2. Hyaluronic Acid (Viscosupplement) Injections
3. Orthobiologic Injections (like PRP)
PRP Means Prevention
/If there is a relatively low-risk and minimally invasive option for cancer prevention, would you choose to do it? If there is a similar option to reduce your risk of heart disease, would you do it? These would be potentially life-saving measures.
Now in the case of orthopedics, we are talking more about quality-of-life saving measures. Platelet-rich plasma (PRP) is one of those options.
We know that PRP is very beneficial in terms of reducing symptoms and improving function in most patients, yet did you know that it has also has a preventative benefit? Slowing the deterioration within your joint, particularly of the articular cartilage, is a benefit of the PRP.
How does being in less pain sound? What about being able to go up and down stairs much more easily? What about being out to enjoy longer walks and hiking? What about enjoying your grandkids with less pain during and afterwards?
What about more fulfilling trips to the gym? What about using fewer prescription medications to manage your symptoms? These are the goals of PRP, especially when we are treating osteoarthritis. When we are treating most tendon problems like of the rotator cuff, tennis/golfer’s elbow, lateral hip and the Achilles, the goal of PRP is not only to feel better, but actual healing.
This week, we repeated PRP on a patient with moderate knee osteoarthritis (OA) that last had PRP with us 5 years ago. Her benefit has lasted that long. This week we updated x-rays on a patient with knee OA and noted that in the last 2 years, his x-rays have not changed. This means no substantial loss of cartilage. In contrast, the average OA patient is losing 4%-6% of cartilage per year. What if we can change that to 0%-2%? Would you take it? If so, come see us, as we’re doing more PRP than ever, and the results remain very promising.
F. Clarke Holmes, M.D.
5 Things You Want to Know If You Have Knee Pain
/Three factors play a role in knee pain: structural, biomechanical and environmental. Structural means damage, biomechanical means abnormal tracking or loading within a joint or tendon because of misalignment, weakness, and/or inflexibility. Environmental typically means inflammation within the joint or tendon. When formulating a treatment plan for you, we typically want to address one or two of these factors initially. Unless you have major damage, we’re normally not treating structure initially, as that results in a surgery.
Age often plays a role in these different factors: in the absence of injury, in patients under 20 years of age, the problem tends to be biomechanical. In patients ages 20 to 40, the problem tends to be biomechanical and inflammatory. In patients older than 40, structural, biomechanical and inflammatory are typically all playing a role.
Being proactive in the care of your knee problem usually produces better outcomes than being reactive. This means integrating treatments early on and not waiting until you have major pain or disability to see a physician. We term this “PIO,” Proactive Interventional Orthopedics.
Meniscus tears are commonly found on MRIs and may or may not be a source of pain. For decades, the trend was to treat these surgically, typically arthroscopically, removing the torn piece of meniscus. There’s now a trend towards repairing the meniscus tear, when possible, but only about 10% can be successfully repaired. Thus, surgery for meniscus tears, especially those age 40 and above, is becoming less popular. On occasion, surgery is the better choice, but treating these initially nonsurgically is usually the best way to start. We often tell patients “a little torn meniscus is better than less meniscus,” especially long term. Less meniscus often equals greater arthritis.
Three types of injections can be used for most knee problems: steroid, hyaluronic acid, and orthobiologics. Orthobiologics include platelet-rich plasma (PRP) and stem cell injections. Each of these injections can be reasonably good choices, but for long-term success, PRP is likely your best option in terms of producing favorable outcomes, modifying the disease process, and these are often the most cost-effective option. Now, we are adding protein concentrate to many PRP injections, utilizing your excess plasma that we previously would just discard. Stay away from “stem cell” injections that are ordered by physician’s or chiropractic offices and do not come from you own bone marrow or fat. These are often being used inappropriately, and patients are charged exorbitant amounts of money to have these injections.