Effective Osteoarthritis Treatment with Platelet Rich Plasma (PRP) and Hyaluronic Acid Birmingham
Updated: Jul 8, 2020
Osteoarthritis is a very common condition, particularly knee osteoarthritis. Osteoarthritis is characterised by progressive degeneration of joint cartilage, leading to ongoing joint pain, joint instability and functional limitations. A variety of different treatments are available for the treatment and management of osteoarthritis, but the condition often present with limited success. The Osteoarthritis Society International (OARSI) recommends conservative treatment over surgery as the first-line management solution for knee osteoarthritis. General conservative treatment includes general exercise and muscle strengthening. Pharmacological drug therapies include analgesics, non-steroidal anti-inflammatory drugs and corticosteroid injections. Although the above drug therapies are effective to a certain degree, they can possess side-effects and can be damaging to articular cartilage.
In recent years, there have been an increasing number of studies on ortho-biological treatment and the application of joint injection of platelet-rich plasma (PRP) or hyaluronic acid (HA) in the treatment of osteoarthritis. There is now high amounts of evidence to demonstrate that PRP injection treatment and hyaluronic acid injection treatment can alleviate pain symptoms and improve joint function, at the same time as stimulating and facilitating repair, preserving cartilage health and restoring natural function. Furthmore, a double-blind randomised controlled trial with a 5-year follow-up showed that the combination of HA and PRP improved pain and function in patients with a history of chronic symptomatic knee degenerative changes and osteoarthritis. Many recent and past studies have showed that PRP is a very effective treatment for mild to moderate joint osteoarthritis and that the combined use of HA and PRP is better than individual use. In recent years, an increasing number of studies have focused on the rationality of PRP combined with HA for joint osteoarthritis, and their mechanisms have been discussed in depth. Studies comparing the migration capabilities of new tendon cells and joint cells in pure PRP treatment and PRP plus HA injection treatment have shown that combining the treatment of PRP and HA can significantly improve cell mobility, stimulating joint repair and reducing inflammation. It has been found that the combined treatment of PRP and hyaluronic acid can effectively promote the cartilage cell regeneration and improve the ability of cartilage repair. Studies have also shown that this combination of treatment can also benefit from enhanced biological mechanisms and facilitate anti-inflammatory molecules, at the same time as reducing cells which contribute to join breakdown and degradation.
Now, many clinicians or treating treating joint osteoarthritis with therapeutic injections of HA combined with PRP to take advantage of their synergistic therapeutic effects and benefits of the treatment of osteoarthritis.
Osteoarthritis is a disease that can cause extreme disability, reduced quality of life, and have huge impact on physical and mental health. With the ageing of the population, osteoarthritis will gradually become in increasing disease, which is a major challenge for all health systems. Furthermore, the exact cause and mechanisms of osteoarthritis is still unclear, and there is still no continuous and effective conservative treatment.
Surgical treatment is mostly used for patients with severe cases of osteoarthritis. PRP treatment in combination with hyaluronic acid is relatively inexpensive, particularly in relation to surgery, but without the risks associated. In addition, surgical treatment has a long recovery period. Therefore, it is of great significance to study new treatments for osteoarthritis. In recent years, joint injection of PRP or HA for the treatment of KOA has attracted strong interest from many clinicians, and in-depth research has been conducted.
PRP is extracted from a small sample of the patient’s blood, with the platelet concentration being at an increased of nearly 10-fold, which contains approximately 1500 proteins that can release growth factors and many other healing cells after activation, which is beneficial not only for removing damaged/dead tissue and reducing the inflammatory response but also for joint cartilage repair and regeneration. HA is natural substance that is an important part of joint synovial fluid and allows for protection and nourishment of the joint cartilage. Injecting HA into the knee joint can physically lubricate the cartilage surface, reduce friction and wear, and biologically nourish articular cartilage and promote the natural synthesis of HA, thereby slowing the progression of degenerative changes and significantly delaying the joint disease. A large number of RCTs and systematic reviews of the joint injection of PRP or HA for knee osteoarthritis have been published and most studies have concluded that joint injection treatment of PRP, compared with HA, can magnificently reduce knee pain and improve the function.
Ongoing research has shown that the combined application of PRP and HA can repair the degeneration of joint cartilage and significantly slow the progression of osteoarthritis, at the same time as reducing inflammation. More specifically, the synergistic effect changes the role of inflammatory cells in the process of chondrocyte (cartilage cells) degeneration through specific mediators (CD44, TGF-βRII), thereby promoting cartilage regeneration and inhibiting the inflammatory response. Thus, at the same time is naturally stimulating the release of hyaluronic acid.
Intra-articular injections of PRP combined with HA has a unique advantage in the long-term relief of pain in patients with osteoarthritis. Previous studies have shown that PRP combined with HA for knee osteoarthritis can reduce pain scores more than the individual treatments alone, which is consistent with our clinical findings. In terms of the improved function, joint injection treatment of PRP combined with HA, compared with the individual treatments alone, can improve patients’ joint function scores significantly. Again, many authors have reported that compared with PRP alone, HA combined with PRP in the treatment of knee osteoarthritis treatment significantly improves physical function at 1 and 3 months after treatment, with ongoing success long-term. From another clinical physical analysis, it was found that PRP in combined with HA significantly improved scores more than PRP alone did, however, PRP was shown to be significantly more effective in relieving pain.
In compared and analysed of the adverse reactions of PRP combined with HA compared with PRP and HA alone for osteo arthritis, the results showed that no significant difference was found in the incidence of adverse reactions, in any case, indicating that the safety of the treatments.
Studies have shown that HA has limited effectiveness for patients with severe progression of osteoarthritic disease. HA when used independently, mainly acts as a joint lubricant and provides nutrition and protection to joints, but has limited capacity to regenerate damaged cartilage. PRP On the other hand contains a large number of biological growth factors that can promote and stimulate the regenerative capacity of cartilage and cartilage matrix synthesis. Therefore, the combination of PRP and HA may have a better effect in many patients suffering with osteoarthritis, including those that have severe knee osteoarthritis.
Here at Dynamic Regenerative Medicine in Birmingham we have been performing and providing platelet rich plasma (PRP) treatments and hyaluronic acid injection treatment for many years with ongoing successful. In addition, and in comparison to, we also have vast amounts of experience in the treatment of osteoarthritis with pain relief injections like corticosteroid. From an unbiased clinical opinion and a comparison overview of the treatments we have found PRP in combination with HA to be the most effective treatment overall.
Corticosteroid injection treatment:
Relatively good in 70% of cases for reducing pain in the short term. Pain reduction on average of approximately 30–60% (variable on individual cases). However, pain reduction is often short lived, approximately ranging from anywhere to 1-6 months. Furthermore, pain often returns, and when it does return, it is often more severe, more problematic and more difficult to treat. Overview, good for short-term pain relief in the majority of cases, however very poor outcomes long-term due to fading of the drug, tissue weakening/damage/degradation, and a built-up tolerance to the drugs potency. Furthermore, it is important to note that corticosteroid injections are also damaging to joints long-term due to increased toxicity which facilitates cartilage degeneration. Which begs the question of whether they should be used at all in the management of osteoarthritis.
Platelet Rich Plasma
Good outcomes long term 1-10 months plus. Longer success when used in conjunction with a corrective rehabilitation program. Good results in reducing pain, restoring mobility and improving function. Better outcomes in quality of life long-term. Individual cases vary. Good success for mild to moderate cases of osteoarthritis, severe cases are difficult to treat. Good outcomes in reducing pain and inflammation long-term, in comparison to corticosteroid. Also, PRP treatment is used for stimulating cartilage repair and regeneration, as opposed to promoting cartilage breakdown.
PRP with HA
Good long-term outcomes for the treatment of mild to moderate cases of osteoarthritis for pain relief, joint function and quality of life. This can also be used for severe cases of osteoarthritis. Improved outcomes over PRP alone. In comparison to steroid injection, we have noticed significant improvement in disease progression, due to slowing the progression of degenerative changes. We know and understand that PRP with hyaluronic acid protects and lubricates joint cartilage, reduces friction, reduces inflammation at the same time as promoting normal function and stimulating repair and regeneration.
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Don’t let chronic pain and osteoarthritis take over your life. Schedule a consultation with Dynamic Regenerative Medicine today, and let us treat your aches and pains with the aim of restoring your quality of life of again. We have clinics operating out of Solihull (Henley-In-Arden) and Birmingham.
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