PRP Shots for Knee Arthritis – Are They Effective?

Aug 17, 2022 | Injections, Treatment

stem cells for knee arthritis

PRP (platelet-rich-plasma) therapy has been gaining popularity across a variety of areas, such as hair regeneration, wound healing, and skin rejuvenation. PRP shots for knee arthritis have been of interest due to the potential of stem cells to help slow the progression of arthritis.

A variety of high-profile athletes have also touted the benefits of PRP for the knee joint. Many claim the shots have helped them during their recovery from sport-related injury. Currently, over 80,000 athletes are treated with PRP every year.1 

Despite its growing usage, PRP’s therapeutic effect on muscle and bone-related injuries is not clear. If you are considering PRP shots for knee arthritis understand that this area has received limited attention by scientists. Therefore, it is difficult to predict how successful this treatment will be.

For starters, commercial PRP therapy clinics exhibit tremendous variability in their claims of PRP’s effectiveness (40-100%)2 in treating knee arthritis. Before committing to any invasive medical procedure, ensure that you are fully educated on the matter and have consulted your doctor. 

What Is Platelet-Rich Plasma (PRP)?

Your blood has four primary components: red blood cells, white blood cells, plasma, and platelets. PRP refers to a mixture of plasma and platelets isolated from the other aforementioned blood components.

PRP (Platelet-rich plasma): PRP refers to a mixture of plasma and platelets isolated from the other aforementioned blood components.

Plasma

Plasma is a clear yellowish substance that composes 55% of your blood’s total volume. Despite being 95% water it contains a number of important substances such as electrolytes, proteins, and hormones. Think of it as the “liquid” portion of your blood.

prp shots for knee arthritis use stem cells

Centrifuging blood separates it into platelet-rich plasma (yellow) and red and white bloods cells (dark red).

Platelets (Thrombocytes)

Ever had a papercut? Piercing the skin damages blood vessels and causes external bleeding. Fortunately, the bleeding eventually slows and then completely stops. We can thank our platelets for this. We have about 150,000 to 450,000 of them in every milliliter of our blood. These tiny cell fragments drive a process called coagulation. At sites of trauma, blood typically clots and turns into a semi-solid state; halting any bleeding. 

Individuals with a low platelet count are at a higher risk of excessive bleeding because they do not have enough platelets to cause the blood to coagulate around sites of trauma. While platelet’s primary role is blood clotting, they have secondary functions that can be leveraged to speed up tissue repair.

For example, platelets contain a number of growth factors and signaling molecules. These substances can increase stem cell activity, blood supply and the growth of new cells.3 Put simply, the rationale for PRP therapy is that injecting a concentrated dose of these platelets into damaged tissue will trick the body into increasing the number of molecules that promote healing in the area. 

How PRP Injections for Knee Arthritis Work

Using a syringe, a physician withdraws approximately 60ml of your blood. It is then placed into a centrifuge. These devices spin at extremely high speeds generating high centrifugal forces. As a result, the blood separates with denser elements sinking to the bottom of the container.

Once fully separated, the plasma and platelet components can be isolated into a solution (PRP). Approximately 2-6ml of PRP is then injected deep into the knee joint as close to the arthritic area as possible.3 

How Much Pain Relief Do PRP Shots Provide?

Unfortunately, many scientists are still asking this question. Research examining the effect of PRP on knee arthritis is still fairly young. Thus drawing a firm conclusion regarding the benefits of PRP for knee arthritis remains challenging because:

  • The number of studies examining the effect and time-course of PRP treatment are limited.4
  • Comparing PRP studies is challenging because there are a variety of types of PRP formulas used in the research.5
  • Some recent research shows that PRP does not outperform placebo injections.6

A study published in collaboration with Osteoarthritis Research Society International (OARSI) in 2019 compared the effects of PRP to a placebo injection of saline solution. After the injections, they followed patients for 24 weeks and assessed changes in knee arthritis symptoms along the way. Participants rated their knee pain on a ten-point scale.

During the study period, those who received the placebo injection improved on average by 3.5 points. (figure 1a). Those who were administered with the PRP injection had a slightly inferior improvement of 2.9 points (figure 1a). Despite continued improvement for the PRP group at week 12 (figure 1b), by week 24, both the placebo and PRP groups reported similar levels of knee pain.

It is possible PRP may provide you with pain relief, however, research into PRP shots for knee arthritis is still young. It is currently unclear how much pain relief this treatment can provide.

In contrast, a 2019 study published by the Journal of Arthroscopic Surgery found that PRP outperformed placebo injections.7 At 12 months patients who had received the PRP injection reported on average, a 21% increase in their overall knee function. While the knee function in those who received the placebo treatment remained unchanged. 

While there is potential that PRP may one day become a standard knee arthritis treatment, it will take time for the evidence to accumulate. As such, major medical authorities in the treatment of knee arthritis do not currently recommend the use of PRP for knee arthritis:

We strongly recommend against the use of PRP because the evidence in support of these treatments is of extremely low quality, and the formulations themselves have not yet been standardized. 8

– Osteoarthritis Research Society International (OARSI)

The evidence does not allow to make a recommendation for or against the intervention.9

– American Academy of Orthopaedic Surgeons (AAOS)

How Much Do PRP Injections Cost?

In 2018, the average cost for a PRP shot for knee arthritis was $744.00.10 Depending on your region it is common for the cost of treatment to differ by $150.00.10 In comparison, a single injection of Hyaluronic Acid (HA) costs approximately $400.00-800.00.11

Keep in mind that these are the costs for a single injection. If PRP is effective for you – more injections may be required to sustain any benefits. It is not uncommon to require up to three PRP injections within a six months time frame which could cost more than $2000.00.13 If you respond well to a course of PRP treatment, you may experience relief from symptoms for up to a year.13 

How Much Do PRP Injections Cost?

PRP shots for knee arthritis are relatively safe with no serious complications reported.11 However, patients should expect some moderate pain and swelling immediately after receiving the injection. Discomfort around the knee joint typically resolves in several days.11

Alternatives to PRP Therapy

PRP shots for knee arthritis are attractive to many because they are perceived as a natural and low-risk treatment. In contrast, corticosteroids – another popular injection have the opposite reputation. If you want to avoid surgery and the side-effects of anti-inflammatory painkilling drugs here are several viable options:

Offloader Knee Braces

Offloader knee braces address the root of the pain by decompressing the knee joint as it flexes. Some of these devices are able to reduce joint contact forces by over 40%12 during a deep knee bend. Less pressure results in less bone on bone knee pain and the potential to delay and avoid knee surgery. Learn more about how they work and the best products currently available. 

Exercise

Experts unanimously recommend exercise for patients suffering from knee arthritis. While exercise can provide tremendous benefit, performing the wrong type of exercise could be counter-productive. Check out this free guide to exercises for knee arthritis. Here you’ll learn the most effective types of exercise and be able to access free exercise programs designed for different stages of the disease. 

Additional Resources

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References

  1. Bowman, S., Awad, M. E., Hamrick, M. W., Hunter, M., & Fulzele, S. (2018). Recent advances in hyaluronic acid based therapy for osteoarthritis. Clinical and translational medicine, 7(1), 6.
  2. Ricci M et al (2017) Clinical comparison of oral administration and viscosupplementation of hyaluronic acid (HA) in early knee osteoarthritis. Musculoskelet Surg 101(1):45–49
  3. Bowman, E. N., Hallock, J. D., Throckmorton, T. W., & Azar, F. M. (2018). Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment. International orthopaedics, 42(4), 733-740.
  4. Divine, J. G., & Shaffer, M. D. (2011). Use of Viscosupplementation for Knee Osteoarthritis. Current Sports Medicine Reports, 10(5), 279–284. doi:10.1249/jsr.0b013e31822ed1b4 
  5. Bellamy, N., Campbell, J., Welch, V., Gee, T. L., Bourne, R., & Wells, G. A. (2006). Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane database of systematic reviews, (2).
  6. Ong, K. L., Anderson, A. F., Niazi, F., Fierlinger, A. L., Kurtz, S. M., & Altman, R. D. (2016). Hyaluronic acid injections in medicare knee osteoarthritis patients are associated with longer time to knee arthroplasty. The Journal of arthroplasty, 31(8), 1667-1673.
  7. Morgan, T. K., Jensen, E., Lim, J., & Riggs, R. (2015). Image-guided hyaluronic acid injection and knee bracing significantly improve clinical outcomes for high-grade osteoarthritis. Sports medicine-open, 1(1), 31.
  8. López-Ruiz, E., Jiménez, G., Álvarez de Cienfuegos, L., Antich, C., Sabata, R., … Gálvez-Martín, P. (2019). dvances of hyaluronic acid in stem cell therapy and tissue engineering, including current clinical trials. European Cells and Materials, 37, 186–213. doi:10.22203/ecm.v037a12 
  9. Lamo-Espinosa, J. M., Mora, G., Blanco, J. F., Granero-Moltó, F., Nuñez-Córdoba, J. M., Sánchez-Echenique, C., … & Villarón, E. M. (2016). Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: multicenter randomized controlled clinical trial (phase I/II). Journal of translational medicine, 14(1), 246.
  10. Bhadra, A. K., Altman, R., Dasa, V., Myrick, K., Rosen, J., Vad, V., … & Just, C. (2017). Appropriate use criteria for hyaluronic acid in the treatment of knee osteoarthritis in the United States. Cartilage, 8(3), 234-254. 
  11. Danilkowicz, R., Robinson, M., Steffes, M., & Marcus, M. (2017). Inflammatory pseudoseptic reaction to synvisc-one injection requiring diagnostic arthroscopy. J Case Rep Images Orthop Rheum, 2, 7-11.
  12. Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., … & Blanco, F. J. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 27(11), 1578-1589.