PRP and BMC Delay the Need for Knee Replacement
One of the hopes of orthobiologics is that they can help younger patients push a knee replacement out to an older age. Why is that critical? Let’s dive in.
Knee Replacement and Age
A knee replacement is the amputation of the knee joint and insertion of a prosthesis. That’s as big a surgery as it sounds. However, an even bigger surgery is the second knee replacement. Why?
First knee replacement surgeries are 60-90 minute procedures. However, the second knee replacement is a 3-4 hour marathon. The difference is that it’s harder to safely remove the original prosthesis and then insert a second one.
Because of this, most surgeons want a “one and done”. Given that a knee replacement prosthesis lasts about 10-20 years (less if you’re active and more if you’re not), the best age for a knee replacement is the mid to late 60s.
The Knee Replacement Doughnut Hole
So what happens when a patient in their 40s or 50s shows up to get a knee replacement? If the surgeon is really honest and has the patient’s best interest at heart, they will generally tell the patient that they’re too young and send them packing. I call this the “Knee Replacement Doughnut Hole”.
Can Orthobiologics Fill the Doughnut Hole?
Orthobiologics are injectates like PRP and stem cells. To learn more, see my video below:
A recent study may answer that question (1). Here PRP injections were used in more than 600 patients. PRP is made from the patient’s concentrated blood platelets. These platelets release healing growth factors. These injections in knee arthritis patients delayed the need for a knee replacement by a median time of more than 5 years!
Our experience also shows, that in patients with more severe osteoarthritis, bone marrow concentrate (BMC or a same-day bone marrow stem cell procedure) can delay the need for a knee replacement. So while PRP helps patients with mild arthritis fill that doughnut hole, for more severe bone on bone patients, BMC can help more severe patients.
Can Orthobiologics Prevent the Need for a Knee Replacement?
While PRP helped patients delay the need for a knee replacement, can orthobiologics get rid of the need altogether? We have patients that are 10+ years plus out from a BMC procedure and who have never had a knee replacement. More importantly, a recently published study out of France shows that 4 in 5 patients who got advanced BMC injections were able to avoid a knee replacement at 15 years post-injection (2).
The upshot? You really don’t ever want to get two knee replacements. Hence, a great use for orthobiologics is filling that doughnut hole for young knee arthritis patients in their 40s and 50s. Based on the published data, many patients may be able to push the need for that big surgery to a more appropriate age. In addition, using BMC, many patients could be able to avoid the need for a knee replacement long-term.
(1) Sánchez M, Jorquera C, Sánchez P, Beitia M, García-Cano B, Guadilla J, Delgado D. Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis. Int Orthop. 2020 Jul 3. doi: 10.1007/s00264-020-04669-9. Epub ahead of print. PMID: 32621139.
(2) Hernigou P, Delambre J, Quiennec S, Poignard A. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up. Int Orthop. 2020 Apr 23. doi: 10.1007/s00264-020-04571-4. Epub ahead of print. PMID: 32322943.