Orthobiologics

What is Platelet Rich Plasma (PRP)?

Platelet Rich Plasma (PRP) is a concentration of one type of blood cell, platelets, harvested from the patient receiving treatment. Platelets circulate through the blood stream and are critical for blood clotting but are also thought to contain factors essential for cell recruitment, multiplication and specialization that are required for healing. The concentrated platelets along with the plasma help modulate the inflammatory process your body uses to heal.

PRP treatments can be helpful to patients with arthritis, labral degeneration, muscle/tendon/ligament injury/degeneration who:

• no longer respond well to anti-inflammatories, physical therapy, corticosteroids, or viscosupplements
• are not improving with other conservative treatments
• are not candidates for preservation surgeries and want to delay proceeding with joint replacement

How are Platelet Rich Plasma Injections Performed?

At Nashville Hip Institute at TOA, an injection of PRP is usually performed with a single injection with the use of ultrasound guidance. In some cases, if a patient is improving but plateaus before reaching their goals, we may consider repeat injections of PRP. The procedure itself can easily be completed in the clinic.

We ask patients to avoid anti-inflammatories for 2 weeks prior to the procedure and for one month after. Steroids are also avoided one month prior and one month after the procedure to prevent any disruption in the inflammatory process necessary for healing. After a blood sample is obtained from a patient, the blood is put into a centrifuge. The centrifuge separates the blood into many components with each component being concentrated to maximize healing based on the patient’s specific injury or diagnosis. For example, for a tendon injury we would use a leukocyte rich concentration of PRP. For arthritis in a joint, we would inject a leukocyte poor concentration. It is important to make sure the type and concentration of PRP used during the procedure is appropriate for the diagnosis. Once the sample has been processed it can easily be injected into a joint, muscle, ligament or tendon. An anesthetic spray is used to numb the surface of the skin prior to the injection. Ultrasound guidance is used to ensure the PRP is injected into the desired location.

We ask the patient to avoid strenuous exercise and impact loading activities, such as running, for one week after the procedure. In some cases we will limit weight bearing with the use of crutches for several days after the injection. Physical therapy will likely be prescribed to help guide you back into activity following PRP and is typically started 10-14 days after the procedure.

How Long Does It Take for PRP Injections to Work?

Many patients will start to see improvement about one month after the procedure, but this process can take longer depending on the diagnosis. In some situations, we may not see improvement for several months, or maximal improvement for up to six months. At Nashville Hip Institute at TOA, we try to amplify the benefits or PRP by making sure the patient is also taking advantage of an appropriate rehab program and restrictions during treatment.

Who Is a Candidate for PRP Treatments?

PRP injections can be a good option for patients who are not ideal candidates for an arthroscopic procedure due to the degree of arthritic damage in the joint but are also looking to delay the need for a joint replacement. PRP injections can be used for arthritis, labral degeneration, tendinitis, tendinopathy, tendon/muscle tearing and ligament injury. It is also an option for patients to consider in lieu of a more costly stem cell procedure or when an alternative orthobiologic treatment is not a good option. The goal of PRP is to reduce pain, increase mobility, decrease the need for anti-inflammatories or narcotics and get you back to a more natural level of activity.

What is Viscosupplementation for the Treatment of Arthritis?

Viscosupplementation therapy, hyaluronic acid injections, can be helpful to patients with arthritic damage in their joints who:

• no longer respond well to anti-inflammatories, physical therapy, corticosteroids
• are not improving with other conservative treatments

The arthritis in the joint may be secondary to impingement, osteoarthritis, rheumatoid arthritis or other articular surface injuries.

During the procedure a thick gel-like liquid made from a natural substance called hyaluronan is injected into the arthritic joint. Hyaluronan is naturally found in the body, and specifically in very high amounts in joints. The body produces hyaluronan to act as a lubricant as well as to absorb shock related to the joint’s functional movement. It is needed for a joint to work appropriately and without pain. Patients with arthritis tend to have less of this fluid naturally which can contribute to pain, loss of mobility and overall dysfunction. A viscosupplement, or hyaluronic acid injection, does just that, supplements the fluid your body may not be naturally producing to help lubricate and cushion the joint.

How are Viscosupplementation Injections Performed?

At Nashville Hip Institute at TOA, viscosupplementation is usually performed with a single injection. The injection itself can easily be completed within just a few minutes in the clinic. An anesthetic spray is used to numb the surface of the skin prior to the injection. Ultrasound guidance is used to ensure the viscosupplement gets in to the joint.

Typically we ask the patient to avoid strenuous exercise and impact loading activities, such as running, for one week after the injection. In some cases, physical therapy may be prescribed to help guide you back into activity following viscosupplementation.

How Long Does It Take for Hyaluronic Acid Injections to Work?

Many patients will start to see improvement about one month after the procedure. This procedure is covered by many insurance plans when performed for arthritis of the knee. We find it can also be useful for early arthritic changes in the hip.

Who Is a Candidate for Viscosupplementation Therapy?

Viscosupplementation injections can be a good option for patients who are not ideal candidates for an arthroscopic procedure due to the degree of arthritic damage in the joint but are also looking to delay the need for a joint replacement. It is also an option for patients to consider in lieu of a more costly stem cell procedure or when an alternative orthobiologic treatment is not a good option. The goal of viscosupplementation is to reduce pain, increase mobility and get you back to a more natural level of activity.