Your PRP Didn’t Work. Now What?

by Chris Centeno, MD /

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PRP Didn't Work

Platelet Rich Plasma, or PRP, is becoming well known these days, with many professional athletes using it to return to play faster and with many weekend warriors following their lead. But for some, there is either an early impression that the PRP injection didn’t work, or their PRP actually fails to help resolve the problem. Why does this happen and what’s next?

What is PRP?

PRP stands for platelet rich plasma. This is a concentrate of the patient’s own blood platelets in their own serum. Platelets are fragments of cells that clot the blood and then release helpful growth factors to stimulate repair. You can think of PRP like concentrated espresso shots for the local cells to kick them into gear.

The first thing to understand is that few physicians possess the technical expertise to prepare PRP manually in their offices (every Regenexx Network Provider does). Hence, most doctors purchase automated centrifuges to reduce complexity and costs. These are push button machines that utilizer kits that the doctor buys. What this typically means is that all the doctors know about the PRP is where to put the kit and where the “On” button is located on the machine.

Your Platelet Rich Plasma Mix is Unique to the Doctor and Clinic

Believe it or not, there are many types of PRP out there. From the patient’s perspective, this falls into three categories:

  1. Red PRP – This is literally red in color and often concentrated to lower levels. This is the first type of PRP available with many of the older machines sold to doctors. It’s rich in white blood cells, so it generally causes more inflammation and reaction when injected. Many doctors believe that red PRP may be less effective for most orthopedic applications because of these extra white blood cells. Having said that, there may be a few conditions where red PRP is the best way to go.
  2. Lower Concentration Amber PRP – This is amber in color and concentrated to lower levels (fewer platelets). This is a newer PRP type that is usually poor in red and white blood cells. This is also called “Pure PRP”. This causes less of a tissue reaction and less swelling when injected. Many doctors consider this type to be ideal for injecting into tendons and ligaments.
  3. Higher Concentration Amber PRP – This is also amber, but with more platelets. Few automated machines that doctors purchase can produce this higher concentration amber PRP, so this type is less common. Our research has shown that this type of PRP is ideal in joints and is best used to treat arthritis.

What are PRP Injections Used to Treat?

  1. Tendinopathy – “pissed off” and degenerated tendons are likely the number one use for PRP today
  2. Small tendon or ligament tears
  3. Arthritis – a joint that has begun to lose cartilage and develop bone spurs

Why Does PRP Fail?

In our extensive clinical experience, sometimes PRP shots are just a bad fit for the problem being treated. For example, PRP can produce great results when used to treat mild knee arthritis, but can often fail when used to treat moderate or severe arthritis. For the latter more severe variety, we’ve noticed that better results can be obtained with high concentration amber PRP or stem cells. Other problems that may be too severe for PRP include bigger tendon or ligament tears. These again may respond to stem cell injections. If they’re massive tears, they may require surgery.

Another reason PRP may fail is due to the wrong type used for the problem. Regrettably, once a doctor makes an investment in a specific automated machine that produces a specific PRP type, that’s all he or she usually has to use. However, the broad scope of patient problems aren’t one sized fits all. For example, older patients have less potent platelets and may need much higher concentrations injected. Another example is that red PRP may not be the best fit for problems like knee arthritis. Regenexx providers can custom tailor prp preparations to best match the patient and the condition.

PRP failure may also result from a doctor who is inexperienced in using the technology. For example, many physicians who inject toxic anesthetics like Marcaine / Bupivicaine, or harmful high dose steroids, may continue to use these noxious drug chemicals with PRP, counteracting much of its healing effects. Lastly, PRP should only be injected under imaging guidance like ultrasound and/or fluoroscopy to ensure that the platelets are getting to the exact spots where they’re needed. Unfortunately, many older physicians and surgeons have never been trained in the proper use of guidance technologies, leaving them to perform blind injections that are likely to miss the mark.

The upshot? PRP is great stuff and it usually works well when the right type is used for the right problem. However, like any medical technology, it can fail. If PRP didn’t work for you, see if you might need a different type, a more experienced provider, or another technology that packs more punch, like the Regenexx patented stem cell protocol.

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55 thoughts on “Your PRP Didn’t Work. Now What?

  1. Sarah

    I had PRP in October on my knee that was diagnosed with osteoarthritis by a Regennex provider.Unfortunately, as of yesterday a little over 3 months to the day of my injection, I am now feeling a lot of discomfort, I was told I may need 2 or 3 injections, but not sure if I want to make the investment. Was really hoping it would have lasted longer. It was nice while it lasted.

    1. Regenexx Team Post author

      Sarah,
      The discomfort might be unrelated or temporary. If it continues, contact your treating doctor. It might be that you need an additional treatment to get enough regenerative potential for the problem as your doctor said might be the case. Being the one who examined your knee, his would be the important opinion in this case.

  2. Susan Maass

    I have had a second PRP treatment following my cultured stem cells last March into my shoulder with rotater cuff and several other problems. It’s been slow but worth it. I would say my shoulder is 90-95% back to normal. While the first PRP did wear off, the second has lasted so far. I am thinking of it as two steps forward, half a step back and repeat. At age 65 I have to admit that these are great results.

    1. Regenexx Team Post author

      Susan,
      Great news! Thanks so much for sharing your update, and valuable perspective.

  3. Rosalie

    Dear Regenexx-Team,
    do you have a statistic available? Ho high is the hit rate for cartilage repair of PRP?
    Thank you
    Rosalie

    1. Regenexx Team Post author

      Rosalie,
      Here is an Infographic on Regenexx SCP, which is very much more powerful than regular PRP: http://regenexxusa.wpengine.com/wp-content/uploads/2012/08/Regenexx-SCP-Infographic-General.pdf That said, generally speaking stem cells have more cartilage repair potential than platelet procedures: http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  4. Rosalie

    Thank you, do you have also data about the outcome in patients?
    Do you know how high is the hit rate in patients?
    Thank you
    Rosalie

    1. Regenexx Team Post author

      Rosalie,
      The Infographics were representing patient outcome. Regenexx SCP is much stronger and targeted than PRP. Depending on several factors, some patients do very well with Regenexx SCP, and some will require stem cells, our Regenexx SD procedure. In order to determine in which category your are, you would need to fill out a Regenexx Candidate Form on this page http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/, which will set up a phone call with one of our Doctors to evaluate your specific situation..

  5. mary bradish

    While receiving prp in my hip the piriformis was injected. I screamed as the intense pain radiated down my leg to the calf. I was involved in exercises every other day, electromagnetic stimulation which only helped remedy the pain in my hip for a short time. Then prolotherapy was attempted and again pain relief for only for a short time.
    In a year and a half I have tried stretching exercises, water therapy, physical therapy and chiropractic adjustments and stretches only to have the pain in my hip and buttocks remain and many times at a severe level.
    I now have been told that I need my hip replaced by one orthopod and the second one thought I should get some physical therapy first. Replacing the hip will not take away the pain from the piriformis and sciatica.
    What do I do now?

    1. Regenexx Team Post author

      Mary,
      What type of PRP was this and where were you treated?

  6. Anne Boyd Kimball

    June 2011 I tore my right supraspanatus tendon %70 and my labrum. In Nov. 2011 the tendon was repaired arthroscopically. The labrum had a small tear and was not repaired. In the spring of 2012 I was diagnosed with a partial tear in my left supraspanatus tendon. In 2013 I still was having chronic pain in my right and left shoulders. I did some research and found Regenexx. I scheduled a PRP procedure in my right and left shoulders at the Maclean,VA office. Dr. Robert Wagoner performed the procedure. About 6 months later I had a second injection of PRP in both shoulders.
    Later I returned to the clinic to have the stem cell procedure in both shoulders, since I was still having pain. A follow up MRI confirmed that the labral tear in my right shoulder was healed, but the partial tear in my left shoulder was not healed. I am still having pain in my right and left shoulders especially when I perform physical activity with either shoulder. I don’t want to have surgery again. Where do I go from here?

    1. Regenexx Team Post author

      Anne,
      There are so many factors that go into treatment and the treating doctor is the person with your medical history and treatment records. Have you contacted Dr. Wagoner? We would be happy to assist you in reaching him, please let us know if you would like us to do that..

  7. mary bradish

    Mary Bradish
    I was given red prp done by an orthopod that has been doing knees with this procedure with good results. My blood was taken from my arm and put in the centrifuge spun down and then injected into my hip joint under floroscopy along with hylauronic acid in a hospital setting. That evening I had a strange reaction and this may have been a coincidence
    but I got a severe pain in my left shoulder that lasted perhaps a minute. Does a platelet ever migrate to an area such as the cardiac area?

    1. Regenexx Team Post author

      Mary,
      You’re right, replacing the hip will not take away the pain from the piriformis and sciatica. While I know it seems like an Orthopod would be a logical person to go to for such things, and a lot of them are beginning to do some of these procedures, it is an entirely different specialty and by and large their knowledge, training and experience in this area is simply not adequate. We see these patients afterwards regularly. So rather than listing the issues with what was done, we will gladly do our best to help you sort it out so that the current nerve issue does not get worse. http://www.regenexx.com/stem-cell-clinic-reviews/ http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

  8. Tom

    I am looking for Regenexx in Europe? Where can I get your treatment, only in the USA or in Europe, too?

    1. Regenexx Team Post author

      Tom
      At the moment, only the USA and Australia. We are currently looking into possibilities in the UK.

      1. Eliot

        any update on possibilities in the UK?

        1. Regenexx Team Post author

          Eliot,
          We’ve been in discussion with a physician in the UK, but do not have any information as of yet. However, Regenexx Europe is now open in Brussels. Please see: http: http://www.oreme.eu

  9. Tom

    How long do I usually have to stay in the USA to receive a stem cell therapy for damaged cartilage?
    For example 4 PRP-applications once a week? Is it possible to combine this with holidays?

    1. Regenexx Team Post author

      Tom,
      Is this a treatment plan that resulted from a Regenexx Candidacy Evaluation?

  10. Tom

    No, I just found you in the internet and heard about your studies. I just wanted to know, how/if I could may receive your therapy in the USA, and how long I need to stay in the USA for your therapy.

    1. Regenexx Team Post author

      Tom,
      Generally we recommend 8 days for Regenexx SD which is our Stem Cell Therapy. Depending on diagnosis, knees can also be treated with our platelet (PRP) therapies. In order to know what time to allow, please fill out the Regenexx Candidate Form on this page: http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/, which will also give you more information on our knee procedures. Submitting the form will result in being contacted by Regenexx about setting up a phone call with one of our doctors, so that they can determine what type of procedure would work best for your particular case. Once that is accomplished, you will have a clearer picture of what to expect.

  11. Vee

    I have leaky heart valves and mitra value prolapse, is the PRP safe . Spoke to heart Dr. He said he was not familiar with the procedure

    1. Regenexx Team Post author

      Vee,
      Because the PRP and or stem cells are your own cells which are administered by precise injection directly into the area of the joint being treated, there would be no issues with your heart valves.

  12. A2M.

    Hello, I was diagnosed with a tear in my rotator cuff. My doctor recommended A2M. Can you explain to me the difference between an A2M , PRP and stem cell procedures.

    1. Regenexx Team Post author

      A2M,
      Platelets, stem cells and A2M are all things that occur naturally in your body, but they do different things, so it’s about applying them to the right problem and using techniques and procedures to maximize their potential. PRP is Platelet Rich Plasma; Platelets are involved in clotting the blood, so it’s about getting the right components of the blood to enhance your body’s natural ability to repair. A2M is a naturally occurring protein found in blood plasma which is thought to help block cartilage breakdown in joints, so it’s about figuring out how to use that potential. Stem cells are the actual repairmen of the body designed to replace cells which are no longer functional, and therefore have the greatest regenerative potential. The treatments created from these three different things can have minimal or maximum potential depending how they’re prepared, what’s in the treatments, and how the treatments are performed. But there are issues to be aware of. The PRP made in bedside centrifuges that is generally available often causes excessive inflammation because it still contains red and white blood cells.http://www.regenexx.com/what-is-prp/ A2M is extracted from the blood and administered into the joints and appears to have potential, but there are no studies on humans regarding dose or it’s effectiveness in real patients. http://www.regenexx.com/what-is-a2m/ Stem cells have the greatest regenerative potential, however, it’s important to use stem cells from the correct source for the problem being treated and use techniques that maximize the amount of stem cells harvested. Stem cells from bone marrow are the most effective for orthopedic purposes. http://www.regenexx.com/stem-cell-cartilage-regeneration/ Importantly, all of these injection therapies should be done under ultrasound or fluoroscopic guidance. http://www.regenexx.com/stem-cell-research/ http://www.regenexx.com

  13. Mike

    I have had numerous PRP injections from different doctors. A few times it was the red PRP and a few times it was the clear/yellow. It seems that in either case it took repeated injections to put somewhat of a dent into the pain, and to be honest the results were not quite what I had hoped for. My injures are/were: tennis elbow, quad tendon tear/tendinosis and tendinosis and slight tearing of the infraspinatus. That being said, I have continued to be plagued by what seems to be tendon pain throughout my body (tennis elbow in both elbows, hamstring,brachialis ?? and what seems to be the front deltoid) so I wonder how if systemic issues or genetic issues are making me prone to this and preventing me from responding well to treatment.

    1. Regenexx Team Post author

      Mike,
      Biomechanics could definitely be in play, so an exam by someone who can evaluate these issues is essential, as the body is a finely tuned machine and a little nerve in your back or neck other issues can knock everything else off, leading to injury. These free books explain those concepts: http://www.regenexx.com/library-complimentary-regenexx-resources/ So that’s the first thing to consider, but research does show there can be a genetic component to tendon/ligament type injury: http://www.regenexx.com/blog/is-being-prone-to-injury-a-genetic-thing/. Since those genetic anomalies are ever present, they can also affect treatment response. However given the issues with generally available PRP and injection techniques, you might not have seen it’s maximum potential. When the most powerful platelet procedures aren’t effective, stem cells which have much greater regenerative potential often are. http://www.regenexx.com

  14. Hugh

    Hi,
    I have had Plantar Fascitiis for two years in which time I have tried everything from orthotics, calf stretching, shockwave therapy. I now feel like it is Planta Fascosis since it is most likely dead tissue or scar tissue and the natural healing process has stopped working. PRP is now my last resort. Would PRP have a positive effect on scar tissue or dead tissue?? THe spot of pain is on the medial side of the heal where the planta Fascia connects to the calcenous. I am a fit, 35 year old male. Have had to stop walking and running 2 years ago. Swim and go to the gym to stay fit.

    1. Regenexx Team Post author

      Hugh,
      We treat Planatar fasciitis regularly. Having had it for two years before seeking treament is not unusual. Please see: http://www.regenexx.com/plantar-fasciitis-release-surgery-is-a-bad-idea/ and http://www.regenexx.com/blog/plantar-fasciitis-steroid-injection-side-effects/ and http://www.regenexx.com/the-regenexx-procedures/ankle-surgery-alternative/ here’s a list of Physicians who can see what’s going on and treat it: http://www.regenexx.com/find-a-physician/ Alternatively, with a current MRI, you can submit the Candidate form to see if you’d be a Candidate.

  15. Pam

    I just had a prp injected into my elbow 10/5/17, for tennis elbow. I have had no relief at all. at times the pain is worse and my fingers and wrist are harder to get moving.I thought on the 7 th day I would see some results for the better. I’m still in terrible pain at night, a lot durning the day.The Dr recommended no ice at all, to stop the norco and take just the tramidol for pain which isn’t touching the pain. I was back to 8 hrs work last Monday but on very light duty just wiping down things and vacuuming with my good arm. What is your suggestion? I have been dealing with this since July 17 of this year.

    1. Regenexx Team Post author

      Pam,

      What type of PRP was this? What type of imaging guidance was used? Who was the treating physician?

  16. Alyssa

    Hi,

    I’ve had hamstring tendinosis for a little under a year now and just had a PRP injection yesterday. I was warned there would be soreness and swelling but the area feels no different than before, certainly not any more pain or soreness. Is this a normal response? Does it indicate that the treatment is failing or is it too early to tell?

    1. Regenexx Team Post author

      Alyssa,

      Much too early to tell. Importantly, using the right type of PRP for the issue and getting the PRP to the exact spot needed with appropriate imaging guidance are crucial to the success of the procedure. Please see: https://regenexx.com/blog/what-is-prp/ If this was a Regenexx procedure, those things would have been done and this will explain the cycles of healing a ligament goes through. Please see: https://regenexx.com/blog/understanding-ligaments-repair-regen-med-treatments/

  17. Pete

    Hi, I had 3 PRP sessions, each 1 month apart, starting 4.5 months ago. It helped me tremendously, but now the affected area seems to be flaring up again. I was wondering if its undergoing a mini-healing crisis, or whether its time for me to get some more?
    Thanks!

    1. Regenexx Team Post author

      Pete,
      We’d need more information. What area was treated? What specifically within that area was treated? (a ligament or tendon, a structure within the joint, etc) Was this a Regenexx procedure?

  18. Bill

    Hi, with the PRP procedure, do your clinics use any anesthetic prior to injection?

  19. Deborah

    I had prp for hip bursitis in March. My pain management dr thought it would be more beneficial than repeated cortisone injections. I have been through surgeries and many blood draws, but this time was terrible. The nurse could not draw enough. The dr. Took over and thankfully retrieved enough blood for the injection. Had the injection, later in the day some soreness. That night however, I had excruciating pain in my knee. Like a vice. I had experienced something similar with lumbar fusion and it went away. This has continued for two months! It happens at night, in bed. Tramadol helps, but my leg is weak, my hip and knee now hurt, I’ve been to pt, my dr says it’s the IT band. What? I’m not an athlete, this happened as a result of the prp injection. I finally got a steroid injection in the knee for relief. I’m frustrated, limping and angry. What next?

    1. Regenexx Team Post author

      Deborah,
      Hips and knees have a direct effect upon each other. Cortisone injections kill stem cells, breakdown cartilage and can damage tendons. On the other hand, PRP contains important growth factors and would be the better choice. But in interventional orthopedics, correct diagnosis based on exam, both what you’re injecting (the type of PRP used, as some types can be very inflammatory), and the ability of the Dr. to get the PRP precisely where it is needed is crucial. Please see: https://regenexx.com/blog/explain-interventional-orthopedics/ and https://regenexx.com/blog/what-is-prp/ What type of PRP and imaging guidance was used for your Hip injection?

    2. Chris Centeno Post author

      I would have to know which areas your doctor injected. Was ultrasound used? What kind of PRP (red or amber)?

  20. JaeS Lee

    Is there anyone in new york city?

    1. Regenexx Team Post author

      JaeS Lee,

      Yes, Dr. Kramberg is our NYC Regenexx Provider. Please see: https://www.rehabmd.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  21. Linda Young

    My problem is in the SI joint. Some doctors say prolotherapy is better for the SI joint, some say PRP, some say neither one.

    1. Regenexx Team Post author

      Linda,
      We’ve used both successfully. Which one is more appropriate depends on the the specific SI joint of the specific patient.

  22. Mike Mirabelli

    Hi there

    I have had hip arthroscopies on both hips and still have some scar tissue / tendonopthy on them . I tried 3 prp injections on my one and found helped a bit but not what I expected. I am considerinf doing a clean up surgery which is less intense . I don’t know what else to try expect stem cells and those are too expensive for me . Any recommendations ?

    1. Regenexx Team Post author

      Mike,
      Research shows that “cleaning up” a joint is not a good plan. Using the right treatment for the right issue is crucial and being able to customize that treatment to the individual is needed for successful treatment. Determining what caused the issue in the first place is equally important, and we’d need to examine you to advise what type of treatment would make sense in your case. Please see: https://regenexx.com/blog/surgery-to-remove-cartilage-in-knee/ and https://regenexx.com/blog/regenexx-flexible-lab-platform/

  23. Elaine Froehlich

    What can you tell me about electromagnetic field used as a therapeutic tool in stem cell regeneration of cartilage? Do you use this in your stem cell therapy?

    1. Chris Centeno Post author

      We tested several EM units with stem cells back in 2008 in our research facility, none helped the cells, so we do not use.

  24. Molly Madden

    Curious to learn your thoughts on ocd lesions of the talus and prp. The orhos’s we have seen for my 12 year old gymnast seem to think surgery is firstline for lesions of her size and of her elite load requirements. They said we could “try” casting or prp but shrugged off the idea of any success.
    So… my question – obviously there are few studies with prp that can prove success mostly based on the various formulations used for creating prp and the non standard injection protocols…. but does your company have any data for younger patients like my daughter and ocd healing?

    1. Regenexx Team

      Hi Molly,
      We’ve treated many young athletes because the of the long term consequences of orthopedic surgery in this age group. OCD lesions of the Talus are very unlikely to respond to PRP. This would need at a minimum bone marrow concentrate, (Regenexx-SD), in a precise image guided stem cell procedure. Please see: https://regenexx.com/blog/orthopedic-stem-cell-treatment/ We’d need more information through a Candidacy review to see how we could best help. To do that, please submit the candidate form here: http://www.regenexx.com

  25. Laura Chavarria

    My 14 years old gymnast had amber PRP injected for an ankle sprain. . It was given in Canada . The doctor said that it would take about 2 months to notice the improvement. Is this correct? Also, is it ok to used laser treatments after the PRP ?
    Thanks

    1. Regenexx Team

      Hi Laura,
      Because this wasn’t a Regenexx procedure, we can’t predict what to expect specifically, as we customize the procedure to the specific injury and the patient. Please see: https://regenexx.com/blog/regenexx-flexible-lab-platform/ But this gives a general idea of how healing works in regenerative ligament treatment. Please see: https://regenexx.com/blog/understanding-ligaments-repair-regen-med-treatments/ We recommend Infrared Heat Therapy Units post treatment. The Cold Laser therapy would likely be fine, but please check with the Physician who performed the procedure. .

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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