Platelet Rich Plasma Injections (PRP)
What Is Platelet Rich Plasma?
Our blood consists of 3 major
components – red blood cells, white blood cells and plasma. Whole blood
contains all 3 of these components mixed together and in varying
concentrations. The plasma contains acellular structures called platelets,
together with molecules that function as clotting factors and growth factors.
If we place whole, unclotted
blood in a centrifuge (machine used to separate blood) and “spin it down”, we
are able to distinguish 3 different layers. The red blood cells are the
heaviest and sink to the bottom, while the white cells and plasma sit above
this. The “clear” plasma, including the platelets, is then found between these
two distinct layers.
Various techniques have been
developed to concentrate the plasma and increase the relative concentration of
platelets compared to that of our original whole blood. The absolute number of
platelets in the plasma is dependent on the platelet concentration and the
volume of whole blood that is taken from the patient.
What Do Platelets Do?
Platelets circulate freely within
our vascular system. When there is an injury, the platelets become activated
and stick to one another. This forms a mesh-like structure that traps other
cellular material to it and forms a clot. This clot then helps to stop the
leakage of contents out of the vascular system, i.e. stops the bleeding.
The clot also traps the contents
of the plasma. The platelets are also activated to release their alpha
granules. These contain a host of growth factors which stimulate healing in
this area. These combine with other, free floating, growth factors from the
plasma, which are also trapped in the clot. This area then becomes a site for
healing and angiogenesis – new vessel formation.
What Are The Clinical Uses For Platelet Rich Plasma?
PRP was first used in
maxillofacial surgery to help the incorporation of bone grafts. Its use has now
extended to the treatment of acute muscle and ligament tears, chronic muscle
and ligament tears, chronic wound healing and intra-articular use for
Acute injuries – the addition of a high
concentration of PRP to the area of injury has shown, in some studies, to
result in faster healing and a quicker return to activity.
Chronic injuries – chronic injuries result in the
formation of scar tissue and this often results in chronic pain. PRP is thought
to stimulate/reinvigorate the healing process, resulting in the chronic scar
tissue being replaced by healthier tissue.
Chronic wound healing – PRP in a gel or paste
form has been shown to increase the chances of healing chronic wounds.
Intra-articular use – although the mechanism is
poorly understood, an injection of PRP intra-articularly can produce a degree
of pain relief and stiffness in some people. We reserve the use of
intra-articular injections into the knee for patients with an advanced stage of
degenerative disease. Our latest research (review of 225 patients) showed that 60%
of the patients gained some relief from their continual symptoms. The duration
of relief lasted from 1 month to 3 years.
Will PRP Help Me?
There are no
randomised control trials to definitively say that PRP will cure your pain.
However, where other modes of non-surgical treatment have failed, PRP remains
as an alternative trial therapy. In certain conditions, PRP may be tried as
first line/initial therapy.
What Does The PRP Procedure Entail?
You will be
required to fast (do not eat or drink) for 4 hours prior to your appointment
(you may drink water only). Once you arrive at our consultation rooms,
approximately 15 minutes prior to your booked appointment, you will be given
special blood tubes for your blood to be drawn. We will then refer you to the
laboratory (Ampath) where your blood will be taken by expert phlebotomists.
Once your blood has been taken, you are then free to eat and drink.
You will then
give the tubes of blood, which will be marked with your name, to our nursing
sister. She will place it in the centrifuge and spin it down. The platelet rich
plasma is then carefully removed in a sterile procedure, and placed separately
in a new container. Once we have collected enough PRP, we discard the remaining
blood and platelet poor plasma.
The PRP is
then injected into your knee/s using aseptic technique.
whether you are having one or two knees done, we will draw approximately
30-60mls of blood from you and will get 2-6mls of PRP for each knee (taking
into consideration that everyone has different platelet levels).
How Many Injections Will I Need?
recommend 2-3 injections over the course of 3-4 weeks.
that you make two appointments to begin with, 10-14 days apart. If you find
that the therapy is working well for you, you can make an appointment for a 3rd
injection. We also offer a 4th (top-up) injection 6 months following
You can repeat
the therapy on a yearly basis as needed.
What Medication Must I Notify You About?
us if you are using any chronic medication, especially blood thinning
medication (e.g.: Warfarin, Aspirin, Ecotrin or anti-inflammatory drugs).
Please also notify us if you are on any medications for rheumatoid arthritis.
What Are My Limitations Post Injection?
injection we suggest that you do the activities that you were doing before the
injection. There are no formal limitations, but we recommend that you do not
overdo anything, but rather gradually build up physical activity.
Do I Need To Take Any Medication After
recommend that you refrain from taking anti-inflammatory drugs after your PRP injection.
However, a small percentage of people have a painful flare up following their
PRP injection (this includes swelling/pain/stiffness) for a few days. For this
we recommend a short course of anti-inflammatories. Don’t forget to take your
usual chronic medications.
How Long Do They Last And Can I Have
of relief varies from person to person. Our experience is that patients have
about 6 to 12 months of relief. Patients who have good relief for many months
may have repeated injections. Some have continued relief while in others repeat
PRP therapy does not help.
What If PRP Doesn’t Help Me?
conservative measures, including PRP, fail to relieve your symptoms, then
surgical options should be considered.
What Is The Cost Of PRP?
We are a cash
practise and charge the following:
Platelets 1 knee: R791.60
Platelets 2 knees: R1173.20
We ask the laboratory (Ampath) to
do platelet counts on your whole blood when they draw it initially, and on some
of the spun down PRP that we inject into your knee (that our nursing sister
sends to the lab). This allows us to compare the counts for quality and research
We will ask you before each
appointment to please complete a questionnaire on your knee for our research on
PRP. This enables us to ensure that the PRP therapy is successful and of good
quality. All your personal details will remain confidential in this process.