Platelet Rich Plasma (PRP)
Your blood is made up of mostly liquid (plasma) but it also contains some solid components (red blood cells, white blood cells, and platelets). Platelets are best known to be responsible for blood clotting, however they are also a rich source of growth factors and other proteins that enhance your natural healing and growth processes which are very important in the recovery of injuries. PRP is a concentration of platelets (therefore growth factors) in a small volume of plasma which is prepared by drawing your own blood, extracting the platelet rich portion by centrifugation, and then injecting back into the affected area.
PRP is an emerging treatment in a new health sector known as “orthobiologics”: the philosophy of which is to merge cutting edge technology with the body’s ability to heal itself. When injected, the concentrated platelets release huge reservoirs of bioactive proteins, including growth factors that help to initiate and accelerate tissue repair and regeneration. PRP initiates the body’s natural processes necessary for the repair of damaged or worn tissue, such as tendons, ligaments, cartilage and muscle.
A systematic review of all the recent research has confirmed the benefit of PRP in alleviating pain in osteoarthritis of the knee. It can also be used to treat all other osteoarthritic joints such as the ankle, thumb, big toe and hip.
PRP is increasingly being used as an alternative to a steroid injection to treat tennis or golfer’s elbow as well as many other tendinopathies. It can also be used to treat partial tendon, ligament or muscle tears as well as both acute and chronic injuries and may be recommended where conservative treatments have failed.
The main benefit of PRP is that it uses the body’s own natural healing properties to alleviate a pain or problem in the musculoskeletal system. Unlike steroid injections, there are no limits on the number of injections you can have.
PRP FAQ’s
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PRP may be a one-time injection but may need to be repeated depending on the condition and severity. For example, injections for osteoarthritis often last 6-12 months, but treatment of tendinosis may be possible with one injection.
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· PRP does not directly interfere with surgery.
· For the same joint, most surgeons wait 6-12 weeks before operating.
· For a different joint, surgery can usually proceed without issue.
· Your surgeon should know about timing of ALL injections.
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The degree to which PRP will work will depend on what condition it’s being used for (e.g., knee osteoarthritis, tennis elbow, rotator cuff tendinopathy etc.), as well as patient factors like age, severity of injury, and overall health.
Most people get benefit from the injection, and we are currently doing a study at our clinic looking at it’s effectiveness.
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Some patients may notice an improvement within 1-2 weeks. Results are individually dependant as some patients notice results right away and some take 4-8 weeks for the injection to start to work.
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nSTRIDE (autologous protein solution) is a version of PRP that is spun in the centrifuge twice and is specifically indicated for osteoarthritis. The second spin isolates more of the anti-inflammatory proteins.
Studies show that nSTRIDE has a longer duration of effectiveness and can last for multiple years.
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PRP is a safe injection with minimal risks. There is always a risk of infection with any procedure, although this is very minimal. Patients may also experience a post injection flare up of pain due to the healing response the PRP produces. If this happens it usually improves within 24-48 hours although has been longer in rare cases.
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This is considered an elective procedure and not funded by OHIP.
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Some private insurance plans may offer partial coverage under extended health benefits, but that varies and often requires patients to submit claims themselves.
The areas we have seen patients have PRP/nStride covered by their Extended Health Benefits are through “Health Spending Accounts” or as a “Medical Device” category.
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Yes. Cortisone can decrease the effectiveness of PRP. It is recommended to wait 6-8 weeks post cortisone injection before doing PRP to get maximum effectiveness.
It is also recommended not to have cortisone 6-8 weeks after a PRP injection. This is more applicable to the area that was injected with PRP as opposed to injecting cortisone in a different area. However, the administration of cortisone in any area has the potential to decrease the effectiveness of the PRP.
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No there is not an interaction between hyaluronic acid and PRP. In fact there have been recent studies looking at using the two together, as they work differently, to further improve outcomes.
Combining the two may not be possible depending on the size of the joint/severity of the condition due to the lack of physical space for the amount of fluid that will be injected. This would be assessed on an individual basis.
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Avoid NSAID’s 48 hours prior to injection. These may include but are not limited to Advil (ibuprofen), Aleve (naproxen), Aspirin (ASA). This includes both oral and topical formulations.
Drink plenty of water (1-2 L) starting the day before as well as the day of the injection as this helps facilitate the blood draw.
Tylenol (acetaminophen) is ok. Heat and ice are also ok.
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We usually recommend blocking off 60-90 minutes of time from arrival to time of departure. Most appointments are on the shorter end of this time frame. The blood is drawn, spun in the centrifuge, and then injected back into the affected area.
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Yes, we use ultrasound guidance with our PRP injections. It is not necessary for all injections but is available and most often used.
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Rest the injected area for the first 24-48 hours. You can do day to day activities but avoid strenuous activities or heavy lifting.
Gradually return to low-impact activity after 2-3 days, as tolerated.
Avoid high impact activities (running, jumping, heavy weight training) for at least 1-2 weeks.
No NSAID’s for 10-14 days post injection. These may include but are not limited to Advil (ibuprofen), Aleve (naproxen), Aspirin (ASA). This includes both oral and topical formulations
Tylenol (acetaminophen) is ok. Heat and ice are also ok.
DOWNLOAD POST PRP INSTRUCTION & CARE FOR HOME -
It is recommended to have a driver for hip joint injections. Most injections are ok to drive afterwards, but you may experience pain due to the injection, so it may be beneficial to have someone drive you.
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There is no set time between injections. We often suggest waiting 6-8 weeks between injections in the same body part so that the full effect may be evaluated before deciding if you need another one.
If you get an injection in one body part, you can get a PRP injection into a different body part at any time.
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PRP is being researched for spinal cord injury but is not yet an established treatment.
We do not do any spinal injections at our clinic. This includes both back and neck.
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It is possible you may be able to work after the injection, but this depends on your occupation as well as the body part being injected. You may experience local discomfort after an injection into an area that is already painful. We cannot make this decision for you and you would have to decide this on your own depending on the body part, the severity of the condition, how much pain you’re in at baseline and what the duties of your job entail description