Platelet-Rich Plasma (PRP) Injections: Can They Delay or Avoid Knee Replacement?

 

Understanding PRP for Knee Osteoarthritis

PRP therapy, which involves injecting a patient’s concentrated platelets into the affected joint, is increasingly being explored as an alternative to knee replacement for managing knee osteoarthritis. Its primary goals include pain relief, reducing inflammation, improving joint function, and delaying or avoiding surgical intervention. However, the effectiveness of PRP varies based on patient factors, disease stage, and injection technique.

PRP as an Alternative to Knee Replacement

For patients with severe knee osteoarthritis, especially those deemed "bone-on-bone," knee replacement is often recommended. However, factors like young age, work demands, or an active lifestyle may lead some to seek non-surgical options such as PRP. Additionally, patients who’ve experienced pain or limited success after a previous knee replacement may turn to PRP for relief.

Key Study Findings

  1. Delaying Knee Replacement:

    • A February 2021 study in International Orthopaedics reviewed 667 patients and found that 74.1% delayed knee replacement for more than 1.5 years, with an average delay of 5.3 years. Additionally, 85.7% did not require surgery within the five-year follow-up period.
    • Factors influencing PRP efficacy included disease severity, patient age, frequency of PRP cycles, and the injection technique.

  2. Pain and Function Improvement:

    • A December 2022 study in Cureus involved 30 participants with moderate osteoarthritis receiving three weekly PRP injections. Results showed significant improvements in pain (measured by VAS) and joint function (KOOS scores) within 90 to 180 days post-treatment. Ultrasound results also indicated cartilage repair.

  3. MRI Evidence:

    • A January 2020 study in the Journal of Pain Research revealed that PRP led to improvements in cartilage volume and reduced synovitis (inflammation) based on MRI imaging, though not all radiologic variables improved.

Limitations of PRP Therapy

While many studies highlight the benefits of PRP, not all findings are conclusive:

  • No Cartilage Growth: A July 2020 study reported no significant cartilage thickness changes over six months, despite improvements in pain and function.
  • Non-Superiority: A May 2022 meta-analysis from The Journal of Arthroplasty compared PRP to hyaluronic acid, corticosteroids, saline, and exercise therapy. PRP was effective for pain relief but did not demonstrate superiority in cartilage regeneration.

PRP for Advanced Osteoarthritis

PRP is commonly associated with early-to-moderate osteoarthritis. However, studies have shown that it can also offer pain relief and functional improvement for advanced-stage (stage IV) osteoarthritis:

  • A January 2022 meta-analysis reviewed 31 clinical trials and reported significant improvements in pain and function across all osteoarthritis stages.
  • A July 2023 study in Drugs and Aging suggested PRP may act as a disease-modifying therapy by counteracting cartilage breakdown, inflammation, and bone remodeling. However, evidence supporting its ability to slow disease progression remains inconsistent.

Practical Considerations for PRP Treatment

Patients considering PRP should understand that it is not a "cure" but a management strategy that may delay or avoid knee replacement. Treatment efficacy can vary, and multiple injections may be required. Consulting with an experienced practitioner who uses tailored techniques is crucial to optimizing outcomes.

Final Thoughts

PRP therapy offers a promising option for those seeking to manage knee osteoarthritis and delay knee replacement. While it may not work for everyone, studies suggest it can significantly improve pain and function, especially when traditional treatments no longer provide relief. Patients should discuss their specific conditions and treatment goals with their healthcare provider to determine if PRP is a suitable option for them.



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Pioneering regenerative medicine for over a decade, TriCell PRP stands as the global leader in Double-Spin PRP technology, trusted across Europe, Asia-Pacific, and the Middle East.

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