How platelet-rich plasma can impact knee arthritis

Adam Anz, M.D.
Orthopaedic Surgeon / Sports Medicine Specialist
Andrews Institute for Orthopaedics & Sports Medicine
850.916.8700
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 Q: What is PRP?
Adam Anz, M.D.: PRP stands for platelet-rich plasma, and it is a product that we make from your blood. What we do is take some of your blood with just a needle into your vein as if you were giving a blood draw to donate blood or get a blood test done. We take about 15 milliliters of that blood and stick it into a special syringe that we can put into a centrifuge. The centrifuge spins and that layers out the blood based upon on the molecular weight or the contents of that blood. We take the blood, we spin it in a centrifuge, and all the red blood cells push to the bottom. Then there is a layer called the ‘buffy-coat,’ and then a top layer that is the plasma later. We can take that top layer that has plasma and platelets in it, and it is a PRP, and that is the product that we use.
 Q: How can PRP impact a patient’s arthritis?
Adam Anz, M.D.: Arthritis means joint inflammation. Typically what we have is degenerative arthritis and what that means is that there are changes in the cartilage that then signal to the joint that it should be inflamed. It’s like a warning signal to your body. With inflammation, there are ways to decrease it. Some of those are things that we take by mouth such as ibuprofen, other things we can inject into your knee to also help control that inflammation cycle, one of them being platelet-rich plasma (PRP). PRP has been developed around knee arthritis. They did preclinical animal studies, meaning they did studies in animals to see if growth factor therapies would work or help. They also did PRP studies with animals and they did studies in humans starting with just clinical trials or clinical series and then going to randomized control trials. That whole body of evidence now is pretty much a pyramid of evidence with the base being the animal studies, the next layer of being the early human trials and the following layers as we learn more and more. To the point now I can say there's a pyramid of evidence that supports PRP for knee arthritis. And what it does is help control the inflammation of the problem, because your body is understanding the changes of cartilage and meniscus inside and helping you as a system or an ecosystem adapt to that and change. We use PRP to leverage your own immune system to help you through this degenerative process.
 Q: Is PRP researched at Andrews Institute and if so, why should that be important to patients? Why you are comfortable providing this as a treatment option if not FDA approved?
Adam Anz, M.D.: With PRP at this point it does not need U.S. Food and Drug Administration (FDA) approval for me to be able to offer it to patients. There is one company that's bringing it through the FDA for the indication of knee arthritis. That's kind of the key to be able to convince the insurance companies to reimburse for it. For that reason right now we can offer PRP but it's not FDA approved for knee arthritis. The reason is, with FDA approval, it starts with that whole pyramid (of evidence), and they have to see it go through the entire pyramid before they'll give an approval for that. That's the reason that although we can provide it because it's not FDA approved for knee arthritis. Once it does get an approval, then we'll have leverage to convince the insurance companies to reimburse for it. What we are doing on this campus is we're trying to see how PRP compares to some of the other regenerative medicine technologies that we can provide such as bone marrow aspirate concentrate (BMAC). That's a study that we've completed enrollment on and we're waiting on the data to mature to know whether PRP is better than BMAC or the same or worse and that's what we're very excited about that study. Because in this space there's still a lot of fog or there still a lot of uncertainty about how well these procedures perform – and that's one thing that we feel is our charge is to take these technologies and provide real clear evidence how they're going to help our patients.

 

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