Platelet-Rich Plasma (PRP) for Osteoarthritis In The Knee

Osteoarthritis In The Knee – Overview

Osteoarthritis – or OA – is also known as degenerative or “wear-and-tear” arthritis. Similarly to other forms of arthritis, OA is an inflammatory condition that occurs when the body begins to attack and wear down healthy tissues and, in particular, the joints’ cartilage.

As the cartilage in the knee deteriorates, its cushioning and shock-absorbing effect declines. This exposes bones and other surrounding tissues to shock and friction damage. Today, knee OA is considered to be a leading cause of disability and a major source of societal costs among older adults.

Knee OA can stem from a combination of risk factors, including:

• Aging-related degeneration of the cartilage
• Overuse (e.g. playing sports or performing activities that involve repeated and forceful knee movements, such as jumping and squatting)
• Carrying excess weight or being obese
• A new or old knee injury that impacted the mechanics or structure of the knee (e.g. fracture or dislocation)
• Genetic factors, such as having thin cartilage 
• Posture and abnormal knee mechanics (e.g. valgus or varus knee)

Being overweight or obese can increase the risk of knee OA by 2.5 and 4 times, respectively.

Symptoms Of Osteoarthritis In The Knee

At first, knee OA manifests itself with pain and discomfort. However, as cartilage degeneration progresses, the unprotected bones of the knee joint begin to rub against each other during movement. This triggers a cascade of complications, including structural damage, reduced mobility, severe pain, deformities, and damage to structures such as ligaments, tendons, and nerves.

Some of the most common symptoms of knee osteoarthritis include:

• Chronic pain that worsens over time. It usually intensifies during or after movement.
• Stiffness and loss of flexibility. As cartilage degeneration progresses, you may become unable to fully extend or bend your knee. The swelling and pain associated with inflammation can also make movement difficult. 
• Swelling. Inflammation causes fluids to leak into the tissues surrounding the site of the injury – in this case, the knee. The build-up of fluids can reduce your knee’s range of motion and make movement difficult and painful. 
• Crepitus. Grating sensations accompanied by clicking or popping noises when moving the knee may occur when the damaged cartilage no longer lubricates the knee joint during movement. 
• Instability and inability to bear weight. Damage to the knee joint translates to a sense of instability and sensations that your knees will “give out” under your weight. 
• Bone spurs and deformities. As your body attempts to repair the damaged cartilage, it creates new bone tissue, which leads to bone spurs and deformities. These complications further reduce the knee’s range of motion.

Conventional Treatment Options

According to 2014 research, what makes osteoarthritis truly unbearable for many patients is the belief that this disorder is incurable and progressive. Making things worse is the fact that patients often have to endure years of taking medications daily or live in fear of requiring surgery.

These complications stem from the fact that, often, people are recommended treatments that involve pharmaceuticals or invasive procedures. These do very little to modify or reverse the disease, and they come with significant risks and side effects. Below, we’ll look at the most commonly prescribed therapies for knee OA.

Corticosteroid Injections

Corticosteroids are the synthetic version of cortisol, a hormone that is naturally produced by the body. Normally, this hormone is responsible for inhibiting pain signals traveling from the site of the injury to the brain, as well as reducing inflammation.

Corticosteroids are usually delivered in the knee area via injections and offer a longer-lasting pain-relieving effect compared to other medications. Nonetheless, taking corticosteroids comes with side effects such as mood swings, muscle weakness, and increased blood pressure. Recent studies also found that corticosteroid injections for knee osteoarthritis were associated with disease progression.

NSAIDs

NSAIDs – or non-steroidal anti-inflammatory drugs – are pain-killing drugs that work differently from corticosteroids. These medications work by blocking the cyclooxygenase (COX) enzyme, which is responsible for creating prostaglandins. Prostaglandins are chemicals that intensify pain signals, foster inflammation, and cause tissue swelling. By inhibiting the production of these chemicals, NSAIDs can offer temporary pain relief.

One of the greatest appeals of NSAIDs is that they are easily accessible as an over-the-counter alternative to ease pain. However, when taken chronically for long-term diseases like knee OA, they increase the risk of heart attack and stroke, cause stomach ulcers, lead to kidney dysfunction, and may even cause addiction.

Arthroscopy

Arthroscopy is a type of minimally invasive surgery used to diagnose and correct joint diseases. During this surgical intervention, a surgeon will use a thin viewing instrument called an arthroscope. The arthroscopy is inserted into the knee joint via one or more small incisions. The instrument can be used to take images of the joint or guide surgical repairs of areas damaged by osteoarthritis.

Although this surgery is commonly offered as a less invasive alternative than arthroplasty in the treatment of knee OA, the results of large randomized trials published in 2010 show that it is not effective in the treatment of osteoarthritis.

Osteotomy

Osteotomy is a surgical procedure that involves cutting off part of the bone (usually the shin bone or tibia). This surgical procedure can be used if OA has damaged one side of the joint, to re-establish knee mechanics and prevent further damage. It works by relieving the pressure on the side of the knee affected by reshaping the bones.

Compared to other surgical interventions, osteotomy is highly invasive, comes with severe side effects, and its outcomes cannot be predicted as well as for arthroplasty.

Knee Arthroplasty

Total or partial knee arthroplasty is an invasive procedure usually recommended when other treatments have not worked. It involves replacing damaged compartments of the knee – or the entire joint – with artificial prostheses made of metal or plastic. Parts of the knee that may be replaced include bones, ligaments, and cartilage.

Besides risks such as infection, allergic reactions, and blood clots, knee arthroplasty also involves lengthy recovery and rehabilitation times. What’s more, due to complications such as the artificial joint becoming loose and the pain persisting, 5% to 20% of patients require revision surgery after the initial intervention.

What Is Platelet-Rich Plasma, Or PRP?

Platelet Rich Plasma (PRP) refers to samples of the patient’s blood, processed to optimize the concentrations of platelets in the plasma. The platelets are components of the blood and are in charge of essential processes that take place during healing, such as clotting and stopping bleeding.

One of the greatest appeals of platelets is the fact that they have high concentrations of growth factors. Found within platelets in “packets” called alpha granulate, growth factors are proteins that:

• Stimulate the activity of repair cells, such as stem cells
• Are capable of calling to action repair cells from across the body and directing them to the site of the injury.

You can think of growth factors as “espresso shots” with the power to amplify the healing capabilities of repair cells.

Compared to normal blood, PRP contains higher concentrations of platelets – and, consequently, higher concentrations of growth factors.

PRP for Osteoarthritis In The Knee

Given the fact that the growth factors in PRP stimulate the body’s self-healing capabilities, this therapy is considered to be a form of regenerative medicine. In regenerative orthopedics, PRP is efficiently used to treat muscle strains and tendon or ligament tears, as well as to reverse minor arthritis and joint instability.

So far, over 30 randomized trials prove the efficiency of PRP in helping the body heal itself by stimulating the stem cells around the site of the injury. PRP can also be successfully used in the treatment of knee osteoarthritis.

For knee OA, PRP is used to stimulate the regeneration of degraded cartilage, as well as to repair damaged tissues and prevent disease progression. A study published in 2023 shows that PRP injections significantly reduce pain and stiffness while also improving knee function. Additionally, research published in 2021 and 2022 highlights that PRP injections offer better outcomes – including greater pain reduction, increase in pain-free walking distance, and improved function – than hyaluronic acid injections.

Why Are Orthagenex PRP Injections Superior?

Although PRP injections represent an innovative and superior way to treat knee osteoarthritis, not all platelet rich plasma formulations are created equally. At Orthagenex, our mission is to achieve optimal treatment outcomes and full patient satisfaction. To achieve this, we have introduced super concentrated platelets (SCP) – a cutting-edge technique – to create better, purer, and more concentrated PRP injections.

Using image guidance to enhance precision and proprietary laboratory settings to produce super-concentrated platelet rich plasma, Orthagenex offers PRP procedures that can be entirely customized to each patient’s health goals.

Here is what sets SCP apart:

Image-Guidance To Place PRP Solutions

Without image guidance, even trained physicians miss the target location of injections such as PRP 20-40% of the time. However, most orthopedic practices in the US offering PRP today perform blind injections, i.e. injections without any form of image guidance. And the physicians who do use image guidance often don’t have the training necessary to accurately interpret the results.

At Orthagenex, we understand that when your knee health is at stake, nothing should be left to chance. That is why we leverage cutting-edge techniques to guide our injections to the site of the injury:

• Ultrasound guidance: Using ultrasound waves, this form of imaging guidance offers physicians real-time images picturing the position of the needle from the moment it enters the skin. This significantly reduces reliance on tactile sensations and boosts the accuracy of the needle placement. 
• Fluoroscopy: Performed using a C-shaped machine, fluoroscopy is another form of imaging guidance, which leverages X-rays to offer real-time X-ray images to the physician during PRP injections. 
• Trained physicians: Without specialized training, the information provided by imaging guidance is wasted. That is why, at Orthagenex, each PRP injection is performed by physicians who are highly trained to use imaging guidance tools in combination and to interpret the results.

Interventional Orthopedics

Thanks to the innovative protocols introduced at Orthagenex, the use of imaging guidance in PRP is today recognized as a new medical specialty, interventional orthopedics. This field of medicine is based on three key principles: 

• The use of injectates to stimulate the healing of musculoskeletal tissues 
• The use of imaging guidance to improve needle placement accuracy
• The continuous innovation of tools and techniques to improve outcomes.

Lab-Processed For Higher Concentrations Of Platelets

The concentration of platelets in PRP, as well as the purity and customization of each injection, is what truly makes a difference in treatment outcomes. To ensure the best results through super-concentrated PRP injections, Orthagenex uses an in-house, state-of-the-art cellular lab environment.

To understand how this is in contrast with the protocols used by other clinics offering PRP, let’s look at the comparison below.

Most clinics use standard bedside centrifuge (spinning) machines to process the samples of blood collected from the patient. Not only are these machines not powerful enough to offer high concentrations of platelets, but they are also inefficient in removing impurities. The resulting mixture is then immediately delivered to the site of the injury, without further processing or customization.

Orthagenex uses a proprietary cellular lab environment within the clinic setting, where the patient’s blood sample is processed to create Super Concentrated Platelets. SCP is exceptionally pure, concentrated, and customized to the patient’s health needs.

Amber PRP vs. Red PRP

Depending on how it is created, PRP can either appear red or amber in color. Besides the difference in appearance, the color of the PRP indicates its level of purity and efficiency:

• Red PRP: Red PRP (leukocyte-rich PRP or LR-PRP) is high in white and red blood cells, as well as concentrations of platelets. 
• Amber PRP: Amber PRP (leukocyte-poor PRP or LP-PRP) is poor in white and red blood cells, and high in platelets.

Both mixtures are rich in platelets, but they don’t offer the same results.

According to our own lab tests, PRP mixtures that contain white and red blood cells – or are less pure – can have a counteractive effect. This is because the white and red blood cells inhibit the action of the same stem cells PRP is attempting to stimulate. Unfavorable blood cells may also contribute to inflammation at the site of the injury after the procedure. These side effects, combined, can decrease the efficacy of PRP.

On the other hand, amber PRP is poor in white and red blood cells. This characteristic reduces inflammation and increases the efficacy of each injection. Because of this, amber LP-PRP is the injectate of choice at Orthagenex.

Next-Generation Platelet Lysate

Platelet lysate (PL) injections leverage the same principles of PRP, but they are an advanced form of this treatment. Depending on your specific needs, the team at Orthagenex may use PL in combination with or instead of platelet rich plasma.

Here’s what makes PL different from standard PRP:

Standard orthopedic clinics are just getting to know the benefits of PL injections. In contrast, the Orthagenex team made them part of the protocol years ago, and it is now offering patients the third and fourth generation of PL injections while working on the next developments.

PRP Customized To Every Patient’s Need

With over 365 million people living with knee osteoarthritis, this condition is one of the most widespread musculoskeletal disorders worldwide. Nonetheless, the nature and intensity of the symptoms of knee OA will vary from one person to another. Because of this, a one-size-fits-all approach won’t just be inefficient, but also detrimental.

At Orthagenex, our goal is to provide each patient with a unique PRP treatment program designed around their unique needs and goals. To achieve this, we customize our PRP injections through our Flexible Lab Platform, and we combine platelet rich plasma with therapies like bone marrow concentrate and platelet lysate (PL) injections.

Here’s how we are able to offer this and more:

Solutions Are Customized Using A Flexible Lab Platform

Not all PRP injections are equally pure or effective. To offer superior concentrations of platelets and exceptionally pure injections, Orthagenex leverages a cutting-edge cellular lab environment called Flexible Lab Platform.

Through the Flexible Lab Platform located within each Orthagenex clinic, we are able to customize each injection, monitor the concentrations of platelets, and accurately remove unfavorable substances from the injectates. Each step of this sophisticated procedure is carried out by specialized physicians who are experts in cellular lab processing techniques, imaging guidance, and interventional orthopedics.

Bone Marrow Concentrate Can Be Used

Bone Marrow Concentrate (BMC) is offered alongside PRP. BMC is another form of regenerative medicine that involves using imaging guidance to inject high concentrations of stem cells into the site of the injury.

The stem cells are collected from the liquid part of the bone marrow, by cannulating the bone near the pelvis. Injected at the site of the injury, BMC is able to stimulate the healing and regeneration of damaged tissue by replenishing the levels of stem cells.

Doctors Specializing In Interventional Orthopedics

Although the use of advanced lab platforms and machinery is essential to create superior PRP injections, nothing of what is offered at Orthagenex would be possible without our team of specialized, highly trained physicians.

Each member of our team is a musculoskeletal (MSK) expert, specializing in imaging guidance. Our doctors are also board-certified and fellowship-trained in interventional orthopedics.

Currently, only 1% of US physicians are trained in interventional orthopedics. Given these numbers, our clinics have been able to help more orthopedic patients than any other regenerative medicine clinic worldwide.

Core Competencies

• Leveraging imaging guidance techniques to improve the accuracy of needle placement during PRP injections
• Using a proprietary, cutting-edge cellular lab environment (Flexible Lab Platform) to create customized, more concentrated, and purer injections
• Using superior amber LP-PRP as the PRP injection of choice
• Providing other interventional orthopedics therapies, including platelet lysate (PL) and BMC
• Using SANS – our proprietary method of evaluation

SANS (stability, articulation, neuromuscular, and symmetry) is an innovative evaluation method created to improve the accuracy of the diagnosis and treatment of chronic pain conditions.

Chronic pain is not always easy to diagnose, and millions of patients are often left to wonder what the real cause of their disorder is. Consequently, treating a condition with an unknown cause is challenging, often leading to undertreatment or misdiagnosis. Aside from the complex nature of chronic conditions, the reason behind this can be found in the lack of efficient evaluation tools. 

This is where Orthagenex stands out. The SANS approach allows our physicians to precisely diagnose the nature, cause, location, and extent of inflammation and pain. This creates a comprehensive clinical picture that can be used to guide treatment decisions and improve outcomes.

Orthagenex – Your Alternative To Osteoarthritis Knee Surgery

If you are tired of experiencing pain every time you take a step or wish to stop enduring the side effects of pain medications, you are not alone. Fortunately, thanks to the Orthagenex approach, based on the principles of interventional orthopedics, you no longer need to put up with the complications of OA.

Our customized PRP treatment programs are designed to help you regain knee function, reverse the progression of disease, and help you return to enjoying your life to the fullest.

Take the first step towards knee health: choose the Orthagenex approach.