Knee Injection
Knee injection. Click to enlarge

Platelet-rich plasma injections are outpatient procedures. Because the patient's blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.

Whether the patient has a one-time injection or a series of injections spaced over weeks or months is up to the individual patient and doctor. If a series of injections is planned, a doctor may recommend a single blood draw during the first visit and use fresh PRP in the first injection and freezing and thaw the remaining PRP as needed for future injections. However, some experts believe freezing and thawing PRP negatively affects its usefulness and prefer to do a separate blood draw for each PRP injection.33

Platelet-Rich Plasma Injections Require Precision

An experienced physician should perform the injections. The use of imaging technology (e.g., ultrasound guidance) ensures a precise injection.

Precision is important because, like viscosupplementation treatments, platelet-rich plasma injections must be made directly into the joint capsule.

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Pre-Injection Precautions

The American Academy of Orthopaedic Surgeons recommends patients adhere to the following pre-injection guidelines:

  • Avoid corticosteroid medications for 2 to 3 weeks prior to the procedure
  • Stop taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or arthritis medications such as Celebrex, a week prior to the procedure
  • Do not take anticoagulation medication for 5 days before the procedure
  • Drink plenty of fluids the day before the procedure
  • Some patients may require anti-anxiety medication immediately before the procedure

Although the American Academy of Orthopaedic Surgeons published these pre-injection guidelines, the organization does not advocate for or against platelet-rich plasma treatment for osteoarthritis.34

See Stem Cell Therapy for Arthritis

Platelet-Rich Plasma Injections, Step-by-Step

This is an in-office procedure that involves a blood draw, preparation of the PRP, and the injection:

  • Blood is drawn from a vein in the patient's arm into a vial (typically 15 to 50 mL, or less than 2 ounces of blood is needed).
  • The blood is processed using a centrifuge machine.
  • A doctor or technician prepares the centrifuged platelet-rich plasma for injection.
  • The affected joint area is cleansed with disinfectant such as alcohol or iodine.
  • If ultrasound is being used, a special gel will be applied to an area of skin near the injection site. An ultrasound probe will be pressed against the gel-covered skin. A live image of the joint will be projected onscreen for the doctor to see.
  • The patient is asked to relax; this will facilitate the injection and also can make the injection less painful.
  • Using a syringe and needle, the doctor injects a small amount (often just 3 to 6 mL) of platelet-rich plasma into the joint capsule.21
  • The injection area is cleansed and bandaged.

The platelet-rich plasma typically stimulates a series of biological responses, and the injection site may be swollen and painful for about 3 days.

After the PRP Injection: Immediate Follow-up Care

Patients are advised to take it easy for a few days and avoid putting strain on the affected joint.

Doctors may require or suggest that a patient:

  • Does not take anti-inflammatory pain medication; another pain medication may be prescribed by the doctor
  • Wear a brace or sling to protect and immobilize the affected joint; a patient who receives an injection at the ankle, knee, or hip may be advised to use crutches
  • Use a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling

Patients who do not have physically demanding jobs can usually go back to work the next day. Patients can resume normal activities when swelling and pain decrease, typically a few days after the injections. Patients should not begin taking anti-inflammatory medications until approved by the doctor.

Physical therapy

If the injection(s) is successful in reducing the patient's pain, the patient will likely be prescribed physical therapy. Doing simple exercises to build and maintain muscle strength around the affected joint serves to decrease osteoarthritis symptoms and can slow down or halt further joint degeneration.

References

  1. Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clin J Sport Med. 2012 Dec 12. [Epub ahead of print].
  2. Zhu Y, Yuan M, Meng HY, Wang AY, Guo QY, Wang Y, Peng J. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthritis Cartilage. 2013 Aug 7. doi:pii: S1063-4584(13)00903-5. 10.1016/j.joca.2013.07.017. [Epub ahead of print] PubMed PMID: 23933379.
  3. Santo F. Martinez, M.D. Practical Guidelines for Using PRP in the Orthopaedic Office. American Academy of Orthopaedic Surgeons. www.aaos.org. Published September 10, 2010. Accessed November 15, 2012.
Further Reading: Osteoarthritis Treatment
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