Osteoarthritis of the knee, a common degenerative condition that causes pain and restricted joint movements, can severely affect the quality of life of those affected by it. Temporary relief can be had by injecting the knee hyaluronic acid injection or corticosteroid injection. The former may give up to 6 months of relief, but after the hyaluronic acid degrades the problem is still there. I am not a big fan of corticosteroid injections into a damaged joint. Think of the old days in professional and collegiate sports where a painful injury (whether it be ankle, shoulder, or knee) was injected. Often, within a few days, the patient had enough pain relief to get on the field. Guess what? Those players often ended up with sustained long-term injuries. I know, as I was one of the key physicians assigned to examine a number of post-NFL as part of the NFL Player’s Union CTE lawsuit. Mother nature gave us the sensation of pain from inflammation for a reason. It is her way of telling us there is an underlying injury and continuing on could make it worse.
Until recent times, knee replacement surgery was the only sustainable option for advanced arthritis of the knee. Surgery was recommended when patients didn’t get good pain relief from oral medications and other conservative treatments. However, with the advent of Platelet Rich Plasma (PRP) injection, it is possible in many cases to avoid surgical intervention. The injection of platelet-rich plasma isolated from the patient’s blood is a type of regeneration therapy that promotes the healing of damaged tissues and thereby reducing pain. PRP contains various growth factors that reduce destruction and promote the proliferation of chondrocytes and remodeling. With PRP injection, synoviocytes get activated and increase the secretion of mucopolysaccharides to build favorable surroundings within the joint. Stem cells are recruited in the process of regeneration. In a recent study, patients who received PRP saw regeneration of the cartilage with PRP based on MRI imaging. PRP injection may renew the tissue, allowing for decreased pain, growth of degenerated cartilage, and improved knee function. Moreover, PRP therapy is safe.
Ultimately, the goal of total knee replacement surgery is pain relief and return of function. Despite undergoing total knee replacement surgery, there is a likelihood of pain persisting or worsening in a significant proportion of patients even when the surgery is done properly. PRP injection is safe, requires no surgery, allows regrowth of cartilage, and brings pain reduction. Therefore, it can be argued that PRP should be considered before resorting to surgical treatment. BTW, PRP works similarly in ankles, hips, wrists, as well as shoulders. The only downside to PRP is it is not yet covered by most insurance carriers.
As a physician, people often ask me, “what would you suggest if it were your family member?” Without question, I would favor a safe regenerative procedure with PRP before undergoing the knife.