Platelet Rich Plasma (PRP)
Platelet Rich Plasma Therapy (PRP)
Blood is composed of red blood cells, white blood cells, plasma, and platelets. Platelets are responsible for blood clotting and healing. When activated at a site of injury in the body, platelets release healing proteins called growth factors and attract cells that contribute to regrowth (stem cells).
This procedure is done in the office setting with local anesthesia. The blood is drawn the same day of treatment and approximately 45 minutes is required for the visit. Once the platelet portion of the blood is concentrated and separated, it is injected under ultrasound guidance to the problem area. The patient may experience between 2-5 days of soreness after the treatment and use of anti-inflammatory medications is not advised during treatment. Depending on the problem, multiple treatments may be required.
Studies have shown that PRP may be effective in treating many conditions such as mild-moderate joint arthritis and tendon and ligament injuries. Studies are being published regularly describing the appropriate use and effectiveness of this treatment.
Does PRP really work?
Yes. Much research has gone into the development of PRP based procedures. (see blog)
How do I know if I am a candidate for PRP therapy?
PRP therapy is advised for patients with mild-moderate osteoarthritis or chronic tendonitis in or around the large and small joints (shoulder, elbow, wrist, fingers, hip, knee, ankle, toes). Typically the patient has failed conservative treatment options such as rest, medication, and physical therapy.
Who is NOT a candidate for PRP therapy?
- Any one with a cancer (such as prostate cancer or breast cancer), not in remission for at least 5 years
- Certain other malignancies or blood borne diseases that you are being treated for
- Any current infection
- Patients using a high dosage of Coumadin who very easily bleed
- General procedural contraindication
- Patients with multiple medical issues may not be good candidates
What is the cost of PRP therapy?
The cost of PRP treatment may vary depending on the area(s) being treated. Insurance companies will not pay for PRP. This is paid for out of pocket. Injections start at $650.
How long do I have to wait to return to my normal activities?
How quickly you can return to your normal activities depends on the condition and body part being treated.
- Depending on what area is treated a brace, sling or walking boot may be used for a few days.
- Most patients are able to return to work the day following the procedure unless they experience a significant post-injection flare. In that situation, the patient may need an extra day off work.
- There will likely be some post-injection soreness. Return to normal activities may be related to how long this lasts - several days usually.
How long does it take the PRP to "work"?
PRP does not offer quick pain relief. Pain gradually subsides as the injured tissue repairs and pain relieving factors activate. This can take weeks or months, but when successful, the effect is lasting. Maximum effects are usually seen at 6-9 months. Some areas may require 2-3 injections in closer succession. Protocols are regularly evolving.
How soon can I return to normal and athletic activities?
Return to athletic activity depends on the type and site of injury. Most chronic tendon injuries that have failed to respond to any other type of treatment will generally take quite a number of weeks to heal. Injections into joints and acute muscle injuries respond a bit sooner.
Are there any side effects or complications of PRP?
No serious complications have been reported related to PRP. Like any injection, there is a risk of infection, or damage to a nerve or blood vessel. However, there is not a risk of adverse reaction to the platelets the way there is to a medication (ex. corticosteroids)
What are the side effects of commonly used cortisone injections (alternative treatment)?
Cortisone injections have been widely used over many years to treat sports injuries and arthritis. Unlike PRP injections, cortisone injections allow only inflammation and pain to settle down and they do not induce healing. Hence, in many conditions the pain will recur due to lack of healing. Also steroid injections have potential complications such as skin atrophy, discoloration, weakening and rupture of the tendon where injection is given, joint deterioration and infection, among others.
Can I drive home after the PRP injection?
It is Dr. Lehman's preference for you to have a driver.
Do I need to schedule a follow up appointment?
Yes, Dr. Lehman will want to see you back in clinic to check your progress. You will be asked to make a follow up appointment usually 10-12 weeks following the injection.
Can I take my normal medication(s) before and after the injection?
Do not take anti-inflammatory medication such as Advil, Aleve, Motrin, Ibuprofen, Mobic, Naproxen, Nabumetone, or Diclofenac for 7 days prior to the injection and several weeks after the last injection. Pain medication will be prescribed the day of the procedure to be taken as needed. A regular aspirin regimen (81mg/day) is ok. Tylenol/Acetaminophen is allowed.
What is the "typical" response to PRP treatment?
Research and clinical experience suggest that PRP can successfully treat pain from chronic degeneration and tears of tissue tendons, and pain from mild-moderate joint articular cartilage degeneration. It is important to understand that PRP isn't a miracle cure. Dr. Lehman sees a pretty high percentage of patients get over 50% relief though. For a minimally invasive procedure for injuries/conditions that are notoriously hard to heal, that's pretty impressive.
Technique and Ultrasound guidance is essential to accuracy of placement and enhancing efficacy of the injection.
What if I don’t get a good enough response with PRP treatment?
Then bone marrow derived cellular therapy or surgical treatment might be the next step.
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Asheville, North Carolina 28803
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