Since the first Randomized Controlled Trial (RCT) 9 years ago (1), there have been over 40 studies that support the significant benefits of Platelet-Rich Plasma (PRP) in knee OA. PRP is superior to saline placebo at 6-12 mos, and though Hyaluronic Acid (HA) parallels PRP at six mos, it is not beneficial at 12 months.
There are large differences between the manufacturing of products and concentrations of what is actually injected into an arthritic knee. In fact, some studies (2) showing minimal benefits of PRP in knee OA only concentrated the platelets 1.2x that of the serum normal levels. Those trials purporting better outcomes achieved concentrations 5-7x blood platelet levels, with much improved results (3). This does require a larger draw of blood from one’s arm, up to 120cc, compared to lesser amounts in the 15-20 cc range that were used in the less beneficial studies.
Outcome scores reviewing pain and function were improved regardless of the degree of joint space narrowing, including more advanced stages of arthritis. One study (4) showed PRP was equivalent to Bone Marrow Aspirate after one year. Data from 2018-20 at the Mayo Clinic Jacksonville Campus showed over 90% satisfaction, and only 9% of patients went on to Total Knee Replacement (Personal communication Shane Shapiro, MD).
Finally, Knee OA is a disease, and it can be managed, but not always cured, using PRP, physical therapy, bracing, and safe alternatives. Much like hypertension and high cholesterol, we aim to control, not cure the disease. A Total Knee Replacement is a cure for a painfully arthritic knee joint and is always an option to discuss with your orthopedic surgeon or healthcare providers.
References:
1. Patel S, et al; Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013; 41(2): 356-64.
2. Degan RM, et al. Commercial separation systems designed for preparation of platelet-rich plasma yield differences in cellular composition. HSS J. 2017; 13(1); 75-80.
3. Baria M, et al. Cellular Components and Growth Factor Content of PRP with a Customizable Commercial System. Am J Sports Med. 2019 Vol XX, No. X, XXXX. pp 1-7.
4. Anz, AW, Andrews, JR, et al. Bone Marrow Aspirate Concentrate Is Equivalent to PRP for the Treatment of Knee OA at 1 Year. Orthop J Sports Med, 8(2), 2020. pp 1-9.
5. Cook CS, et al. Clinical update: why PRP should be your 1st choice for injection therapy in treating OA of the knee. Curr Rev Musculoskeletal Med . 2018; 11(4): 583-92.
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