Below you will find information about PRP and Stem Cell Injection. After that you will find videos of actual patients who have been treated telling their stories. Dr Prodromos is an international leader in this field. He is one of the most experienced Orthopaedic Surgeons in the world in this area, having performed thousands of Stem Cell and PRP Injections. He also has one of the largest databases of the outcomes from an ongoing prospective study of the use of this treatment through his research foundation. He uses this data to give you a good idea of what you can expect if you have treatment.
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.
See These Published Papers for Additional Information:
- Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Spakova, et al, 2012.
- Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Filardo, et al, 2011.
- Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Sanchez, et al, 2008.
80% of eligible arthritis patients successfully treated with PRP INJECTION instead of Joint Replacement Surgery. Most Sports injuries also successfully treated.
Platelets are solid particles in human blood mostly known for their clotting properties. However they also contain natural growth factors that the body uses to enhance healing and decrease inflammation. PRP is plasma in which the platelets have been concentrated.
What Does PRP Do?
Although results vary, PRP has been shown in a number of studies to decrease pain and inflammation and enhance healing. The media has recently focused on some high profile athletes who have traveled overseas to have this procedure.
What Is PRP Used For?
PRP is an ideal alternative to total joint replacement and cortisone injections for patients with arthritis of the knee, shoulder, hip or other joint. It is also useful for treating tendinitis
What are the Results?
Most, but not all, patients have been substantially improved, both in the literature and in our prospective study: usually within the first week, although the full effect takes about a month. The injection can be repeated. Unlike cortisone, PRP does not harm tissue.
How is PRP Prepared & Administered?
In our office a small amount of blood (less than one-tenth of one unit) is removed from the patient’s arm vein. This blood is spun down in a centrifuge to separate out the red blood cells. The remaining plasma is spun down again at a faster rate of speed which separates the platelets into a pellet. Excess plasma is removed. The platelet pellet is resuspended into the remaining plasma. This "platelet rich plasma" or PRP is then injected into the affected area under ultra-sound guidance to ensure it goes to the desired location. No sedation is used. A small amount of lidocaine is injected to numb the skin for some injections. The entire procedure takes less than one hour.
Are There Any Risks to PRP?
PRP injection is exceedingly safe
Patients can use the affected area immediately. Most patients will have soreness lasting a few days. Any injection carries a very small risk of infection or of the patient feeling faint as a result of being injected. We have had no infections or complications from our injections. There is no radiation exposure from the ultrasound guided knee injection: unlike x-ray guided injections performed in some centers.
We are among the national leaders in the use of PRP injections. Because we have our own laboratory we are able to offer it very inexpensively, for a fraction of the usual cost.
PRP vs Stem Cells
Despite their tremendous utility in other disorders, there is very little Good Non-Proprietary Evidence that stem cells are useful in arthritis or sports injuries at this time. In contrast, there are many studies showing PRP to be effective. Stem cell treatments are also very expensive, usually costing between $5000 to $9000 for per treatments. However, we will soon be starting a limited stem cell study at a reduced cost to enhance the scope of our biologic treatments.
Joint Mobilization and Exercise
Reduction of knee joint contractures enhances the benefit of PRP. Affected patients will be put on a program to increase flexibility. Our licensed physical therapists will also design a custom exercise program for you that will allow you to maintain conditioning and muscle mass without hurting your affected joint.
Over-the-counter supplements can be very helpful. We will provide information on what we recommend and where to find it.
Problems That Can Be Treated
- Arthritis of any joint.
- Other select Musculoskeletal Problems
PRP is highly effective at reducing joint inflammation. Results after PRP are longer lasting if pills, creams, ice, wraps, and acupuncture are not used. This allows you to feel when you are damaging the joint and eliminate or reduce the offending activity.
Before You Have PRP
Do Not Take any of the Following
Medications (NSAIDS) for 10 days before the procedure.
- Aspirin *
- Ibuprofen (Advil, Motrin)
- Indomethacin (Indocin)
- Topical creams including Voltaren cream
It is OK to take Tylenol. *If you have been told by a doctor to take a baby aspirin every day, continue taking this. If you are unsure if something you are taking is an NSAID, please contact our office or your pharmacist
Let Dr Prodromos know if you are taking blood thinners, but they do not need to be stopped.
On the day of the appointment, it will take about an hour to prepare and inject the PRP.
You should not take any NSAIDs or other pain medicines for 1 month after the procedure (see the above list), and ideally stop using them entirely
You need to plan on having followup appointments 1 week, 1 month, 3 months and 6 months after the PRP injection.