PRP Stem Cell Treatment Overview
Stem Cell & PRP (Platelet Rich Plasma) Treatment
Experience:
With thousands of injections performed as part of a prospective study begun in 2010, we are one of the most experienced orthopaedic centers in the world in the use of this treatment.
Results:
Overall most, but not all, patients show significant benefit. Through statistical analysis of our extensive database, we are able to show patients the likely success rate for treatment for their particular disorder and its level of severity. Numerous peer-reviewed published research papers have shown beneficial results. Our own internal data has also shown significant benefit. We are preparing several papers for publication to share our extensive experience. In general, patients respond for at least one year, and often much longer and sometimes permanently to one or two injections.
Our Data & Our Study:
You will be asked to fill out initial paperwork so that we may assess a rating of your initial condition. Then every six months we update this data as part of an ongoing study so that we can assess the results. We use sophisticated Socrates software for this purpose to assess our results and generate statistics from it. Our ongoing prospective study is the largest by an orthopaedic surgeon of which I am aware. This follow-up allows me to give you evidence-based data regarding the likelihood of success for your problem depending on its location and severity. Carrying out this study is quite costly and I fund it personally through my 501c3 clinical research and education foundation. I go to this expense because I believe it is incumbent on those at the cutting edge of this field to generate data on which to base treatment decisions and to help advance the field for the benefit of others.
Number of Injections:
Unlike many centers that perform three injections, we initially perform only one injection and then wait one month to gauge the full effect. For many patients, this is all they will need. Some patients will need a second for further improvement. Very rarely will a patient need a third initially.
Repeatibility:
In general, patients who initially respond to these treatments continue to respond, and some of our earliest patients have had continued good results more than five years after initial treatment with periodic repeat treatment.
Adverse Events:
Although theoretically possible, we have had no infections or significant adverse events.
Cost:
Neither insurance companies nor medicare pay for PRP nor Stem Cell injections. However, our out-of-pocket cost of treatment is among the lowest in the country. We endeavor to make this treatment available to all, not just people of wealth.
How PRP and Mesenchymal Stem Cells Work:
Platelets and Stem Cells contain growth factors, such as Platelet Derived Growth Factor and Transforming Growth Factor Beta that enhance the healing of damaged tissue; and anti-inflammatory cytokines - hormone-like substances, such as interleukin 1 receptor antagonist - that decrease inflammation and tissue destruction naturally. They also contain lubricin, a naturally occurring substance that decreases friction in the joint.
How PRP is Prepared:
40cc of blood (3 teaspoons) of blood is drawn. It is then twice centrifuged to remove red blood cells and then excess plasma to reduce the volume to 4cc of plasma with the platelet count roughly quintupled. Studies have shown this to be in the optimal range for clinical efficacy. The PRP is then treated in the Adilight which has been shown to increase the amount of Interleukin 1 receptor antagonist. Some other single-spin techniques do not raise the concentration to this level and may not be as effective. From blood draw to injection, the total elapsed time is generally under one hour.
How Stem Cells & Fat are Prepared:
The patient lays face down and the posterior iliac crest (a pelvic bone behind the love handle area) is sterilely cleaned. This bone serves as an attachment point for muscle but has no weight-bearing function. The hip and spine are not involved. A thin needle then injects lidocaine into the skin and the periosteum, the surface of the bone, to numb it. Then a larger needle is tapped into the space between the outer and inner hard bone where a small amount of bone marrow is aspirated. There is little if any pain involved in this process. No sedation is used or needed. Then the patient is turned on their side and a thin cannula is used to inject saline/lidocaine solution into the fat of the love handle and buttock area to numb it and partially liquefy the fat. Very little discomfort occurs. Then another thin cannula withdraws a little over a teaspoon of fat generally with no pain at all. This fat is washed, sized, gently centrifuged, and treated with the adilight all in accordance with FDA regulations – in preparation for injection.
What is Injected:
We have found PRP to be sufficient for tendon injuries. For arthritis, we inject either PRP or PRP with Stem Cells and Fat.
How Injections are Performed:
The area to be injected is numbed superficially with lidocaine. The deeper area, either the tendon or the joint, does not have lidocaine injected because there is evidence lidocaine can inhibit the efficacy of the injection. Ultrasound is used to guide the injection. Injection of the joint usually produces very little discomfort. Injection of the tendon can produce more discomfort.
What to Expect After Injection:
Ice on the affected area and Tylenol are sufficient for post-injection discomfort in almost all patients. Joints are usually back to baseline in 2 -3 days, tendons are usually back to baseline in 7-10 days. Tramadol is prescribed occasionally if needed. Non-steroidal anti-inflammatory drugs (NSAIDs) which include, Motrin, Advil, Aleve, Meloxicam, and Diclofenac are avoided due to their anti-healing properties. Aspirin for the heart or circulation is not a problem but is otherwise better avoided.
Patients on Anti-Coagulants:
We are able to inject patients with PRP or Stem Cells who are on Coumadin, Plavix, or other anti-coagulants without difficulty and do not recommend stopping them.
What Body Parts May Be Injected:
The following are based primarily on our extensive personal experience, as well as on the scientific literature.
Joints:
Any inflamed joint will usually, although not always respond to injection. Our most commonly injected joints are the knee, shoulder, hip, foot and ankle, A-C joint, and base of the thumb. Bone-on-bone joints often respond but at a lower rate. The only exception we have found is bone-on-bone hip arthritis which has not responded for more than six months in our patients.
TMJ (Temporomandibular Joint):
PRP has been shown to have beneficial effects on those with TMJ pain. My partner Marilyn D. Hatz DDS and I use PRP and low level laser therapy treatment for this region.
Tendons:
Any inflamed tendon will also usually, but not always respond to injection. The most commonly injected are the rotator cuff, patellar, gluteus medius (hip trochanteric bursitis), biceps at shoulder, Achilles, and ECRB (tennis elbow).
Ligaments:
Studies have shown better healing of ankle ligaments after ankle sprain. However, there is no evidence of benefit after ACL reconstruction.
Surgical Use:
Studies have not shown significant benefit for use at surgery for rotator cuff repair or other surgical procedures although it is used by some for spine fusions.
Scar Tissue:
Treatment can benefit areas of chronic painful scarring within muscles.
Back & Neck Pain:
There is no convincing evidence of benefit although some spine surgeons are injecting PRP into the facet joints and intervertebral disks. I have chosen not to do so due to the potential risk involved compared to the so far demonstrated benefit.
The Future
- We are preparing a research proposal to engage in an FDA study regarding more extensive processing of stem cells under their guidance which has the potential to greatly improve results
- We are engaged in a clinical trial of cold laser activation of growth factors, building on the burgeoning use of light therapy in regenerative medicine. It has shown good preliminary results in patients who did not otherwise respond to treatment
- We are investigating the effects of secondary factors, such as swelling, alignment, BMI, and other factors on our results
We are committed to publishing results from our data base and we are currently preparing a paper for publication on our results with shoulder arthritis. We believe that biologics such as stem cell treatment and PRP derived from your own tissues represent the future of medicine. This technology is producing amazing results in the treatment of multiple sclerosis, ALS, glaucoma, Parkinson's disease, heart disease, cancer, and much more.
