So you received a Platelet-Rich Plasma (PRP) injection for your Orthopaedic condition, but it didn't help.
A few questions arise :
Is All PRP Created Equal?
Do All PRP Providers Have the Same Training?
Was the diagnosis correct?
There has been an explosion of medical clinics, sports physicians, musculoskeletal physicians, Orthopaedic surgeons and Radiologists offering platelet rich plasma, or PRP injections for joint and tendon conditions. So much so that I am beginning to see an influx of new patients attending OrthoRegen who have had a PRP injection at another clinic where it did not have the desired effect. One of the reasons is that there is a huge difference in the quality of PRP being created. The other stark difference is the expertise of the physician providing the injection.
It is a common occurrence where a new patient presents for their initial consultation with me and states that they have tried PRP and it didn’t work. They usually book the appointment thinking the next step is a stem cell procedure. My first question is asking the patient where they received the PRP injection? This enables me to understand whether it was a high-quality or a low-quality PRP treatment. Unfortunately, the information being provided to patients is that all PRP is the same. This could not be further from the truth.
So let’s delve into PRP and the different types that are used and what conditions they are used for.
What is PRP?
Platelet-Rich Plasma, or PRP is when platelets are concentrated from the patient’s whole blood. These platelets contain many different types of growth factors that aid in the body’s healing process. So, by using centrifugation protocols to concentrate the number of these platelets, physicians hope to provide pain relief and improve function through enhanced healing of the patient’s condition.
The different types of PRP
Over the years, as our understanding of PRP has increased, there have been a number of different types of PRP used. Here are the different types:
1. Red or Leucocyte-Rich PRP – concentrated platelets and white blood cells
2. Amber or Leucocyte-Poor PRP – concentrated platelets, but very few white blood cells
3. Autologous conditioned serum – high concentration of growth factors from white blood cells but no whole cells
4. Platelet Lysate – high concentration of growth factors from platelets, but no whole cells
Research has shown that the different types of PRP should be used to treat different types of conditions. For example, scientific research now shows that LR-PRP is better for tendinopathies and tendon injuries, whereas LP-PRP obtains better outcomes and less inflammation as a side effect from the injection for joint disease such as osteoarthritis.
Concentration of Platelets
To be honest, we still do not know what is the optimum platelet concentration or platelet number needed for optimal results. However, we do know that we have the best chance of positive outcomes if the platelet concentration is over 5-7x baseline. At OrthoRegen, we can “tailor-make” our PRP to what we are treating or for the patient’s age. Unfortunately, not all PRP systems are the same and there is a huge variability relating to platelet concentration and platelet viability. Therefore, it would be prudent for a patient considering PRP therapy to ask the physician what system they use and what concentration they obtain from their system. Your physician should also be using a cell counter to quantify the number of cells being injected and therefore the concentration being obtained. Most PRP providers are not utilising cell counters to provide this information.
Image Guidance
Just as the type of PRP being injected is important for healing, the way it is injected is also very important. Most physicians inject PRP blind, meaning without any ultrasound or x-ray guidance. This begs the question that if the PRP is not injected precisely into the damaged tissue, how is the tissue suppose to heal? Therefore, it is of paramount important that the physician treating you is an expert in ultrasound guided or x-ray guided injections.
Questions for your physician.
Below is a list of questions that will hopefully you make an informed decision on the clinic providing the PRP therapy
How much experience do you have treating musculoskeletal injuries?
How much experience do you have with PRP?
How much experience do you have with diagnostic musculoskeletal ultrasound?
What kind of PRP will you use? LR-PRP, LP-PRP, Platelet Lysate?
What system(s) do you use to produce PRP? Concentration? Cell counter?
Will you combine PRP therapy with any other form of therapy?
Have you had any complications following PRP therapy?
How many treatments will I need?
Will you combine exercise or rehabilitation with my PRP therapy?
How long will it take for my condition to improve after the treatment with PRP?
Summary
Remember, not all PRP is the same and not all providers of PRP therapy have had the training or experience needed to get the best results. There is a lot to know as a patient and a lot of misinformation out there. Do your research and ask lots of questions.
Dr Paul Schiavo is a specialist in regenerative medicine and the new field of Interventional Orthobiologics. Dr Schiavo is the founder of OrthoRegen, a premier Regenerative Musculoskeletal Medicine Clinic in Brisbane, Australia.
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NOTE: The reader can better comprehend regenerative medicine, musculoskeletal health, and related topics by reading this blog post's broad information. The language, graphics, photographs, patient profiles, outcomes, and other information included in this blog, website, or any related materials is not intended to be used in place of professional medical advice, diagnosis, or treatment. Please always seek the advice of a qualified healthcare practitioner before deciding whether to pursue a particular course of therapy.