Hoag Orthopedic Institute - Hoag Memorial Hospital Presbyterian has developed a unique partnership with a select group of Orange County based orthopedic physicians with many years of experience providing care to orthopedic patients- orthopedichospital.com
American Society for Surgery of the Hand - Medical society for hand surgeons. Provides education for patients and health care professionals regarding diseases and injuries of the hand and wrist. - www.assh.org/Pages/Default.aspx
American Academy of Orthopaedic Surgeons - AAOS - Medical organization for orthopedic surgeons provides patient information on injuries and diseases of the bones, joints, ligaments, tendons, and muscles. - www.aaos.org
North American Spine Association - Non-profit medical society focused on improving spine medicine through advocacy, research and education. Includes patient information on spine disorders. - www.spine.org/Pages/Default.aspx
American Orthopaedic Foot and Ankle Society
WHAT IS PRP?
Platelet Rich Plasma is composed of plasma with a high concentration of white blood cells (WBC) and platelets containing growth factors. The WBCs help fight infections, while the platelets help clot the blood and contain the powerful growth factors needed to start the healing process. A normal platelet count is 150,000 - 350,000. PRP contains 3-6 times that number and sometimes more.
Surgeons now have a tool to significantly enhance the healing process and speed up recovery time. When we undergo surgery or sustain any kind of wound, our bodies go through a lengthy healing process. Our bodies call up natural healing factors, but sometimes that is not enough.
PRP helps jumpstart the healing process because it is a concentration of your own autologous platelets, which have reservoirs filled with powerful growth factors and healing agents. To get PRP, we obtain a small amount of your blood, 1-2 oz, then separate and concentrate the platelets. Your surgeon then applies the concentration of platelets to your wound, surgical site or injury site.
In many different surgical specialities, the data shows that PRP accelerates the healing process, slows or stops post operative oozing, reduces blood loss, accelerates bone regeneration, helps tendons and ligaments repair more quickly, reduces inflammation, and decreases postop time.
PRP Growth Factors:
Your platelets release healing proteins called growth factors. There are many growth factors with varying responsibilities, however, cumulatively they accelerate tissue and wound healing. Therefore, after increasing the baseline concentration of these platelets, we are able to deliver a powerful dose of growth factors that can dramatically enhance the healing process.
In summary, PRP growth factors: promote the growth of specific types of cells and tissues, increase development of new blood cells, accelerate bone regeneration, and initiate connective tissue.
Where can PRP be used?
PRP can be used in almost any surgical speciality where tissue or bone has been injured, cut or bruised, such as in orthopaedics, pain management and wound care.
How is PRP applied?
The use of PRP varies from procedure to procedure and can be applied in a variety of ways. Generally, it is sprayed on topically at the end of the procedure to control post-op oozing, to fixate small bone graft material, and to spread the concentrated growth factors under and around soft tissue and tissue grafts. PRP can also be injected into an injury site without an incision to help the injury site heal. The presence of high concentration of platelets starts and accelerates the healing process and reduces post operative swelling, bruising, scarring and pain.
Who makes PRP?
Most of the time, blood is drawn by a nurse or other qualified healthcare professional. An ABR technician specifically trained in proper application and use of PRP then processes the blood. Our technician will assist and advise the surgeon in the proper application of PRP. The process takes approximately 15-20 minutes.
Who can benefit from PRP?
Anyone, from professional athletes to those who enjoy recreational activities or whose wounds are difficult to heal, can benefit from PRP. If you have been told you need surgery for your ailment, PRP may be a way to avoid costly surgery.
Is PRP safe?
PRP is derived from a small quantity of your own blood. Using a tabletop device, your blood is processed and prepared at or near your bedside in your doctor’s office or surgery center. Since it is your own blood, there is no risk of disease transmission.
Documented uses of PRP:
Total joints (hip, knee, etc.), bone grafting, tennis elbow, plantar fasciitis, rotator cuff, ACL injuries, patellar tendons, tendinopathies, and muscle strains, just to name a few.
PLATELET GEL: HELPING YOURSELF HEAL
Understanding how your body’s natural growth factors can help accelerate the healing process.
How Long Has PRP been Used?
PRP has been used clinically for over a decade. Leading clinicians in specialties such as Orthopaedic Sugery, Dentistry, ENT, Facial Plastic & Reconstructive Surgery, Cardiovascular, Plastic Surgery, and Wound Healing routinely use PRP to deliver a “cocktail” of concentrated, natural, bioactive growth factors.
How Could PRP Be Used For Any Surgery?
The use of PRP varies from procedure to procedure. It can be applied topically to the wound site, via cannula or with a grafting material. PRP is often applied to bone grafts and soft tissue grafts to stabilize and up-charge the graft material. PRP is used to help fixate and accelerate bone growth in orthopaedic and dental procedures. PRP’s main benefit is to accelerate soft tissue healing in total joints, wounds, tendons, abdominal and plastic surgeries, up-charge bone regeneration, while also sealing wounds naturally and increasing the body’s natural capacity to fight infection.
Why Is PRP (Enriched with Growth Factors) Preferred Over Other Products or Methods?
PRP is the only available product that contains elevated levels of all your natural occurring growth factors. These factors are maintained in precisely the same ratios found circulating in your body. Although recombinant products are available, these products are usually synthetic derivatives of a single growth factor. Fibrin glues are another product readily available to the physician. However, the fibrin glues currently marketed do not contain any growth factors and are virally inactivated derivatives of blood components drawn from other donors.
Is PRP Safe?
PRP is derived from a small quantity of your own blood drawn at the time of surgery. The PRP is made point-of-care at the time of surgery and under physician’s control. Also, since the PRP is made from your own blood, it is insulated against the risk of disease transmission.
Who Makes PRP?
Historically, the production of PRP at the time of surgery was complex, time consuming, expensive, and required large blood volumes. The process often involved outside personnel and a transfusion of blood products. The recent introduction of automated, higher concentrated systems makes the benefits of PRP practical in the hospital and outpatient setting as well as more effective. Now, your surgeon or nurse can prepare PRP in parallel with the surgical procedure.
How Is PRP Made?
The surgeon draws a small amount of your blood at the time of surgery or in the office. The blood is placed in a specialized buoy that spins and automatically separates the red blood cells from the plasma into the platelet rich (concentrated growth factors) and platelet poor (hemostatic agents). The PRP (your natural growth factors) are then available for your doctor to use as needed. The entire process takes less than 15 minutes.
Golfer Tiger Woods and Kenyon Martin of the Denver Nuggets have both been treated with platelet-rich plasma taken from their own blood and inserted into the site of their sports injuries.
Seattle Mariners pitcher Cliff Lee used it for an abdominal strain. Denver Nuggets power forward Kenyon Martin used it on a strained left knee. Last year, Tiger Woods had injections of it in his left knee before four majors and Pittsburgh Steelers Troy Polamalu and Hines Ward used it to treat a strained calf and a sprained knee ligament before the team's Super Bowl win.
The treatment, known as platelet-rich plasma, or PRP, is one of a growing number of therapies that enhance the body's ability to heal itself. A physician extracts about one to two ounces of blood from the patient's vein and spins it in a centrifuge to separate out the platelets, the part of the blood that secretes growth factors to promote clotting and healing. The doctor injects that platelet-rich plasma back into the patient at the site of injury, where it spurs the repair of injured tissue. Most patients experience relief within several weeks.
PRP, which has been used in dentistry since the 1970s, has caught on only recently for treatment of orthopedic injuries—and on patients outside professional sports, too. It's sometimes used in conjunction with surgery, but most often by itself, and can sometimes eliminate the need for surgery. While it sounds like science fiction, it is legal for professional athletes to use—since it isn't injecting foreign or banned substance into the body.
Studies presented this month at the annual meeting of the American Academy of Orthopaedic Surgeons found that PRP was effective at treating chronic tennis elbow, severe Achilles tendonitis and osteoarthritis of the knee.
Some experts, though, say more research is needed to determine what kinds of injuries PRP is best suited for and whether it's better than standard therapies.
In the meantime, word is spreading about the therapy. PRP allowed Janie Frieman to return to playing tennis several times a week in Scarsdale, N.Y., after tearing a tendon in her forearm, and let Heather Hathaway get back to running her dog-boarding business in Brighton, Colo., after suffering for years with chondromalacia, a painful condition of knee cartilage.
"I was in so much pain that I hadn't slept for more than 45 minutes at a time for nearly a year," says Ms. Hathaway. "It's remarkable how much better I feel."
"Where it's been kind of a godsend is in tissues that traditionally don't do a good job of healing by themselves—like tendons, ligaments and cartilage," says David Karli, a physical medicine and rehabilitation specialist at Steadman Clinic in Vail, Colo., who has treated more than 1,500 patients, including Ms. Hathaway, with PRP.
It's also used to treat plantar fasciitis, an inflammation of the bottom of the foot, and muscle injuries. "I've used it for hamstring sprains, calf strains, oblique strains and found that it really helps decrease the healing time," says E. Edward Khalfayan, an orthopedic surgeon who is the team doctor for the Seattle Seahawks and Seattle Mariners. Ankle sprains, he notes, can typically keep a player sidelined for six to eight weeks. But with PRP, he says, "I've had players come back after two to three weeks."
Heart surgeons use PRP to strengthen tissues in bypass operations and some plastic surgeons and dermatologists use it as an alternative to facial fillers.
As useful as it sounds, some doctors caution that PRP's popularity has gotten ahead of scientific evidence. Research is still going on to determine not only what conditions it works best for, but also what concentrations of platelets are most effective, how many injections are most useful and at what intervals. "I get asked about this all the time—people have to be patient while we generate the data," says Rocco Monto, a orthopedic surgeon with offices in Nantucket and Martha's Vineyard, Mass.
While more research is necessary, doctors are increasingly using PRP for a wide range of problems:
• Recent research indicates PRP was effective at treating chronic tennis elbow, severe Achilles tendonitis and osteoarthritis of the knee.
• Has been used to treat plantar fasciitis, an inflammation of the bottom of the foot, as well as muscle injuries, such as hamstring sprains, calf strains and oblique strains.
• Heart surgeons use PRP to strengthen tissues in bypass operations, and some plastic surgeons and dermatologists use it as an alternative to facial fillers.
There have been few randomized controlled trials to date, and not all the results have been positive. One study presented at the orthopaedic surgeons conference found that one form of PRP was not effective when used to support tissue during rotator-cuff surgery. And an article in the Journal of the American Medical Association in January found that saltwater was just as effective as PRP for repairing mildly injured Achilles tendons in patients who had symptoms for at least two months.
But in a study of patients with more severe Achilles tendon problems who had failed other treatments, Dr. Monto found that 28 of them recovered well using PRP and needed no further treatment.
Indeed, some doctors believe that patients should try other, conservative approaches before PRP, since many injuries heal on their own.
"I would not start out using PRP - unless you've tried other treatments such as anti-inflammatories or physical therapy," says Brian Halpern, a specialist in non-surgical sports medicine at the Hospital for Special Surgery in New York City who says he has used it patients for two years with excellent results.
PRP has made doctors rethink the role of inflammation, which it increases temporarily in the affected tissues. For years, doctors have tried to reduce inflammation with anti-inflammatory medication, thinking it was the source of pain. "But rather than silence it, we want to harness the power of inflammation," says Dr. Monto. "By allowing the body to go through its natural healing arc, we can relieve pain by getting rid of the problem." To that end, patients need to avoid taking anti-inflammatories for several weeks after a PRP treatment, since they can counteract the healing process.
There are very few downsides to PRP, but one of them is pain—mainly because it involves injecting fluid into tissues that normally don't have much of it. Many doctors numb the site before the injection and give patients pain medication for 12 to 48 hours.
"I was in agony for awhile afterwards," says Michelle Pieffer, a 54-year old nurse from Bel Air, Md. She had such severe degenerative pain in both Achilles tendons that she could barely walk before she learned about PRP and traveled to Vail to be treated by Dr. Karli last April. "But by August, both of my tendons had completely regenerated," she says. "Now I have no pain. I work out. I even wear high heels. It's changed my life in a very profound way."
Patients do need to rest for a few days or weeks after the treatment to not push the injected tissue too quickly. "I follow patients at one week, four weeks, eight weeks and six months," says Dr. Halpern.
But there have been very few reports of problems. "The great thing about PRP is that you are using your own tissue. People do not have adverse reactions to their own tissue," says Dr. Halpern.
PRP has not required Food and Drug Administration approval, since it involves only minimal manipulation of a patient's own tissue, although the FDA does regulate the blood-separation equipment. And unlike human growth hormone, PRP is not banned by U.S. pro sports organizations.
The Canadian doctor, Anthony Galea, who treated Tiger Woods's left knee with PRP four times last year is under investigation for allegedly dispensing HGH and practicing medicine in Florida without a license. The PRP is not illegal.
Costs for PRP injections range from about $500 to $1,000 per treatment, and the costs are typically not covered by insurance, since it is still considered experimental. But doctors who use it expect the costs to come down and insurance coverage to rise as more studies are completed.
Osteoarthritis is the most common type of arthritis of the knee. In the United States alone, 27 million people suffer from Osteoarthritis. Frequently in patient’s with OA, the synovial fluid breaks down and doesn’t provide adequate lubrication for the patient’s knees. Patients complain that this condition interferes with their way of life and prevents them from doing things that they enjoy.
Discuss your pain with your doctor and work with him to find the right solution for you whether it is over the counter medications, prescriptions, steriod injections or viscosupplementation injections. There are three products on the market used by our office, Synvisc, OrthoVisc and Euflexxa. These products act like a lubricant for the knee joint and help to relieve pain and often improve function. They are injected into the knee over a period of usually three to four weekly appointments in the office. You should avoid strenuous activity for 24-48 hours after the injections.
Frequently you will hear our doctors refer to “NSAIDS”. Just what are those? NSAIDS are non-steroidal anti-inflammatory medications used for treating conditions such as arthritis. You are probably most familiar with aspirin and ibuprofen as being the two most common NSAIDS.
NSAIDS are more than just pain relievers, they are also great for reducing inflammation. They can cause stomach upset when taken over a period of time so be sure to mention to your doctor if you have existing gastric issues such as GERD (gastro-esophageal reflux disease) or ulcers.
NSAIDS are not just over the counter products but can also be prescription medications such as Lodine, Naproxen, Feldene, and Mobic to name a few. Again, if your doctor prescribes these medications and you have a history of stomach upset, be sure to let him know. He can prescribe medication to protect your stomach or alternatively prescribe you a COX-2 inhibitor in lieu of an NSAID.
COX-2 Inhibitors are a special category of NSAIDS. These medications target only the COX-2 enzyme that stimulates the inflammatory response. Because they do not block the COX-1 enzyme, these medications generally do not cause the kind of stomach upset or bleeding that traditional NSAIDS do. COX-2 inhibitors also do not offer the same kind of protection against heart disease. An example of a COX-2 inhibitor is Celebrex. You should not use traditional NSAIDS along with COX-2 inhibitors.
Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot or hypertension or if you are sensitive to aspirin, sulfa drugs, or other NSAIDS prior to starting COX-2 inhibitors.