Platelet Rich Plasma

 

what is PRP?

Platelets are pieces from cells called megakaryocytes which are produced in the bone marrow. Blood consists primarily of plasma (liquid), red blood cells, white blood cells and platelets. Platelets are best known for their importance in clotting blood, but they are also what triggers healing when an injury occurs. Platelets contains hundreds of different growth factors and cytokines essential to healing.

 

PRP can facilitate healing and decrease inflammation of tissue when the PRP mixture is introduced into the right location under precise guidance. Different locations and conditions in the body require different concentrations of platelets and leukocytes (white blood cells).

 

To make PRP, blood is drawn from the patient and mixed with a small amount of anticoagulant (so the blood does not clot). The blood is then placed in a centrifuge that separates the red blood cells, and the remaining platelets and plasma are then concentrated. The red blood cells are discarded. Depending on the location and condition, we will vary the concentration of platelets and leukocytes. This process, along with the injections, usually takes 30-40 minutes.

 

At the CAPRI clinic, we have done extensive research on the optimal PRP preparations for different conditions. We have a lab with a hematology analyzer so that we can measure the concentrations of the different components of our PRP.

 

A thorough assessment is perhaps the most important factor in PRP success so we can ensure we are treating the right area. Very often we will find that multiple areas need to be treated. Using the right concentration of PRP is also important, as this can vary for different areas and conditions. We also believe that image guidance by a skilled physician is important, in particular with tendon, ligaments and spine injections

 

frequently asked questions

What conditions can be treated with PRP?

 

PRP treatment is a good option for chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:

  • Neck injuries such as whiplash 

  • Rotator cuff injuries

  • Tennis & golfer’s elbow

  • Hamstring & hip tendon degeneration

  • Pubic symphysis injuries & instability (Athletic pubalgia)

  • Knee sprains

  • Trochanteric pain syndrome (hip bursitis)

  • Patellofemoral syndrome & patellar tendinosis (Jumper's knee)

  • Ankle sprains, tendon degeneration & instability

  • Achilles tendinosis & plantar fasciitis

  • Knee, hip, and the other chronic tendon and ligament problems

 

PRP can be very good at reducing the pain and disability of osteoarthritis for extended periods of time, but we do not consider PRP to “heal” or reverse arthritis changes. A joint with osteoarthritis has a high rate of apoptosis (death of cells). When PRP is injected into the joint, it changes the environment of the joint. Your body will start producing more healthy cells that can produce hyaluronic acid that cushions the joint, and cytokines and growth factors that stimulate the growth of new blood vessels. All of these factors allow the the existing cells of the joint to function better and live longer. PRP may slow progression of arthritis, but this has not been proven in studies at this point in time.

 

 

  • Knee arthritis

  • Hip joint arthritis

  • Shoulder arthritis

  • Wrist and hand arthritis

  • Spine (facet) arthritis

  • Any other joint arthritis

 

Back pain from the cushions (discs) of the back is a challenging condition to treat and there is currently no good evidence for surgery or other spine interventions in most people, but there are promising early studies with PRP. This is a procedure we offer at CAPRI which appears to be very safe and often effective.

 

Is Platelet-Rich Plasma covered by Alberta Heath Care or Insurance?

 

Alberta Health care does not cover the cost of PRP. Most private insurance plans do not pay for PRP either although you can use money from a health spending account if you have one. On occasion WBC will pay for PRP.

 

Do I need a referral from my doctor?

 

Yes.

Will I need to schedule a consult before the procedure?

 

Yes. We require an in-house consult that will take approximately 30 minutes for most conditions and 1 hour for spine conditions. The consult involves a review of you health history as well as a physical exam to identify any area that may benefit from PRP. We will review with you all treatment options including PRP, and lifestyle factors that could be modified to improve your joint health and the effect of PRP treatment. 

If you are found to be a candidate for PRP, it is ideal to get the PRP done another day after you have had time to think things over. However, we do offer same day consult and PRP, in particular if you are out of town. For spine PRP, we usually like to do some anaesthetic blocks to see if you are a candidate for PRP and if this is the case, you will need to wait till at least the next day to get PRP done. If a disc needs PRP, we sometimes require an updated MRI of your spine before injection.

 

How long do I have to wait after cortisone injection?

 

Cortisone will interfere with PRP therapy, therefore you should wait three months after a cortisone injection before PRP therapy.

 

Can I take anti-inflammatory pain relievers?

 

We ask that you stay off anti-inflammatory medication one week before and four weeks after the treatment. For this procedure to be effective, we need healthy inflammation to take place following the procedure to be effective. Tylenol, tramadol and opioid medications are allowed.  We have a list of the most common anti-inflammatories under our pre-treatment instructions.

 

What is the cost for PRP?

 

The cost for preparation of the PRP and injection of one tendon, joint or ligament is $400. For additional tendon, joint or ligament injections the cost is an additional $150 done the same day. This price is using Ultrasound guidance. 

The cost for preparation of the PRP and injection of one disc is $900. For additional disc injections, the cost is an additional $400 done the same day. This procedure requires Fluoroscopy guidance which is an additional $400.

 

For arthritis and most other conditions, evidence suggests that a second treatment gives best results. We typically recommend a second treatment 3 months after the first. We will NOT inject a disc more than once.

 

For patients treated for arthritis and for whom the initial treatments were successful from that point on we recommend a single treatment periodically as needed (varies between 6-18 months).

 

Are PRP Injections painful?

 

The amount of pain of any treatment depends on the area being treated. It can also depends on the skill of the physician and if image guidance if being used. With PRP Injections into joints like knees, one would expect only some minor discomfort. With injections in and around tendons and ligament one would expect more discomfort. All injections are normally tolerated well, but for some of the more extensive injections of multiple tendons, joints, or ligaments we often will use sedation with nitrous oxide or Penthrox. In some cases, we will perform a regional nerve block (freezing) before injecting the PRP.

 

There is usually some increased pain for a few days when multiple injections have been done and typically minimal to no increased pain with large joint injections (i.e. hips and knees).

What are the risks of PRP treatments?

 

As with any injection, there is always a risk of infection, serious bleeding or nerve damage, but this would be extremely rare and we cannot recall one case of any of these with PRP at our clinic over the past 10 + years we have been doing PRP.

 

Increase pain and swelling of the injection site for more than a few weeks is a risk, but this would still be quite rare. The main risk is that the treatment is unsuccessful.

 

 

When will I expect to see improvement?

 

 

Most patients report improvement within a month with the most improvement about 3 months after treatment. Improvement is measured not by only less pain, but the ability to be more active and improved function. Remember, we are using your platelets to incite a natural healing response, which takes time.

Will I need repeat PRP Injections?

 

In cases of tendon and ligament injuries the results are often permanent, but with joint arthritis, one would expect to need periodic repeat treatments. Most people with arthritis who experience success want another injection around the 1 year mark.

 

Will PRP regrow my cartilage?

 

Probably not. The goal of PRP treatment is to improve function and reduce pain.

 

Will PRP treatment allow me to avoid needing a

joint replacement for arthritis?

 

PRP treatment is very different than a joint replacement .The reasons one would choose one over the other will vary, so deciding which is better for you depends on many factors. PRP is less invasive and has less risk, whereas joint replacement is a more definitive option. Many people use PRP to delay the eventual need for a joint replacement. Some people are not candidates for joint replacement. Some do not want a joint replacement under any circumstance. While PRP for arthritis is a viable option to control symptoms and improve function, it is not a permanent solution and repeat treatments will likely be needed periodically.

How does PRP compare to Bone Marrow Concentrate (BMAC)

therapy in terms of success?

 

When we compare the results of BMAC therapy to similar studies of PRP, the success rate is within 10-20% of each other. The main difference is that a PRP treatment will need to be repeated sooner than BMAC treatments. The average time that PRP lasts is about one year, whereas BMAC treatments can last 3 years or longer. Currently in Canada, PRP is the only cell therapy injection available for joint problems. BMAC can only be used in the capacity of a Health Canada approved research trial.

 

Will PRP treatment work for me even though I am “bone on bone”?

 

PRP is most effective in mild to moderate osteoarthritis, but we have seen good results in some patients with end stage osteoarthritis as well.

What exactly does platelet rich plasma (PRP) therapy do?

Blood is drawn from your arm and the platelets are concentrated and re-introduced into the site of injury/degeneration. PRP consists of concentrated platelets from your own blood that release chemicals called growth factors or cytokines. They signal to other cells to gather and heal at the site of injury/degeneration. A joint with osteoarthritis has a high rate of apoptosis (death of cells) and the cells that replenish these dead cells are unable to keep up. When these healing cells are introduced into the joint through PRP, this changes the environment of the joint. Your body will start producing more healthy cells that can produce more hyaluronic acid that can cushion the joint and chemicals that stimulate the growth of new blood vessels. All these factors help reduce pain and inflammation and trigger your body’s natural healing response which may start to regrow the worn away tissue at the cellular level (typically not enough to be evident on a subsequent medical image).

How long is the recovery period?

The injected area may become inflamed and more painful than normal for a few days to a week. After this period, your pain should subside to the levels you felt prior to the procedure. Most of our patients start to see a reduction in pain in months 2 or 3 with maximal relief by month 6. Remember, we are using your platelet cells to incite a natural healing response, which takes time. 

I am traveling a long distance; may I schedule a consult and procedure

for the same day?

This is possible in some cases. The initial assessment is where we confirm whether you will benefit from the treatment or not so we cannot guarantee that you will be able to proceed with treatment. If you would like to do this, make sure you let the receptionists know and request all the instruction sheets for treatment to ensure that you are following all the guidelines that will give you the best chance of success. We also have discounted rates with the Greenway Inn and Best Western Plus  in Lacombe and Microtel Inn & Suites in Blackfalds (10 min. drive) if you plan to stay overnight. Be sure to mention CAPRI Clinic when booking a room.

 
 

pre-prp

Do not have a corticosteroid injection within 3 months before or after treatment.  These injections will inhibit treatment success and we will not treat a patient who has had a cortisone injection within 3 months of their scheduled procedure.  In the case that you have had a corticosteroid injection within the 3 months of your scheduled treatment please let us know as soon as possible so we can reschedule your procedure.

Discontinue taking anti-inflammatories and cholesterol-lowering medications (statins) one-week prior to and 4 weeks following your treatment. These medications have shown to adversely affect the healing cells used in our cell therapies and may inhibit your treatment. Anti-inflammatories include orally and topically administered medications such as Aspirin, Advil, Motrin, Aleve, and Voltaren. Please avoid taking natural anti-inflammatories such as turmeric or using ice as well. Other medications that treat pain, like Tylenol, Tramadol and other narcotics are permissible. Baby aspirin for heart health is OK. Statins like Crestor, Lipitor, Pravachol, and Zocor should be avoided.  Please only discontinue taking your statin medications if your doctor feels it is safe to do so.

Please coordinate having someone else drive you home following the procedure. There may be some increased soreness following an injection that could inhibit your ability to drive safely.

On the day of your procedure, please shower and wear clean clothes. This will reduce the risk of infection. You will be changed into our shorts, t-shirt, booties and a hair covering for the procedure to help prevent this as well.

Please do NOT wear any perfume, cologne, scented lotions, or scented hair products.

On the day of the procedure, we will proceed with your treatment only if it is safe to do so. If you show signs of infection (fever, chills, nausea) or if your blood pressure is too high we may need to reschedule your treatment. If you have high blood pressure, please take your regularly scheduled medication before your procedure.

Please eat a light meal before your procedure.

Have realistic expectations and be patient. A small percentage of our patients do not experience any relief from these treatments, however, the majority get a 50% reduction in pain or better. Our cell therapies encourage a natural healing process to take place. This takes time. Be patient. Although some experience relief within days, most won’t notice a difference until 8-12 weeks following treatment. 

 

post-prp

EXPECT POST-INJECTION SORENESS.  You may experience added stiffness, soreness, pain and discomfort in the area(s) you had treated for a few days or weeks following treatment.  Although some patients report no increase in pain, you may experience some increase in pain, or “flare-up,” especially during the first 24 hours after treatment.  Our therapies stimulate healing by causing local inflammation, so soreness is a normal response, please do not panic.

 

PLEASE COORDINATE HAVING SOMEONE ELSE DRIVE YOU HOME FOLLOWING YOUR PROCEDURE. There may be some increased soreness following an injection that could inhibit your ability to drive safely.

 

DO NOT USE ANTI-INFLAMMATORY OR CHOLESTEROL-LOWERING (STATINS) MEDICATIONS OR ICE ON THE INJECTION SITE(S) FOR AT LEAST FOUR WEEKS AFTER TREATMENT.  Medicines such as aspirin*, ibuprofen, Naproxen, or Aleve (either oral or topical) including natural anti-inflammatories, like turmeric, and/or ice may limit the benefits of treatment. Statins (Crestor, Lipitor, Pravachol, and Zocor) should be avoided as they have been shown to be harmful to the healing cells used in our cell therapies.  Topical creams should also be avoided for 4 weeks after treatment. Corticosteroid injections should be avoided for 3 months after treatment. You may use heat for 15 minutes at a time along with gentle stretching to relieve discomfort. Using acetaminophen, narcotic pain medicines, or muscle relaxants may also relieve pain without interfering with the effect of the treatment.  

*Baby aspirin (81mg) for heart health is OK to use.

 

IT IS CRITICAL TO REST TO ALLOW YOUR TISSUE TO HEAL. We recommend that you rest for a minimum of three days after treatment, which means minimal weight-bearing activity (minimize activities such as standing, walking, stair climbing etc.), this includes operating motor vehicles.  After this time, we would like you to ease yourself back into normal activity of daily living as tolerated. Avoid heavy exercise or impact sports for the first 4-6 weeks after treatment. Physical activities such as walking, cycling, swimming and gentle stretches such as yoga are encouraged as tolerated after two weeks.  The rehabilitative stretches and exercises you received should be started gradually, after two weeks, or as soon thereafter as you are comfortably able.  A common setback is that people will feel better soon after the treatment then overdo it by deciding to catch up on all the manual work they need to do, such as yard work or housework.

 

BE PATIENT WITH THE HEALING PROCESS AND CURB UNREALISTIC EXPECTATIONS. Although some patients notice a reduction in pain within a few days after treatment, most start to notice pain relief between 3-6 months.  Most often, maximal pain relief is not experienced until 6 months after treatment. Repeating the treatment may be necessary to optimize benefits, especially for old chronic injuries or advanced, “bone-on-bone” arthritis.

 

Ibuprofen (Advil, Motrin, Robaxasal)

Naproxen (Aleve)

Celecoxib (Celebrex)

Indomethacin

Ketoprofen or Ketorolac (Toradol)

Anaprox

Piroxicam

Sulindac

Topical NSAIDs (ie. Voltaren,

diclofenac, Rub A535, etc.)

These are the most common anti inflammatories (NSAID) and statin medications (used for high cholesterol) that you will need to discontinue for ONE WEEK prior to and ONE MONTH following your procedure. If you take any medications for any other purpose, please continue to take them like normal. For example, if you take medication for high blood pressure, please continue to take those like normal. If applicable, we would like you to continue taking baby aspirin for heart health as well. Any Tylenol (Acetaminophen) product can be used as a substitute pain killer if necessary.

Common Natural Anti Inflammatory Medications

Turmeric

Boswellia

White Willow Bark Extract

Ginger Root Extract

Bromelain

Quercetin

Devil's Claw

Common Anti Inflammatory Medications

 

prp appointment overview

Consultation

At an assessment appointment the doctor will review your medical information and perform an orthopaedic exam on the areas you would like considered for treatment. You will have a chance to ask the doctor any questions you may have. This is when the doctors will collaborate with you to finalize the areas to be treated, so any joint you would like considered should be brought up at this  appointment. Please keep in mind that assessing certain areas may take more time:

  • Tendons, Joints & Ligaments Assessment - 30 minutes

  • Spine or Neck Assessment- 60 minutes

Treatment

Once in the procedure room, we will extract a sample of blood, typically from your arm. The blood will then be processed in a centrifuge to concentrate the platelets, and this concentrated solution will be injected directly into the areas discussed at the assessment. This is all completed under ultrasound guidance. After the procedure you may be provided with a prescription for a pain killer(Tramadol or Tramacet). You can try Tylenol extra strength and fill the prescription only as a last resort. We will contact you within a week after the procedure to check on your recovery and answer any questions you may have.es) 

  • Tendons, Joints & Ligaments PRP: 30-45 minutes

  • Spine or Neck PRP: 60-90 minutes 

© 2016 CAPRI Central Alberta Pain & Rehabilitation Institute