled, randomized, prospective study confirms the safety, tolerability, and effectiveness of PRP injections for pain relief and improvement of function in a limited number of patients with hip OA.” (Sanchez et al. Ultrasound-guided platelet-rich plasma injections for the treatment of hip osteoarthritis. Rheumatology. 2012;51:141-150.)

The effectiveness of plasma therapy for arthrosis

After the procedure, discomfort and soreness may linger for some time at the injection site, but they quickly pass. After the first procedure, all patients note improvement: their pain gradually decreases by the end of the week. In the future, with each procedure the pain becomes less and less.

Any localization of arthrosis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

After 5–6 injections, most patients feel an improvement in limb function: walking becomes less painful, and the duration of painless walks increases. After completing the course of joint treatment, patients forget about their problems. For severe arthrosis, courses of injections are repeated twice a year, which significantly improves the quality of life of patients.

Plasma therapy is a new effective method for the treatment and rehabilitation of arthrosis. Doctors at the Moscow Paramita clinic successfully use it in the treatment of both initial and advanced stages of arthrosis of various localizations.

Literature:

Emelin A.L., Pankov I.O. MODERN APPROACHES TO THE TREATMENT OF POST-TRAUMATIC ARTHROSIS OF THE KNEE // Modern problems of science and education. – 2021. – No. 3.
Mastykov A.N., Deykalo V.P., Samsonova I.V., Boloboshko K.B. The effectiveness of platelet-rich plasma in the treatment of traumatic cartilage defects of articular surfaces. Surgery news 2013.
Kashevarova N.G., Alekseeva L.I. Risk factors for the progression of osteoarthritis of the knee joints // Scientific and practical rheumatology. 2014. No. 52(5). pp. 553–561
Martel-Pelletier J., Mineau F., Jolicoeur FC et al. In vitro effects of Diacerhein and Rhein on IL-1 and TNF-a system in human osteoarthritis synovium and chondrocytes // J Rheum. Vol. 25. P. 753–762.
Hochberg MC, Martel-Pelleiter J., Monfort J. et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicenter, randomized, double-blind, non-inferiority trial versus celecoxib // Ann Rheum Dis. 2021. 75. P. 37–44.

Themes

Arthrosis, Treatment methods, Joints Publication date: 12/08/2019 Update date: 11/12/2020

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