Platelet Rich Plasma (PRP)
Platelet Rich Plasma, also known as PRP, is a concentration of elements that are found naturally in blood. Blood is drawn from a vein, centrifuged and separated to created a concentrated solution of platelets and other growth and healing factors. The platelets and the growth factors in the PRP stimulate the body’s natural healing processes.
With the proper equipment, PRP can be produced and injected in a doctor’s office. When you arrive in the office, some blood will be drawn from your arm. After 20 to 30 minutes of processing, the completed PRP will be ready to use. After the PRP is created, it can be injected directly into the injured area.
PRP can be injected into the knee, shoulder, hip or other joint to help relieve the pain and inflammation of arthritis symptoms. In some cases, 1 injection is used. Other times, 2 or 3 injections are given over a period of months. Although it is not effective in all patients, most have a substantial improvement in their symptoms. It appears to be most effective in patients with mild to moderate arthritis and less effective in patients who have bone on bone arthritis changes. Some patients experience an increase of pain or swelling for 1-2 days immediately after the injection.
Patients need to avoid taking aspirin, ibuprofen or any other NSAIDs for week before and after the PRP or stem cell injection. Taking a daily baby aspirin (80mg) if prescribed by a doctor is OK to continue.
Bone Marrow Mesenchymal Cells
Bone marrow is a rich source of mesenchymal stem cells. Stem cells have powerful anti-inflammatory properties and can in some cases regenerate new tissue.
Procedure: This procedure is performed in the office. While lying face down, the iliac crest bone and the tissue over it is numbed with a local anesthetic. A special needle is then advanced into the bone marrow. This area is a rich source of stem cells.
A syringe is then used to aspirate a small amount of this bone marrow, only about 12cc or two teaspoons. The bone marrow is harvested one cc at a time while the needle is painlessly rotated to increase the yield of stem cells.
The syringe is then transferred to another needle for relatively painless injection into the joint.
Results: Clinical experience has shown a beneficial effect on joint pain in most but not all patients.
Complications: Infection is a possibility after any injection, but there have been no reported infections with this technique to our knowledge.
Fat Graft Injection
Fat has been shown to have cushioning and anti-inflammatory properties. Fat is also a very rich source of stem cells. For example, Hoffa’s fat pad in the knee is important in knee function and healing. We believe that fat graft functions by augmenting joint function in a natural, biologic fashion.
Procedure: The procedure is performed in the office. After local anesthetic is applied to the skin, tiny nicks are made in either the abdomen or “love handle” area. A thin cannula is inserted and fluid containing a saline solution and local anesthetic are instilled, which numbs the area. Another thin cannula is inserted and a small amount of fat is removed, about 2 ounces or so. This is much less than is removed in cosmetic liposuction. There is generally very little pain during the liposuction. You may have a little soreness for a few days after the injection.
The fat is washed to remove blood and fat and then is injected into the joint.
Results: Clinical experience has shown a beneficial effect on joints in most, but not all patients.
Complications: Infection is a possibility after any injection, however, we are unaware of any reported infections with this fat graft technique.
Treatment Protocol: Bone marrow stem cells, fat graft, and PRP are in most cases collected and injected at the same time. Occasionally, only bone marrow stem cells or fat graft will be used, though they are usually combined with PRP. Injection for most areas is done with ultrasound guidance. Injection into the hip or shoulder is done with xray guidance.
After the treatment, patients often have a flareup of symptoms that may last several days. A decrease in activity is recommended during this period, although patients do not need to take time off of work or stay at home. Ice and Tylenol can be used to decrease local discomfort. Patients may also have some soreness at the sites where the cells were harvested. These areas should be kept clean and dry but should heal quickly.