Can PRP Delay Knee Replacement?

Looking for a knee replacement alternative? That’s probably wise. Though performed often, knee replacement is major surgery. In a total knee replacement, the knee joint is completely removed and replaced with a prosthesis.. But are there viable alternatives? What is Platelet-Rich Plasma (PRP)  and can it delay knee replacement? Let’s explore the topic.

Reasons for Delaying Knee Replacement Surgery

Knee replacement increases the patient’s risk of heart attack or stroke around the time of surgery and comes with a risk of developing a serious infection. Though the risk of prosthesis infection is around 1%, when it happens there are major consequences including IV antibiotics and another revision surgery to replace the infected prosthesis. Total knee replacement also comes with a risk of metal ions entering the bloodstream and knee surgery often doesn’t actually eliminate the knee pain–the reason for undergoing the process. In results from a recent study, up to 44 percent of patients who underwent knee surgery still had moderate pain three to four years following the operation.

These are valid reasons for considering other options before undergoing knee joint replacement. 

Alternatives to Surgery for Treating Knee Joint Problems

  • Steroid injections
  • Viscosupplementation
  • Knee nerve ablation

Orthobiologics

  • Platelet-rich Plasma (PRP) 
  • Bone marrow concentrate

What is PRP?

Platelet-rich plasma (PRP) is an injection of concentrated platelets, derived from your own blood. Platelets contain healing growth factors which assist in tissue repair. This regenerative medicine based procedure intended to promote pain relief and healing, has been perfected by physicians at Regenexx. 

PRP knee injections are often used to help patients with knee arthritis. When performed by Regenexx specialist physicians, PRP procedures involve using a specialized imaging system to precisely inject your own PRP into the damaged knee joint and the supporting stabilizing structures. Sometimes the patient’s knee will experience swelling for a few days. But most patients experience a favorable response within a few weeks. 

PRP injections can provide pain relief and improve function of the knee joint for 1-2 years in most cases. This procedure differs from steroid injections which can harm cartilage. In contrast, the PRP process is believed to help knee cartilage by providing growth factors that improve the environment of the knee joint.

The Importance of RCT Studies

Randomized Controlled Trials (RCT) are the “gold standard” of quality research. Simplified, patients are randomly selected to receive one of two treatment options. Then their response is measured. RCT studies can be improved through placebo control: making “A” the treatment you wish to evaluate and “B”, a placebo treatment.  

Here is a link to a slide presentation which provides an overview of multiple instances of documented research: RCT studies supporting the effectiveness of PRP as an alternative to knee replacement surgery.  

A Comparison:

Knee Replacement Surgery – One RCT study

At the time of this writing, there is only one RCT study available on the effectiveness of knee replacement. That study failed to compare knee replacement to a placebo surgery. It compared knee replacement to physical therapy; a different type of treatment.  Additionally, the study pointedly noted the potential for serious side effects following surgery. 

Here is an excerpt from the study’s conclusion:

“. . . total knee replacement was associated with a higher number of serious adverse events than was nonsurgical treatment, and most patients who were assigned to receive nonsurgical treatment alone did not undergo total knee replacement before the 12-month follow-up.” 

You can learn more about this study here: A Randomized, Controlled Trial of Total Knee Replacement

PRP – Multiple RCT studies

A Level 1 Meta-analysis of 30 Randomized Control Trials was published in the archives of Orthopedic and Trauma Surgery

  • The Results: Patients who received PRP injections for knee arthritis were significantly better in terms of pain and function at 3 months, 6 months, 9 months and 12 months compared with Cortisone, Hyaluronic Acid injections or placebo.

PRP – How often can it delay a knee replacement?

A retrospective study published in 2020 tracked 667 patients with knee arthritis who received PRP, between 2014 and 2019

  • 85.7% of patients with knee arthritis who had PRP achieved delay in TKA throughout the 5 year follow up of the study.

The Conclusion

PRP is supported by research – and avoids surgery’s side effects 

Why hasn’t more research been conducted on the effectiveness of knee replacement surgery? The lack of multiple, definitive RCT studies on it’s effectiveness and the results of surveys reporting lack of pain relief for many patients following knee surgery do not support knee replacement as the right option in many patients. 

Fortunately,  PRP is an option that is supported by quality research, and according to the evidence, can lead to a delay in Total Joint Replacement in the majority of patients as well as improvements in pain and function. PRP is also less likely to cause side effects than surgical alternatives. Some orthopedic surgeons have adopted PRP into their practices. But not all providers who perform the procedure of PRP for knee arthritis and other joint problems offer identical PRP treatment methods.

Regenexx Tampa Bay provides a variety of regenerative medicine options, including treatments for knee injuries and arthritis of the knee joint that offer promise for helping you regain the ability to do the things you love, without surgery. Are you a candidate for a non-surgical alternative to knee replacement surgery? Contact us to find out quickly.

About The Author
Ignatios Papas, DO

Ignatios Papas, DO

Ignatios Papas, DO, is a non-surgical orthopedic physician specializing in Physical Medicine and Rehabilitation at Regenexx® at New Regeneration Orthopedics.

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