Monday, November 21, 2011 by Beny Charchian, M.D., M.S.
40 patients affected by severe hip osteoarthritis were included in the study which was designed to assess the safety and symptomatic changes of PRP injections for hip arthritis. Each patient received three intra-articular injections of PRP, which were administered once a week.
Statistically significant reductions in pain scores were reported at 7 weeks and 6 months. 23 (57.5%) patients reported a clinically relevant reduction of pain (average of 45%, range 30–71%). More importantly, pain relief was shown to be sustained at 6 months with a parallel reduction of disability. Side effects were negligible and were limited to a sensation of heaviness in the injection site.
We look forward to more studies being published detailing the safety and efficacy of Platelet-Rich Plasma Injections for a wide array for joint, tendon, and ligament problems which have failed to respond to other treatments- setting the stage for a new era in regenerative medicine.
Monday, September 13, 2010 by Steven Sampson D.O.
Many patients are fearful of having a total joint replacement. They often express it in our office. At times however the surgery can help the quality of their life & restore their activity level & function. However patients need to be mindful that with any surgery there are increased risks associated. Much of the decision on whether or not to undergo surgery depends on the patients underlying condition, what treatments they have tried & their responses, along with their expoectations and functional goals.
By 2030 there is an expected 670% increase in the demand for total knee replacements alone. Therefore we clearly need to embrace research & development for new therapies to address this growing population. Much research has turned to less invasive injection based treatments.
Unfortunately J&J announced last month that it is recalling 2 of it’s products used in hip joint replacements. The device was found to have appx a 12-13% failure rate. Appx 93,000 devises had been implanted worldwide with over 400 complaints registered with the FDA since 2008according to the NY Times. This results in increased expenditures on osteoarthritis
Sunday, September 14, 2008 by Steven Sampson D.O.
Despite the predominance of knee arthritis in the US, there are few good options for patients hoping to relieve pain & improve function. Physical therapy can help to increase muscle tone to the quadriceps muscles to reduce excessive workload on the joint. Also inflexible muscles can be stretched to restore the normal kinetic chain to reduce pain & prevent further aggravation of symptoms. Orthotics & braces may decrease the mechanical forces that are adding stress on the joint. However these treatments will not influence the underlying inner cartilage defects and biochemical environment.
Knee arthroscopies are quite popular and certainly have a role in particular cases including severe meniscus and ACL tears. However in a recent study in the New England Journal of Medicine, there was no demonstrable benefit of knee arthroscopies for moderate to severe knee arthritis compared to physcial therapy and medications. 92 surgical patients and 86 controls (Physical therapy & medications) were compared over 2 years.
The article was reviewed recently in the LA Times.
This article should raise awareness that we need to develop innovative approaches to maximize healing in an increasingly active population. Over 27 million Americans have osteoarthritis.
We are performing Platelet Rich Plasma Injection Grafts in hip and knee arthritis with encouraging results. The field of orthobiologics is rapidly growing and promises to deliver new approaches to treating tendon and cartilage disorders. In my practice we are treating meniscal tears immediately to accelerate healing. Many patients do not need an arthrocsopy after 2 months of the PRP graft and physical therapy. By potentially avoiding surgical meniscal repairs, we hope to reduce the incidence of subsequent arthritis. We are conducting studies to further refine the treatment to achieve a maximal result.
Wednesday, March 19, 2008 by Steven Sampson D.O.
After initially successfully injecting many patients with tendon & ligament problems, we have been expanding use of PRP to numerous regions including greater trochanteric hip bursitis among others.
A “bursa” is a small fluid filled sac that can be found in many areas that reduces friction of gliding tissues. This bursa fills with synovial fluid as a result of mechanical trauma/irritation & causes considerable pain. Specifically there is a bursa that lies on top of the greater trochanter (femur/hip bone). This pain can be debilitating. Often cortisone injections can be successful & provide temporary relief. However overuse of cortisone can cause adverse effects & should be avoided. Therefore PRP (Platelet Rich Plasma) injections under ultrasound guidance offer an appealing & safe alternative.
Below are case reports from a group in Texas that successfully injected PRP for hip bursitis.
Tuesday, February 26, 2008 by Steven Sampson D.O.
In a Jan/Feb 08 issue of Practical Pain Management, the authors describe PRP use in tendon injuries, spine conditions, as well as hip & knee arthritis. The article emphasizes a need for agreed upon nomenclature.
An interesting concept addressed is whether a gel matrix is needed for the platelets to adhere to the target site. Because of their structure tendons & ligaments may not require the gel, however it is not known if adding calcium chloride with thrombin to the PRP is needed in joint spaces like knee & hip arthritis. Further data needs to compare the usage with gel versus without.
The article showed x-rays post prp injection with subtle smoothing of a previously arthritic femoral head (hip bone). It is not clearly known how PRP acts on arthritis, however a particular growth factor found in PRP, TGF-B has been linked to cartilage growth (chondrogenesis). Furthermore, another study showed that PRP influences hyauloronic acid production which balances cell proliferation (angiogenesis). Also, the authors suggested a possible role in serotonin decreasing pain. Lastly, utilizing “stem cells” (the birth place of platelets and their precursors)may offer the most ultimate potential.