We are delighted to announce our new service – Platelet Rich Plasma Injections (PRP) for osteoarthritis of the knee.

This service has specifically been developed to bring the best available evidence based treatments to our patients. There are now 14 high quality studies supporting the use of PRP for knee joint injection.

Together with our vast experience providing ultrasound guided injections and many years of clinical experience assessing and advising patients on the best course of treatment for their condition this is an exciting additional service for our patients.

Background on Osteoarthritis of the Knee

Osteoarthritis is one of the most common forms of pain and disability and affects millions of people around the UK and worldwide. Osteoarthritis is the medical term given to pain, stiffness and inflammation affecting joints – often times lower limb joints such as hips and knees are most affected because they are ‘weight bearing’ joints – that constantly take the weight and impact of the body as we move.

Osteoarthritis describes the normal aging process that occurs within the tissues of our joints. It can often be accelerated by trauma or injury to the joint – many patients we see with OA of the knees have had a previous injury or surgery to the joint when they were younger.

The mechanics of the knee joint itself are very complex. The knee comprises of the two longest bones in the body (femur and tibia) sitting immediately on-top of one another. The knee is prone to injury from certain forces such as twisting and rotation. The knee is a relatively unstable and vulnerable joint compared with other major joints of the lower limb. Knees are very prone to wear and tear, and this is particularly accelerated where there has been a significant injury in the past and also further exacerbated if people have had, for example, ACL reconstruction or other previous knee surgery. Other risk factors can include a history of injury or related to biomechanics of the joints above and below e.g. the hip and ankle.

Patients often then become caught in a cycle of pain which leads to muscle weakness and joint stiffness which in turn leads to further pain and loss of function.

What treatments currently exist for Osteoarthritis of the knee

The recommended first line treatment for OA knees continues to be exercise, painkillers and weight loss (see also https://www.nice.org.uk/guidance/cg177). Many patients find exercise difficult due to the levels of pain and that painkillers are ineffective and may cause long term side effects if taken for prolonged periods. If patients are unable to exercise they find it extremely difficult to lose weight.

Other treatments for osteoarthritis knee include steroid injection which can be very effective for pain relief, however for many people the relief may only last a matter of months.  There is also a limit to the number of steroid injections you can safely have (recommendations state no more than 3 injections per joint per year).

Hyaluronic acid injections can give longer relief but they are not effective for all patients and may need to be repeated every 6 – 9 months.

PRP for osteoarthritis of the knee - A man in a yellow raincoat with a rucksack on, sitting on a rock looking away from the camera

What evidence is there for PRP treatment?

There is a growing body of evidence to support the use of Platelet-rich plasma (PRP) injections. Much of the research to date has looked at the use of PRP for injections in knee osteoarthritis. The majority of studies have shown favourable outcomes for PRP injections for pain and function compared with control groups and alternative treatments (see below).

To date there has been no reports of any medically significant adverse effects of PRP treatment.  In the 14 studies considered by NICE a total of 1423 patients were included – no patients experienced any side effects apart from some minor post-injection discomfort and a few cases of patients reporting feeling dizzy or nauseous.

The treatment effects (reduced pain and improved function) from PRP treatment are still measurable in many patients at 12 months post treatment meaning that the long term effects of PRP perform better than any alternative treatments.

In January 2019 the National Institute for Clinical Excellence (NICE) updated their advice for PRP injections for knee OA:

https://www.nice.org.uk/guidance/ipg637

A summary document of the research that has been considered by NICE has been collated to provide patients and clinicians with an overview of research findings. A total of 14 high quality research trials were considered – comparing PRP with placebo, hyaluronic acid, painkillers (NSAIDs), prolotherapy and saline injections:

https://www.nice.org.uk/guidance/ipg637/evidence

Whilst recognising there is a significant body of evidence to support the use of this treatment, as with many relatively new treatments, there is a need for on-going research and data collection. The below link may also be useful for patients considering this treatment.

https://www.nice.org.uk/guidance/IPG637/InformationForPublic

PRP for Osteoarthritis of the Knee – Our ‘One-Stop-Shop’

Our expert clinicians will speak with you first over the telephone (or by email if preferred) to discuss whether Platelet-rich Plasma (PRP) is appropriate for your condition. It may be useful if you can forward copies of reports from previous orthopaedics consultations regarding your knees and also the reports from investigations that may have been undertaken already (e.g. X-ray or MRI scan).

At your appointment you will be assessed in relation to your biomechanics:- muscle strength and joint range of motion. We can also provide on-site diagnostic ultrasound evaluation which can be very helpful in determining the degree of changes within the joint tissues and thus helping to decide the best course of treatment.

PRP for osteoarthritis of the knee - Three seniour women holding hands walking away from the camera in summer through a park

What happens after the PRP treatment?

The specific details on PRP pre and post treatment care details can be found here: https://www.ultrasound-guided-injections.co.uk/prp-injection/

In addition, on the basis of our assessment we may recommend you for further strength and conditioning, physiotherapy, footwear/orthotic review. Occasionally we may recommend a formal dietary review with a recommended dietician or nutritionist, or refer you to one of our orthopaedic consultant partners, who can potentially review you and give you advice upon the potential surgical options.

How do I book for PRP Injections?

If you would like to speak to one of our expert clinicians who will be able to advise you whether PRP could be helpful for you please either call 020 7482 3875 or email injections@complete-physio.co.uk.

Fees – our standard package for OA knee injections are programme of 3 injections for total £1100 all inclusive.

 

Research Articles of Interest

Cook, C.S. and Smith, P.A., 2018. Clinical update: why PRP should be your first choice for injection therapy in treating osteoarthritis of the knee. Current reviews in musculoskeletal medicine11(4), pp.583-592.

Paterson, K.L., Hunter, D.J., Metcalf, B.R., Eyles, J., Duong, V., Kazsa, J., Wang, Y., Buchbinder, R., Cicuttini, F., Forbes, A. and Harris, A., 2018. Efficacy of intra-articular injections of platelet-rich plasma as a symptom-and disease-modifying treatment for knee osteoarthritis-the RESTORE trial protocol. BMC musculoskeletal disorders19(1), p.272.

Spaková, T., Rosocha, J., Lacko, M., Harvanová, D. and Gharaibeh, A., 2012. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. American Journal of Physical Medicine & Rehabilitation91(5), pp.411-417.