Procedure: PRP (Platelets Rich Plasma) injection for Knee Pain
The knee joint is the most complex joint in the body, not only does it transmit weight from the upper part of the body to the legs and feet, but it also allows its unique architecture, flexion, extension, and subtle interlocking to allow us to stand for sustained periods of time. It is truly a mechanical feat of a weight-bearing engineering marvel!
The knee joint is affected by almost all of the conditions that affect any other large joint.
Particularly disabling and quite common especially in the elderly is arthritis of the knee. Meniscal tears and tears of the lateral supporting ligaments, such as the medial and lateral collateral ligaments, and anterior and posterior cruciate stabilizing ligaments can also be injured either by trauma or natural degeneration.
This often leads the patient to try various treatments including intra-articular steroid injections, which are usually limited to no more than two injections per year. Although steroid injections do help, they cannot be used often and Platelet Rich Plasma can be an excellent alternative option.
Steroid injections are often given as a single injection for their efficacy, PRP injections are most effective when given more than once.
In a recent April 2021 article, a meta-analysis compared the efficacy of PRP with placebo and other conservative treatments, researchers reviewed 23 controlled trials in which PRP was compared to other treatments it was concluded when compared to placebo, PRP recipients had a lower pain scale and a higher knee function score by the sixth month of treatment. Improvement in function, pain, and stiffness was also seen.
When PRP was compared with oral NSAIDs, PRP had better functional scores, improved pain and decreased stiffness by the sixth month.
Pain scores were statistically decreased when using PRP.
The side effects of PRP versus placebo or hyaluronic acid gel injections were about the same.
The final conclusion is that PRP is more effective in relieving symptoms and the side effect profile is no different than other injections and its safety profile allows a greater more frequent use to maintain pain.
Before and After the Procedure and the Risks
Before the Procedure
You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. In particular, you should temporarily stop taking for at least 10 days before the procedure date, any medication that can cause unnecessary bleeding: Aspirin, Vitamin E, arthritis medications like Advil, Ibuprofen and blood thinners like Coumadin, Plavix, Trental, etc. The doctor will tell you if and when you need to discontinue the medications.
It is very important to tell the doctor if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to any local anesthetic agent used in the past, such as novocaine or lidocaine. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.
After the Procedure
Icing for 15 to 20 minutes several times later in the day of the injection is recommended, along with easy range of motion exercises of the joint. You may return immediately to work or regular activities after the injection. You may drive, although some people feel less nervous if they know they have someone along to drive them home. You should continue any physical therapy sessions already scheduled. You may be sore over the treated areas for the first 24 to 48 hours. If any unusual redness or swelling or warmth occurs at the injection site, notify the physician. You may continue taking all of your regular medications. It may take a few days for the corticosteroid medication to start working and you should notice long-term pain relief starting to work by then.
Procedure Risks
The risks, although infrequent, include: Allergic reaction to the medications used; Nerve damage; Bruising or infection at the injection site. If you experience persistent pain or numbness in the area of the injection site after the normal healing period (usually 3-5 days), you should call the doctor right away.
