The TRUTH about PRP for Joint Pain: Does It Really Work?

0:00 If you search PubMed, you'll find well over a thousand articles in the last decade. Hundreds of articles and more than 50 randomized control trials if you're really looking at the scientific literature. But what really is the truth about PRP? And does it work? Does it work for conditions like osteoarthritis? That's what I'm going to talk about today. I'm Dr. John Tate. I'm a non-surgical orthopedic specialist. And let's just run through some terminology first. So PRP stands for plateletri plasma. We'll get into the science of this in a minute, what that really means. PRGF is plasma rich in growth factors. PRF is plateletri fibbrin and PPP stands for platelet poor plasma. So all of these you'll see thrown about when you're searching this kind of treatment and

0:46 what you're trying to treat with these treatments. So some of these can be used in the orthopedic space, some are used in the aesthetic space, some are treated for other conditions like erectile dysfunction. So there's a lot of variations first of all and what are we using this for? But today of course I'm going to key in on orthopedic stuff because that's what I do. So first if we look at what PRP is stands for plateletri plasma. This means if we take blood from you through a standard blood draw and we separate the cells we'll separate out the red cells and the most of the white cells and the platelets in a system in our lab. And then we want to look at the the individual components of that. What are the fraction of these cells left behind? Because we'll talk about that in a minute. What matters in

1:31 getting the response we want around dose and concentration of these things. But to keep it really simple, if we eliminate the red cells and the white cells and we have the platelets left behind, we get a bunch of growth factors. And growth factors stimulate healing. Think about it as a cut on your hand that the body goes to work releasing growth factors to stimulate self-repair that cut. We don't have to think about it. We don't have to uh do reps every day uh specific exercises. It just heals. And so that's really the simple way to think about what is happening internally down inside this rudimentary drawing I have here of a joint. When we talk about cartilage and we talk about ligament, we talk about tendon, talk about these structures like a meniscus that can break down in the knee as one ages. That's most of what I'm treating in my practice. And that's

2:18 where we're used and have used these treatments for many many years uh in the US dating way back to my fellowship training in 200910 uh but in my own practice now for over 11 years using these type of treatments. So what happens as a joint breaks down. Let's talk about that. So on the drawing here we see a cartilage cap on the end of our bones. So first of all a lot of people you know mix words like osteopenia osteoporosis osteoarthritis and coingle them all together. So if we talk about osteopenia and osteoporosis we're referring to the bone health the bone strength. When we're referring to osteoarthritis it's a process by which first the cartilage starts to break down and degrade but eventually the bone will too and we can get things called uh cyst

3:04 beneath the surface of the uh cartilage into the bone. we can get what's called subcchondrial edema markers of more advanced arthritis. So if we get into our model being arthritis, it's graded. We have grades one stemming out to grade four. And this is early arthritis. And this is later stage arthritis where some people are told they have bone on bone arthritis where there's nearly a complete obliteration of the cartilage cap on the end of these bones that break down leading to a lot of pain, a lot of dysfunction in the knee. And then people can't perform what they want to do very well because of that pain. Quality of life is low and they get into interventions that are conventional such as corticosteroid injections. But we know going all the way back to 2015 and before that really there's published literature on the use of intraarticular

3:50 corticosteroid injections and way that why that may not be a good idea because we know it's going to help pain but damage the knee. It's condrotoxic meaning this cartilage we're trying to keep around actually breaks down every time we put a dose of cartilage in there. And this was published over a decade ago saying at dose it's toxic to the cartilage. Contrary to that, we'll look at platelets and and growth factors and what they can do in the cartilage is they stabilize. Okay? So, if there's an inflammatory process in the joint, which there typically is with arthritis, we have this looping looping phenomenon where the joint cartilage is stimulating the joint lining. Uh, and there's these inflammatory mediators called cytoines that continue to loop in there. So this

4:37 is a chemical process at first that starts to degrade the knee and people feel that and inflammation, soreness, pain, stiffness, but eventually with enough time turn time there there is going to be a mechanical degradation of that cartilage which you will see on a radioraph an x-ray as joint space narrowing. And that's what really gets us into the grading of the arthritis. Once people have lost enough to see on an X-ray, say a grade one into a two, they've already lost 10 to 20 to possibly 30% of the cartilage in there. So, if we move this over to the concept of why is PRP useful? If we take growth factors and we inject them inside the knee, we can stimulate that self-healing process uh that our body is designed to do. We have this innate capacity to

5:23 regenerate and heal just like that cut on your hand. So when we inject growth factors with precision into these areas of tissue damage, we can stimulate a halting of the inflammatory chemical process that stabilizes the knee again. So a lot of people are always excited about seeing changes on an X-ray. So we treat people and they're and they're better and they're happy. Uh they want to get an X-ray to see how much cartilage have I grown back. And this is one of the myths and misconceptions around this. Sure, in the published uh literature, there's been evidence of showing a millimeter or two thickness or density change in the cartilage, but you're not going to get macro changes in that cartilage. Think about it on the micro level, surface level. So that if we can repair some of that surface level

6:09 damage and first shut off this chemical process that's causing pain in the knee, then the body can self-restore some of that at the micro level on that surface, okay? But not at the macro level. So if somebody's already progressed to say a grade four knee and you put platelets in there, we've seen and often do pain relief that can be sustained. People can get sustained pain relief for a year or two, sometimes many more than that, but they're got not going to repair all the cartilage back. Okay, so this is where when do we want to treat with PRP? Like any disease, it's early in the process. Okay, we want to capture things early. And and then if we get over to, you know, what I call my three Ps, well, we got to look at the problem itself. Okay, what is the severity there? If we're talking about arthritis, what's the

6:55 grade? Where are we at in that process? Okay, then the second thing is the pattern. What's the pattern of the pain, the pattern of the dysfunction in the patient, what is limiting them and what are we trying to get them back to and is this the right match treatment for that? And then the the final P is really the patient themselves and what is the um the the positioning around this treatment for the goal. What is the aim that they have to get back to in life? Is this going to help achieve that or not achieve that? Again, so we have the problem, the pattern, the patient. We look at those three Ps all the time to say, okay, what what is the age of the patient? What is the severity of the problem? What is the pattern, the chronicity of this problem? Has it been here for a very long time? which gets us now over to more the nitty-gritty details around PRP. When we get over to

7:40 a successful PRP treatment, we have to talk about dose. So again, you can draw somebody's blood and depending on how much platelets you have in your blood, if we all took if we took the same volume from all of us right now, uh we get different platelet counts inside of the same volume of blood drawn. So when we take it over to the lab and we concentrate this down to get the platelet fraction, we'll end up with different amounts of platelets. And what we understand from the literature and people that have done the scientific research on this is there's a dose related response to this. Meaning we have to get a concentration of platelets. So if we take your platelets and say it's five times your baseline. Okay. Then we really want to look at the dose of the platelets themselves. So within that volume, how many platelets do you have? What the literature

8:26 supports is that you know for big joints it may be as much as 10 billion platelets you need dose-wise into a joint to have a successful treatment. For smaller joints it could be like five billion tendinopathies like u you know commonly tennis elbow and things like that maybe like 3 to 5 billion range. But we got to know what dose we're putting in there to see the response that we want to see. So, where I think see things falling short potentially in other practices or what people are marketed to with PRP products out there is that the front-end system that they're using to concentrate the platelets don't really do an adequate job of getting the dose and and therefore the concentration we need to have a successful treatment. So, somebody may get some short-term pain relief, but when I see a patient that

9:12 has had a PRP treatment and their pain relief is maybe only 3 to 6 months, to me, that's a failure. I want to see somebody have a nice response that has a duration of benefit that ideally goes for a couple of years. Um, you know, and that's that's achievable. And I've seen that often in my practice done the right way with the right systems and the right dose. And again, for the right problem, the right patient, right? and and what we're really trying to achieve to position them for success afterwards. So, this is a little bit high level on PRP today, a little bit of the science, a little bit of the why, but you really got to understand again because there's a lot of co-mingling of these terms out there on the internet when people are searching for potential solutions for the problem they have that they really have to get in the details. You really

9:57 have to know who's treating you. You really have to know how they're setting this up in their office, in the lab. uh what kind of training does the individual have? What kind of technology are they using in the lab and what is their track record really of success uh with their patients using these treatments? Uh but these treatments have been proven to be very safe and effective uh in the application in orthopedics. We've been using these in the US since the 1990s. And again going back to this uh system, you really have to look for the the right provider at the right time for the right situation uh to have success with PRP. So hopefully that helped you today understand a little bit about the uh truth and some of the myths and misconceptions around uh PRP that I've seen over more than a decade of doing this in my practice. If you like information like this, be sure to

10:43 subscribe to the channel. If you have any questions around PRP, drop it in the comments below and we'll answer as many as we can. [Music]