Platelet Rich Plasma Injections

Early in Dr. Nielsen’s career, he realized that no physician was trained to repair joints and ligaments. We delayed healing with Motrin, eased flare ups with physical therapy, and finally removed the joint replacing it with metal. For 13 years, he specialized in delaying surgery, then referring to the best he could find. In his 14th year, he discovered Prolotherapy, a simple procedure of injecting simple sugar into tendons to repair them. The journey began, with a study of biochemistry, then, a decade ago, they invented Platelet Rich Plasma and Stem cell therapy – a revolution. Now, we can FIX joints and their capsules. He studied the $10,000 Stem Cell therapy but it was little better than PRP at $600. No wonder PRP’s existence is suppressed by Corporate.

The procedure is simple – draw 80 cc’s of patient blood with a bit of anti-coagulant in a tube, spin it at 4000 RPM’s for 15 minutes and remove the Growth Factor layer. This amount of product will treat one knee or shoulder, two hips, the lumbar spine or neck. In moderate cases, it will be permanent, in severe cases it may last 5 years.

Prior to visit, we need a Limited New patient visit for PRP, to review all x-rays and MRI’s, medication and confirm minimal lab is complete. Every PRP patient should have a CBC to rule out anemia, a Sed rate to rule out Inflammatory arthritis, a uric acid for gout, and limited hormone workup (total and free testosterone for men, FSH for women to rule out menopause). This is a link to a thorough discussion by another PRP Physician.

PRP, Platelet Rich Plasma injections were developed by an orthopedist at Florida State Medical School ten years before it became commercially available. Orthopedist have been slow to accept it as a $50,000 knee replacement is replaced by a $600 injection.

In 2008, PRP was taught at the annual International meeting of the American Association of Orthopedic Medicine. I came home from the meeting excited to get started a month later. It replaced Prolotherapy which I had been performing since 1993. PRP is faster, less painful and cheaper.

Purpose
Trigger repair of cartilage, ligament and tendon with the bodies own growth factors. Ligaments and tendons contain no cells, they are inert structures that have no ability to heal. PRP triggers formation of Stem cells that create new tissue. This is not true of damaged cartilage in arthritic joints. They are directly stimulated to heal and make new joint surface.

Mechanism of action and how Stem cells work
White blood cells and platelets contain hormones and chemicals that trigger the conversion of Stem Cells to tissue specific healing factories. Prolotherapy triggered migration of WBC’s to tissue. PRP triggers conversion of Stem Cells to activity. Stem cell therapy does the same for 20 times the cost.

Cortisone is the opposite of healing. Inflammation is caused by healing. Cortisone poisons healing relieving pain for 2-6 weeks and turning off healing for 4-6 months accelerating arthritis. This has been proven in dozens of studies. Get cortisone only in life threatening illness, never for pain control.

Prior surgery decreases but does not stop the affect of PRP. Because surgery cuts ligaments and carves away cartilage and replaces it with scarring and metallic items. You can never get back to normal after surgery. PRP should always be investigated prior to surgery.

Technique
Each 7.0 cc’s of PRP is made from 80 cc’s of whole blood, drawn into a natural anti-coagulant, Sodium Citrate. The 80 cc’s is put in six 13cc volumes and sput in a centriguge at 4000 RPM’s for 15 minutes. The resulting blood layers from top to bottom as 7 cc’s of Plasma, 0.5 cc’s of white blood cells, 1.2 cc’s of PRP, and 4.3 cc’s of compressed blood.

Injections are performed using a Flouroscope (my technique) which allow direct vision of bone, spurs, spaces and joints. Some clinicians use Ultrasound which is useful, but information is limited. Each injection is preceded by an injection with Lidocaine to numb the skin to reduce pain.

Complete workup, find the true cause of disease.
Knee pain can be caused by knee, hip, low back, or sacroiliac problems. That same knee may be Gout or Rheumatoid. Cortisone reduces testosterone which then makes PRP not as effective.

A good workup includes plain x-rays of adjacent joints, the opposite side, blood work for inflammation, low hormones, to avoid inappropriate therapy.

Success Rate
On average, 85% of my patients show improvement. Each person’s response depends on prior cortisone use, surgery, and most important- severity of injury and loss of tissue. Any patient can be helped but severe arthritis may require repeated injections over a few years where moderate problems may be fixed at one session-permanently.

Cost is $600 for one treatment with 7.0 cc of PRP.
However, doubling therapy to a double draw, 14 cc’s is $800 and Triple is $1000. This triple draw is less than a single draw at most offices.
Cost should always be compared to current therapy. Orthopedic consults can cost thousands with co-pays of hundreds of dollars and you get nothing but cortisone and surgical plans. Usually they send you to physical therapy with hundreds in co-pays. PRP reduces chiropractic visits by ½ to 2/3’s so if you’re spending $1000 a year, in one year, you are saving money.

Why Double and Triple draws
One knee or shoulder needs 7.0 cc’s. A hip requires 3.5 cc’s so both hips can be treated in one draw. A triple draw at one session can treat two hips and two knees.

This type of decision making can be worked out at a first visit.

Neck and head
Cervical disc disease, TMJ (jaw joint), C1-C2 Instability (Gonsted) can all be treated. If spinal cord compression is present, we must rule out instability with Flexion Extension x-rays because then stenosis can be assisted. Compressed nerves cannot be treated if the foramina is compressed but the facet can be reconstructed and making neck pain dissolve.

Shoulders
Rotator cuff syndrome is one of the perfect disorders PRP treats, the shoulder has a dozen ligaments and tendons making up the capsule and cuff. Surgery cuts through two or three to fix one or two. Some of the ligaments cannot be repaired by surgery. PRP can inject any tendon or ligament. Surgeons fix damaged Acromioclavicular joints (clavicle to shoulder) by cutting out the clavicle and throwing it in the trash. It’s simple to treat. Arthritis is treated with shoulder replacement, but Synvisc or PRP can relieve all but the most severe Glenohumeral arthritis.

Elbow, Wrist and Hand
Tennis elbow, elbow, wrist and finger arthritis are all treatable. A single draw can treat every finger joint in one hand, or both wrists and thumbs.

Rib Heads and Chiropractic
The most common procedure for chiropractors is to relocate rib heads causing back and chest pain. PRP cuts these visits quickly and usually eliminates the problem. Low back, facets Scoliosis and sacroiliac.

The most common reason for double draw in my practice is broad lumbar disc disease associated with sacroiliac instability. Surgeons operate at one level on one side cutting through critical ligaments which is why our local success rate is well under 50%. Low back and leg pain from disc narrowing is complex, being caused by lax ligaments, damaged facets, misalignment and stretched sacroiliac capsules. One double draw can treat the entire low back.

Hips
Perhaps the simplest procedure in PRP, two hips-one draw. The hip joint is so small that 3.5 cc treats the entire joint and capsule. Moderate arthritis is easily treated.

Knees
Pain in a knee can be referred from elsewhere. In the knee, it may be fibula from the ankle, collateral ligaments, cruciates, the knee cap, meniscus, or arthritis. All of these can be treated at one visit where surgery aggravates one while hurting the others.
Combining Synvisc $110, with PRP can greatly increase arthritic recovery.

Ankles, Feet, Plantar Fascia, Bunions
The foot and ankle are very responsive to PRP, even bunions can be made pain free (but not straightened). Feet really require MRI to do accurate injection though much is to be learned from plain x-rays, as well.