We are now pleased to offer ultrasound-guided PRP joint injections. PRP is a minimally invasive, non-surgical option that can alleviate pain, improve mobility and reduce inflammation resulting from injuries or chronic conditions. More and more patients are choosing PRP joint injections, especially for knee osteoarthritis, but it’s important to understand how it works and what to look for in a PRP provider.
PRP for muscle, tendon, ligament and joint injuries
PRP Joint Injections may be an effective treatment for many types of musculoskeletal injuries and conditions. For instance, chronic tendon injuries like tennis elbow or jumper‘s knee can often take months to heal, so adding a PRP shot to your treatment regimen can help to speed up the healing process, reduce pain and allow you to get back to normal activity sooner.
How does PRP work?
Human blood is composed of four key structures, including plasma, platelets, white blood cells, and red blood cells. PRP, when properly prepared, is a plasma with a high concentration of platelets, which is then injected into an area of the body, such as a joint, tendon, or ligament. Clinical research has shown that platelets naturally gravitate towards an injured area in the body and release growth factors. These growth factors aid in the healing of chronic tendon and ligament injuries, as well as muscle injuries.
What are the Risks of PRP Joint Injections?
Overall, PRP injections are very safe and well tolerated. Because PRP comes from a sample of your own blood, there is virtually no chance of allergic reaction. For safety, make sure that the provider is using PRP kits that are approved by Health Canada (or the FDA in the USA). The area should be cleansed carefully to minimize the risk of developing and infection. With any injection, there is a risk of pain, bruising, infection, and there are certain contraindications to having PRP Joint Injections such as active infection, blood disorders, certain medications, etc. A individualized consultation should be done before deciding on any procedure, to carefully weigh the potential benefits against the risks involved.
After the procedure, there could be some inflammation and even increased pain in the area for a few days. Patients are encouraged to ice the area and gradually mobilize as tolerated. For more specific instructions about what to expect and do after PRP Joint Injections, see our information page.
Who should NOT get PRP Joint Injections?
Certain conditions are contraindicated for having PRP Joint Injections, like active infection or very low platelet counts. In addition, PRP Joint Injections will simply not work as well for patients with more advanced osteoarthritis as it works best for mild to moderate cases. PRP Joint Injections have not been studied as well for certain areas and conditions, such as hip arthritis.
What to Expect
If you are thinking about PRP joint injections, we encourage you to book for a consultation with Dr. Yam to talk about your concerns. He will review your history, physical exam and other information as indicated including any imaging studies to help decide if PRP joint injections should be considered in your situation.
If you come in for PRP joint injections, be sure to read our PRP Treatment instructions before your appointment. At your appointment, we will start with a blood draw to check your baseline platelet counts and start processing the PRP. It takes about an hour to prepare high-concentration and quality PRP, which we will verify with our hematology analyzer.
Once the PRP is prepared, we check to make sure it is high enough in concentration and purity and also if the final dose of platelets delivered will be appropriate for the condition being treated. For example, we might use 1.5 million platelets per microlitre, a purity level of >98% and a final dose of about 7.5 billion platelets. If everything looks good, we carefully examine the area and use ultrasound guidance to ensure correct needle placement for the PRP joint injections.
PRP for Osteoarthritis
PRP joint injections are a natural, safe, effective, and non-invasive treatment designed to alleviate the painful symptoms of arthritis and improve joint function.
Osteoarthritis of the knee can lead to a significant amount of pain and disability and is one of the most common causes for visits to an orthopedic surgeon.
Osteoarthritis is a degenerative joint disease that occurs when the articular cartilage, the smooth, white substance covering the ends of each bone, wears down. This can cause the bones to rub against each other, resulting in pain, swelling, and stiffness.
People develop osteoarthritis because of the normal aging process or as a result of previous injury. Genetics may also play a role – if your parents or siblings have knee problems then you are more likely to get it too.
Osteoarthritis is often treated with medications such as acetaminophen (Tylenol), ibuprofen (Motrin/Advil), and other pain relievers and anti-inflammatory medication. Unlike cortisone and other medication, PRP is a natural substance, derived from your own body which contains growth factors and cytokines which have been shown to promote tissue healing and regeneration.
For many people, arthritis of the knee does not respond to oral medications—but pain from it is not severe enough for a person to consider having a knee replacement.
For patients with osteoarthritis, PRP joint injections may be a more effective alternative to over-the-counter medications such as Tylenol and Advil. Some people are too young for knee replacement surgery, but may benefit from PRP injections.
Over the years, PRP joint injections have become more popular as a treatment for people with knee pain due to osteoarthritis.
If you are considering PRP joint injections, it is important to understand that not all PRP is the same, and the quality of the PRP could affect your results. At PRP Medical Aesthetics, we use a hematology analyzer to verify the quality and concentration of every PRP joint injections treatment, to ensure that the right concentration is being used.
What does the Research Say about PRP Joint Injections?
It is becoming increasingly clear that PRP can be an effective treatment for joints. This is especially true for knee osteoarthritis, where studies on PRP Joint Injections have been accumulating rapidly over the years. A recent meta-analysis published in December 2021 in the medical journal Cartilage looked at 34 Randomized controlled trials (RCTs) comparing PRP joint injections with placebo or other injectable treatments and concluded that the PRP provides better results than other injectable options. The benefit appears to increase over time, being most apparent at 6-12 months after PRP joint injection treatment.1
Another systematic review and meta-analysis study in the American Journal of Sports Medicine from January 2021 looked at PRP joint injections vs hyaluronic acid (HA) for knee osteoarthritis and showed that mean improvement was higher in the PRP group (44.7%) than the HA group (12.6%) for a standardized WOMAC score after almost 1 year follow-up.2
Another systematic review and meta-analysis from August 2021, also in the American Journal of Sports Medicine concluded that PRP Joint Injections showed improved outcomes when compared to other injectables, including cortisone, hyaluronic acid and placebo.3
Another systematic review and meta-analysis from the Journal of Orthopaedic Surgery and Research in 2017 looking at only randomized controlled trials also concluded that PRP joint injections are probably more effective in terms of pain relief and function improvement than other injections, including saline, hyaluronic acid, ozone, and cortisone.4
Another systematic review from the Journal Arthroscopy in 2016 looked at six studies involving 739 patients and concluded that in patients with symptomatic knee osteoarthritis, PRP joint injections are better than hyaluronic acid injections up to 12 months after treatment in terms of pain relief and function.5
Although many studies, systematic reviews and meta-analysis have been published on PRP Joint Injections, not all of them are as conclusive as the ones above. A recent updated systemic review of orthobiologics, which included PRP joint injections as well as various sources of stem cells, concluded that despite the growth of the technology, there was uncertain efficacy.6
Part of the reason for the uncertainty in the use and results of PRP Joint Injections, as well as other uses of PRP is the lack of standardization. Unfortunately, many of the PRP kits being used today do not provide high quality PRP and often this may not even be known by the clinics who are offering PRP joint injections. The only way to be certain of the quality and concentration of PRP being used is to test it directly, which is why we use a hematology analyzer at our clinic to check the quality and concentration of every PRP treatment given. For more information, see this post on quality and concentration.
- 1.Filardo G, Previtali D, Napoli F, Candrian C, Zaffagnini S, Grassi A. PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. Cartilage. 2021;13(1_suppl):364S-375S. doi:10.1177/1947603520931170
- 2.Belk J, Kraeutler M, Houck D, Goodrich J, Dragoo J, McCarty E. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2021;49(1):249-260. doi:10.1177/0363546520909397
- 3.Singh H, Knapik D, Polce E, et al. Relative Efficacy of Intra-articular Injections in the Treatment of Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. Am J Sports Med. Published online August 17, 2021:3635465211029659. doi:10.1177/03635465211029659
- 4.Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12(1):16. doi:10.1186/s13018-017-0521-3
- 5.Meheux C, McCulloch P, Lintner D, Varner K, Harris J. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2016;32(3):495-505. doi:10.1016/j.arthro.2015.08.005
- 6.Delanois R, Sax O, Chen Z, Cohen J, Callahan D, Mont M. Biologic Therapies for the Treatment of Knee Osteoarthritis: An Updated Systematic Review. J Arthroplasty. Published online May 21, 2022. doi:10.1016/j.arth.2022.05.031