A Research Update on PRP to Treat Knee Arthritis

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It’s been more than a year since I published my infographic on the use of platelet-rich plasma for knee arthritis. Since that time, the pace of PRP research on knee arthritis treatment has quickened. Hence, today, let’s go over what we know now.

What is PRP?

PRP is when the doctor takes blood from the patient and concentrates the platelets in a centrifuge. The product that’s created is called platelet-rich plasma (PRP). All of those platelets release growth factors and other things like exosomes that can help healing. To learn more about PRP (as well as platelet lysate), see my video below:

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What is an RCT?

RCT stands for Randomized Controlled Trial. This is the “gold standard” for quality research. Basically, patients are randomized to either receive treatment A or B, and then their response is measured. You can make the RCT better by making it placebo-controlled. That means that A is the treatment you want to evaluate and B is a fake treatment.

The Research on PRP Used to Treat Knee Arthritis

In the infographic above, you see 30 circles. Each describes something about a PRP RCT. Each has a hyperlink to the US National Library of Medicine where that study can be found. The PDF can be found by clicking on the image above or here.

We now have 30 randomized controlled trials on the use of platelet-rich plasma to treat knee arthritis. That’s pretty amazing since most of these are of higher quality than the single RCT that we currently have on knee replacement. Let’s dive into all of that for a few minutes.

We have 20 RCTs that compare PRP to common knee gel shots (Hyaluronic Acid or HA). In most of these studies, the PRP was better than the HA and in the minority, it was just as good. Bizarrely, HA is covered by most major insurance companies and PRP is not.

We have five RCTs where PRP is compared to saline control and in all 5, PRP beats saline. There are three RCTs where PRP is compared to the very common knee steroid injection, and in all three PRP beats steroid. Steroid injections for knee arthritis are covered by every major insurance carrier, PRP is not.

Now let’s get back to knee replacement. We have only a single RCT on knee replacement whose results were poor in my opinion. In addition, that study didn’t compare knee replacement to placebo surgery. Instead, it compared it to physical therapy. Hence, this study was of lower quality than many of those PRP studies above with a higher risk of a false result due to the tremendous placebo effect of big surgeries. To learn more about that study, see my video below:

How about other orthopedic surgeries to treat knees?. Do any of them from ACL reconstruction to meniscectomy to cartilage repair have 30 RCTs supporting their use? Nope? Do any of them have 5 RCTs comparing the surgery against a placebo surgery and showing efficacy? Nope.

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The PRP Pushback

While the research supporting PRP use is far better than that supporting most of the common orthopedic surgeries in existence today, that hasn’t stopped certain groups from not liking this disruptive treatment. This largely takes the form of flack from some orthopedic surgeons and some bench scientists.

The Orthopedic Response

For some orthopedic surgeons, PRP has been adopted into their practices. This movement is gaining steam as the obvious high-quality research continues to be published. For others, PRP is a problem. Why? Let’s explore this a bit.

PRP is a problem for some orthopedic surgeons because it disrupts the status quo. For example, if you’re a joint replacement surgeon, PRP may have a real immediate impact on delaying those surgeries. If you’re focused on the health of your patients, that’s great news. If however, you’re focused on device payments to you from knee replacement device manufacturers, surgery center schedules being filled, or other financial, non-patient care concerns, PRP can mess with your bottom line.

The Bench Scientist Response

Just like PRP disrupts the orthopedic surgery status quo, it also disrupts the economics of university discoveries and patients in the world of stem cell drugs to treat orthopedic conditions. How? Let’s dive in.

Some in the bench scientist crowd have been actively campaigning against PRP. These are university professors who focus on the financial health of the commercial stem cell therapy drug market. Why would they care about a lowly blood product that could help knee arthritis patients avoid the need for surgery? Economics 101. Let me explain.

The bench scientist crowd who are financially conflicted all want to push expensive cellular drugs as treatments for common musculoskeletal problems like knee arthritis. These cell drugs, because they require FDA approval and extensive clinical trials, will all be very, very expensive. If PRP has become popular and covered by insurance as a cheap knee arthritis therapy by the time these cell drugs hit the market, there will be no market. Meaning, if their products can’t significantly beat PRP for efficacy, then the major health insurers won’t extend coverage for the more expensive cell drugs and the investments of universities who developed these cell drugs will be ruined. It’s simply that simple.

The upshot? PRP is here to stay. We have more RCTs supporting its use for knee arthritis than we have for most FDA approved drugs. There’s also substantially more research supporting its use than for any orthopedic surgical procedure in existence that’s used to treat knees. This makes PRP a major healthcare disruptor. For physicians focused on trying to find the best available treatment for their patients, this is all fantastic news. For some surgeons who want to maximize their income from joint replacement surgeries, this is not good news. Also, if you’re developing a competitive cell drug, you may not like all of the PRP research, as it could mess with your investment.

This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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19 thoughts on “A Research Update on PRP to Treat Knee Arthritis

  1. Rondo

    What’s the difference between PRP vs. Prolotherapy vs platelet lysate. Is one better than the other?

    1. Chris Centeno, MD Post author

      Sounds like a good blog topic!

  2. Sat Ganesha

    Thank you for this as I totally support PRP as patient. I was wondering if the “pharma industry” could ever create a “substance-drug” that would be reasonable $ and also be able to play nice with all the other options patients have to choose from to remain healthy…looks like not, sad.

  3. Joe

    I tried stem cell treatment on my knee with no lasting improvement. I’m into my third year of PRP, three shots over three weeks once a year. I’m a believer. That’s after five scopes too. Still lifting weights heavy, some high intensity training and very active lifestyle at sixty two. Yeah insurance won’t cover it but my alternative is a new knee

  4. Rondo

    Regarding PRP, wouldn’t taking blood from you on a day you eat red meat be different than if you eat that day vegetables . Wouldn’t the composition be different and we wouldn’t know the load needed?

    1. Chris Centeno, MD Post author

      We have no data that diet impacts growth factor levels. However, it could impact inflammatory cytokine levels.

  5. Phil

    How does prp therapy compared to stem cell therapy using stem cells from embilical cords

    1. Chris Centeno, MD Post author

      “Stem cells from umbilical cords” is a scam here is the US, see https://regenexx.com/blog/dr-singer-will-teach-you-how-to-become-a-stem-cell-millionaire/

  6. David Allison

    Dr. Centeno,
    I would appreciate your thoughts on Dr. Neil Riodan’s clinic in Panama. Is it legitimate? You quite often comment about scams.

    The like below is a one hour YouTube video with Joe Rogan (Fear Factor fame) interviewing Dr. Riodan and Mel Gibson who took his 94 year old Dad to Panama and had his shoulders injected to reduce pain. Mel gives a powerful testimonial.

    Thanks for your insights!

    David Allison
    Patient of Dr. Pitts


  7. Adam Leal

    I did the stem on my right knee about 4years ago im running again lifting again with very minimal pain. That is awesome! Adam Leal. Austin Tx.

  8. Dr Ricardo velasco

    What’s the difference between PRP vs. Prolotherapy vs platelet lysate. Is one better than the other? One does not have to exclude the others.in fact i have used the combination and has a better pencentage of good results than prp alone.
    Nobody has the absolute truth.

    1. Chris Centeno, MD Post author

      We use all three every day…

  9. Manny Katz

    One of the reasons why there is no FDA approval And why insurance doesn’t pay, esp. Medicare, is that the PRP treatment has no standards, or no guidelines about all the factors that go into the preparation of injections. It’s the Wild West, with each practitioner doing what he wants in various different pathologies, sometimes with scan guidance, most often without, and often with poor or unspecified training requirements. You practitioners have no organization or strategy here to make it a covered treatment. At this rate, it won’t ever be.

    Not to mention The out of pocket cost that most seniors who need it could not afford esp. with treatments that need repetition.. It is all VERY disheartening.

    1. Chris Centeno, MD Post author

      Manny, Regenexx standardizes all of that, which is why we have insurance coverage for PRP for about 8 million lives and growing…

  10. Mark

    Is there greater efficacy in 3 shots of PRP over 3 weeks as mentioned in the post by Joe verses one shot?

    1. Chris Centeno, MD Post author

      We have a single study that seems to show that, but that effect could have been seen because low dose PRP was used.

  11. Dane

    Since PRP is so much cheaper and easier than stem cells it seems like it has the potential to be a really good bang for the buck treatment if optimized well enough. The recent studies on PRP bone injections for knee OA show that it’s a lot more effective than just injecting the joint. What about draining excess fluid from the knee before injecting to minimize the PRP getting diluted? Or targeting PRP injection on a cartilage defect? Any chance that could make a scaffold to help cartilage repair?

    1. Chris Centeno, MD Post author

      Dane, we have been optimizing PRP for a decade and a half. The data on PRP into the bone versus joint is low level. We do typically drain excess fluid from the joint. PRP is unlikely to work well in patients with more severe arthritis.

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