Adding Regenerative medicine to your practice.

[drusso]

this is a study better than most. however...

- not sure why you have to be confrontational, about me being pissed...

i am not pissed at science. i am disturbed when someone uses poorly designed "studies" to support a treatment with insufficient scientific basis.

this study is better than 95% of what you have posted previously. but...


- second and more serious - the study was not blinded to either the proceduralist nor the patient. so they knew what they were getting/got. this will affect results. in addition, only the PRP group had blood drawn.

this fact limits full acceptance of the procedure. and while it is a good study - it is still limited. (and yes, the authors noted this limitation)



- also, i dont think that you have evidence to support the supposition that the treatment effect is large. i did not see a separate power analysis



- finally, it does suggest that the real world experience of steroid injections lasting only 3 months is spot on.

https://watermark.silverchair.com/pnac059.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAuQwggLgBgkqhkiG9w0BBwagggLRMIICzQIBADCCAsYGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMcEco9wN0hSGOwnFpAgEQgIICl4AwQC-CJsPU3NHpbZelIxH5NDmHNqu0jbumkbUHjJFl2eC6R3DBaAJ35ePOXtyCOemOnKtVueSMRjK9boYbN6sdnTBf6lFcA_rWWfCfGmqIKFeebQ1UKhjN_J4jusstfbE-J2UUtSHk7otwVnfQJdOv3-yoVXXloOjbJa39-rRahcZ1mIuoHcnRM4M24YO94llODMeuH9Q4eNYdye6TN1SGKz_touw6zbM4dL3SPI3exJi38kxM-SzdEksxyd9sOxVservfWcuDAHqyK63nZRJuoxhFdS24InadbiAH6o3L-zThhwVZER7ABus8-2Kmz-RBuYN8v-GFr65kky33-5e9llhiNCLPA9oLNB1DQJe_SvdVtEbktModzD-955J20_cEsmx5l9GJ6qRIV0EXE50L3LVRp1UilXpCtO-S7oxX75n7NgbYnnRVuvlPdxqgDi0ud669Jws6Rhk_5UXmBC27A-hjSzqA-1O-o7ytG-7EkYWJBDvK7pzvy5s8gyVxB9NvliyMzB8jZc1uuYv8BH_KqitK4Nyqi3KYbBJxlbyj4m9YwAKgnB2cqwNu9OXJmndANSGe7GfiUu0riNd_rpux_TXyOPcDS1x27TMsw4Y0hvNzfD5oh2n36_hLXNyWEFrN34CR_mik4VXAghV_-lwsQulOBQiaFVhDpD8Emo9cCrjaysfywyCkppK-7oPwdgkDC4hOYSlVkzfrOyWqlDOydMvPBHSuzziFpPosxiDvNuy9aTvHHUqr84yLrtxdHisnsKBIAknLIf0HA3Ou-rl4TjnYmSL6baEmWgqpcvsvdkQRKESoR_D6FVfs2JmOYJzMSjTcowvJluQFxY-32Z4eiGXSqxgJy7OYouBUQdS5tmVQBzpEbA

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[lobelsteve]

If someone told me that my rage against the anti-competitive, corrupt, and wasteful SOS/HOPD arbitrage system was imaginary, I'd be pissed.

YOU:

And, I'd be pissed if I were a steroid KOL or anti-Regen KOL. Many people want to see Regen fail because it's a threat to their livelihoods, employer's SOS and facility fees, etc. If you make $$ cooking/sous vide genicular nerves and doing DRG on "failed knee arthroplasty causalgia" the last you want to see is a cheap PRP injection save the day.

ME: steroid KOL is LOL. Anti-regen KOL is not a thing. Genic pays very little (had a genic RF denied by a MC Adv plan yesterday. GDR for failed knees is an over reach. Few of these people will get this done and fewer will get long term relief.
And you said cheap PRP. I do it in office for cost of a 20610 or 20552. No charge for the spin down on their own blood. That's cheap PRP.

 

[drusso]

YOU:

And, I'd be pissed if I were a steroid KOL or anti-Regen KOL. Many people want to see Regen fail because it's a threat to their livelihoods, employer's SOS and facility fees, etc. If you make $$ cooking/sous vide genicular nerves and doing DRG on "failed knee arthroplasty causalgia" the last you want to see is a cheap PRP injection save the day.

ME: steroid KOL is LOL. Anti-regen KOL is not a thing. Genic pays very little (had a genic RF denied by a MC Adv plan yesterday. GDR for failed knees is an over reach. Few of these people will get this done and fewer will get long term relief.
And you said cheap PRP. I do it in office for cost of a 20610 or 20552. No charge for the spin down on their own blood. That's cheap PRP.

Anti-Regen KOLs and corticosteroid enthusiasts are going to be pissed...


Orthop J Sports Med. 2022 Mar 31;10(3):23259671221076496. doi: 10.1177/23259671221076496. eCollection 2022 Mar.

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes

Judit Fernández-Fuertes 1 2, Tamara Arias-Fernández 1 3, Andrea Acebes-Huerta 1, Marlene Álvarez-Rico 2, Laura Gutiérrez 1 4
Affiliations expand
PMID: 35387363 PMCID: PMC8977725 DOI: 10.1177/23259671221076496
Free PMC article

Abstract
Background: Intra-articular infiltration of platelet-rich plasma (PRP) is an alternative therapeutic option to classic hyaluronic acid for the treatment of symptomatic knee osteoarthritis (KOA). However, variation in preparation methods and quality assessment of PRP makes the study of its real clinical efficacy difficult.

Purpose: To (1) evaluate the clinical efficacy of a characterized PRP product prepared in a standardized manner and in a closed-system for the treatment of KOA and to (2) evaluate the association of the clinical response to PRP-related variables.

Study design: Case series; Level of evidence, 4.

Methods: We recruited 130 patients with nonoperative KOA and evaluated them for 1 year. PRP was prepared from a donation of autologous blood, obtaining 3 aliquots of approximately 10mL of product, which were frozen, allowing platelet disruption, platelet factor release, and long-term storage, until administration. Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions. Complete blood count was performed on the whole-blood sample and the processed PRP before freezing it, for product quality assessment. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and basic satisfaction scale at 3 months, 6 months, and 1 year after intervention.

Results: Quality assessment confirmed a leukocyte-poor PRP product (white blood cell count, 0.09 ± 0.09 × 109/L) with a high platelet purity (platelet count, 630.86 ± 191.75 × 109/L). WOMAC scores improved, and basic satisfaction was achieved in 70% of patients. No adverse events were reported. No correlations were observed between PRP quality parameters and clinical results. PRP complete treatment production costs were €108/US$125 (€36/US$41.6 per injection).

Conclusion: This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA. This technique was safe and affordable and ensured consecutive infiltrations with the same product to each patient.

Keywords: infiltration; knee; osteoarthritis; platelet-rich plasma (PRP); regenerative medicine.

 

[lobelsteve]

Anti-Regen KOLs and corticosteroid enthusiasts are going to be pissed...


Orthop J Sports Med. 2022 Mar 31;10(3):23259671221076496. doi: 10.1177/23259671221076496. eCollection 2022 Mar.

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes

Judit Fernández-Fuertes 1 2, Tamara Arias-Fernández 1 3, Andrea Acebes-Huerta 1, Marlene Álvarez-Rico 2, Laura Gutiérrez 1 4
Affiliations expand
PMID: 35387363 PMCID: PMC8977725 DOI: 10.1177/23259671221076496
Free PMC article

Abstract
Background: Intra-articular infiltration of platelet-rich plasma (PRP) is an alternative therapeutic option to classic hyaluronic acid for the treatment of symptomatic knee osteoarthritis (KOA). However, variation in preparation methods and quality assessment of PRP makes the study of its real clinical efficacy difficult.

Purpose: To (1) evaluate the clinical efficacy of a characterized PRP product prepared in a standardized manner and in a closed-system for the treatment of KOA and to (2) evaluate the association of the clinical response to PRP-related variables.

Study design: Case series; Level of evidence, 4.

Methods: We recruited 130 patients with nonoperative KOA and evaluated them for 1 year. PRP was prepared from a donation of autologous blood, obtaining 3 aliquots of approximately 10mL of product, which were frozen, allowing platelet disruption, platelet factor release, and long-term storage, until administration. Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions. Complete blood count was performed on the whole-blood sample and the processed PRP before freezing it, for product quality assessment. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and basic satisfaction scale at 3 months, 6 months, and 1 year after intervention.

Results: Quality assessment confirmed a leukocyte-poor PRP product (white blood cell count, 0.09 ± 0.09 × 109/L) with a high platelet purity (platelet count, 630.86 ± 191.75 × 109/L). WOMAC scores improved, and basic satisfaction was achieved in 70% of patients. No adverse events were reported. No correlations were observed between PRP quality parameters and clinical results. PRP complete treatment production costs were €108/US$125 (€36/US$41.6 per injection).

Conclusion: This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA. This technique was safe and affordable and ensured consecutive infiltrations with the same product to each patient.

Keywords: infiltration; knee; osteoarthritis; platelet-rich plasma (PRP); regenerative medicine.

Advancing the science.

Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions.

What does this mean though?

 

[drusso]

Advancing the science.

Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions.

What does this mean though?

They wore masks and...

 

[lobelsteve]

They wore masks and...

What does 3 consecutive times every 4 weeks mean? Did they get 3 injections in a day, 3 injections in 3 days. And every 4 weeks.

I ask because no protocol for treating anything is done in this manner.

 

[Ducttape]

How does blinding affect cytokine MOA? That's how PRP works. It doesn't work like acupuncture through hairy-fairy "expectancy" effects or placebo. Everyone got a shot in the knee. The steroid was the placebo.

And, I'd be pissed if I were a steroid KOL or anti-Regen KOL. Many people want to see Regen fail because it's a threat to their livelihoods, employer's SOS and facility fees, etc. If you make $$ cooking/sous vide genicular nerves and doing DRG on "failed knee arthroplasty causalgia" the last you want to see is a cheap PRP injection save the day.

And, it's okay to be pissed.

are you measuring cytokine levels to determine patient reduction of pain?

is that how these pain scores are being obtained?

and steroids are not placebo. steroids are treatment medication.



tell the patient that $800 for a PRP is cheap. 95% of the US population will disagree and 100% of my patient population.

i have to fight with them about going to PT once because of a $20 copay. had an argument with 1 patient about buying a $10 bathing suit from Walmart for aqua PT. Too expensive for her.


finally - are you really injecting PRP in to arthroplasty knees? i personally dont inject anything in to a post op knee.

 

[Ducttape]

Anti-Regen KOLs and corticosteroid enthusiasts are going to be pissed...


Orthop J Sports Med. 2022 Mar 31;10(3):23259671221076496. doi: 10.1177/23259671221076496. eCollection 2022 Mar.

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes

Judit Fernández-Fuertes 1 2, Tamara Arias-Fernández 1 3, Andrea Acebes-Huerta 1, Marlene Álvarez-Rico 2, Laura Gutiérrez 1 4
Affiliations expand
PMID: 35387363 PMCID: PMC8977725 DOI: 10.1177/23259671221076496
Free PMC article

this is not a study. its a case series - essentially an observation. no control. no randomization. no blinding.

they acknowledge that it is level 4 evidence. about the level of hearsay. posting it seems to imply it is something more important.

we can do better and post level 2 or better evidence, cant we?

Advancing the science.

Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions.

What does this mean though?

remember the days were "we" did series of 3 and people got better?

was it from the treatment, or the mega doses of steroids, or did people get sick and tired of getting stuck multiple times?

because talking to a lot of these patients now, it seems that for a lot of people it was the latter.

 

[lobelsteve]

The Need to Elevate Research Rigor Involving Regenerative Agents and Orthobiologics as Pain Treatments

We previously addressed the Pain Medicine community regarding the state and future of “Regenerative Medicine” as defined by the National Institutes of Heal

www.doximity.com

 

[drusso]

The Need to Elevate Research Rigor Involving Regenerative Agents and Orthobiologics as Pain Treatments

We previously addressed the Pain Medicine community regarding the state and future of “Regenerative Medicine” as defined by the National Institutes of Heal

www.doximity.com

That's why it is crucial to support IOF and other groups crowdsourcing for regen research. Some KOLs are about to make an important announcement about research funding that came from the death of a benefactor.

Initiatives - Interventional Orthobiologics Foundation

interventionalorthobiologics.org

 

[lobelsteve]

That's why it is crucial to support IOF and other groups crowdsourcing for regen research. Some KOLs are about to make an important announcement about research funding that came from the death of a benefactor.

Initiatives - Interventional Orthobiologics Foundation

interventionalorthobiologics.org

Death of benefactor was solely due to lack of stem cell injections?

 

[Ducttape]

Death of benefactor was solely due to lack of stem cell injections?

i was worried the death was due to stem cell injections...

 

[drusso]

Clin J Sport Med. 2022 Mar 17. doi: 10.1097/JSM.0000000000001029. Online ahead of print.

Efficacy of Ultrasound-Guided Glenohumeral Joint Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Controlled Trial

Jonathan S Kirschner 1, Jennifer Cheng 1, Andrew Creighton 1, Kristen Santiago 1, Nicole Hurwitz 1, Mark Dundas 2, Nicholas Beatty 3 4, Dallas Kingsbury 5, Gabrielle Konin 6, Zafir Abutalib 7, Richard Chang 3
Affiliations expand
PMID: 35316820 DOI: 10.1097/JSM.0000000000001029
Abstract
Objective: To compare the efficacy of ultrasound-guided hyaluronic acid (HA) versus leukocyte-poor platelet-rich plasma (LP-PRP) injection in the treatment of glenohumeral osteoarthritis.

Design: Double-blind randomized controlled trial.

Setting: Academic institution.

Patients: Seventy patients with chronic glenohumeral osteoarthritis were randomly assigned to receive a single injection of HA (n = 36) or LP-PRP (n = 34).

Interventions: Leukocyte-poor platelet-rich plasma was processed using Harvest/TerumoBCT Clear PRP kits. Ultrasound-guided injections of 6 mL HA or 6 mL LP-PRP into the glenohumeral joint were performed. Patients, the injecting physician, and outcomes assessor were blinded to treatment assignments.

Main outcome measures: Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) score, current/average numerical rating scale (NRS) pain scores, satisfaction, and side effects were assessed at the 5 follow-up time points over 12 months.

Results: Baseline characteristics were similar between groups. There were no significant between-group differences regarding SPADI, ASES, and current/average NRS pain scores at any time point up to 12 months postinjection (P > 0.05). However, significant improvements in SPADI, ASES, and current/average NRS pain scores were observed in both groups starting at 1 or 2 months (P < 0.01, P < 0.01, P < 0.001, and P < 0.01, respectively). These improvements were observed regardless of osteoarthritis severity. For patients who received LP-PRP, there was no effect of platelet yield on outcomes. Side effect and satisfaction rates were similar between groups.

Conclusions: There were no differences in pain and functional outcomes after a single injection of LP-PRP versus HA. However, significant improvements in pain and function were observed after both treatments in patients with glenohumeral osteoarthritis.

 

[Ducttape]

study seems decent. however, i wasnt able to see the actual article, only the abstract. cant afford to buy it.

was blinded, and randomized.

unfortunately, it does not show that PRP is better than hyaluronidase in this study. both helped (there was no placebo comparison.)

 

[bedrock]

study seems decent. however, i wasnt able to see the actual article, only the abstract. cant afford to buy it.

was blinded, and randomized.

unfortunately, it does not show that PRP is better than hyaluronidase in this study. both helped (there was no placebo comparison.)

Agree.

For me it comes down to cost. HA isn’t cheap and isn’t covered in shoulder.

If I personally have to pay out of pocket I’m going straight to PRP. I’m ok to start with HA if covered by insurance.

 

[MitchLevi]

Which HA?

 

[DODOCSS]

not monovisc

Anecdotally syn x3

 

[Doctodd]

for knees it's usually 3 visits of HA vs 1 visit of PRP.......id also go PRP

 

[drusso]

for knees it's usually 3 visits of HA vs 1 visit of PRP.......id also go PRP

That's more cost-effective in the long run.

 

[drusso]

What a difference a decade makes...#innovation #becomethefuture #patientsfirst #nonopioidsolutions #thefutureisbright

Clinical Trial Am J Phys Med Rehabil. 2010 Dec;89(12):961-9. doi: 10.1097/PHM.0b013e3181fc7edf.

Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study

Steven Sampson 1, Marty Reed, Holly Silvers, Michael Meng, Bert Mandelbaum

Affiliation
1The Orthobiologic Institute, Los Angeles, California 90025, USA.
PMID: 21403592 DOI: 10.1097/PHM.0b013e3181fc7edf

Abstract
Objective: To evaluate the clinical effects of intraarticular platelet-rich plasma (PRP) injections in a small group of patients with primary and secondary osteoarthritis. Most of the current treatments for osteoarthritis are palliative and attack the symptoms rather than influencing the biochemical environment of the joint. Autologous platelet-rich plasma has emerged as a treatment option for tendinopathies and chronic wounds. In addition to release of growth factors, platelet-rich plasma also promotes concentrated anti-inflammatory signals including interleukin-1ra, which has been a focus of emerging treatments for osteoarthritis.

Design: In this single-center, uncontrolled, prospective preliminary study, 14 patients with primary and secondary knee osteoarthritis who met the study criteria received three platelet-rich plasma injections in the affected knee at ∼4-wk intervals. Outcome measures included the Brittberg-Peterson Visual Pain (Visual Analog Scale [VAS]), Activities, and Expectations score and the Knee Injury and Osteoarthritis Outcome Scores at preinjection visit at 2-, 5-, 11-, 18-, and 52-wk follow-up visits. Musculoskeletal ultrasound was used to measure cartilage thickness.

Results: There were no adverse events reported. The study demonstrated significant and almost linear improvements in Knee Injury and Osteoarthritis Outcome Scores, including pain and symptom relief. Brittberg-Peterson VAS showed many improvements including reduced pain after knee movement and at rest. Cartilage assessment was limited because of the small sample size. The majority of the patients expressed a favorable outcome at 12 mos after treatment.

Conclusions: The positive trends and safety profile demonstrated could potentially be used to inspire a larger, blinded, and randomized clinical trial to determine whether platelet-rich plasma is safe and effective for the treatment of knee osteoarthritis.

 

[lobelsteve]

If off-label, I would never put visco into a non knee joint.
But when I do, I give all 3 shots at once or use a 1 shot product.

 

[Ducttape]

could potentially be used to inspire a larger, blinded, and randomized clinical trial to determine whether platelet-rich plasma is safe and effective

heading that way. almost there.....

 

[drusso]

heading that way. almost there.....

It's such a dangerous placebo.

 

[Ducttape]

It's such a dangerous placebo.

oh my. are you saying PRP is a placebo?

 

[hyperalgesia]

Lots of crappy studies don't add up to one good study.

 

[oreosandsake]

At least 5 PRCT HA vs PRP knee
PRP superior to HA

HA biologically active.

Both HA and PRP shown to upregulate anabolic factors and down regulate catabolic ones. Synergistic effect found in lab studies

 

[oreosandsake]

Agree.

For me it comes down to cost. HA isn’t cheap and isn’t covered in shoulder.

If I personally have to pay out of pocket I’m going straight to PRP. I’m ok to start with HA if covered by insurance.

I get this Q all the time from course participants.

Ha only covered (sometimes) for knee OA. Might be 3 injections. More expensive out of pocket oftentimes than prp. Prp superior to HA in many studies (not this one)

HA 1 percent chance reactive synovitis (forget which one now, synvisc?)

HA already produced by your synovium. Let’s try something different

 

[Iamnew2]

I get this Q all the time from course participants.

Ha only covered (sometimes) for knee OA. Might be 3 injections. More expensive out of pocket oftentimes than prp. Prp superior to HA in many studies (not this one)

HA 1 percent chance reactive synovitis (forget which one now, synvisc?)

HA already produced by your synovium. Let’s try something different

I personally think that if a lot of practices priced PRP more reasonably it would be better accepted. After the initial investment PRP is relatively cheap to administer. Some practices charge thousands of dollars for a procedure that simply is not that pricey to administer. I have seen PRP be most successful in practices that charge reasonably. Most people out there simply do not have thousands of $ to pay for PRP. HA is covered most of the time by insurance including MC for knees. So most patients are going to choose that.

 

[oreosandsake]

here's some science for you

 

[Ducttape]

none of the people i see can afford PRP as it is presently priced.

----

14 min for discussion on PRP.

he emphasizes that PRP is for acute tendinopathy, and not chronic. in fact, at 15:21, he discusses a study that shows that if given 1 week later, then PRP doesnt differentiate cells.

he also states that moderate exercise is anti-inflammatory and regenerative...

38 minutes for his summary.

 

[drusso]

none of the people i see can afford PRP as it is presently priced.

----

14 min for discussion on PRP.

he emphasizes that PRP is for acute tendinopathy, and not chronic. in fact, at 15:21, he discusses a study that shows that if given 1 week later, then PRP doesnt differentiate cells.

he also states that moderate exercise is anti-inflammatory and regenerative...

38 minutes for his summary.

For people stuck paying facility fees, SOS, and high deductibles it will always be out of reach unless it is subsidized. There is no such thing as a free lunch.

 

[hyperalgesia]

Let's see the best references you have for PRP working better than control in knee djd specifically...

 

[Ducttape]

yes those.

but even those who are private insurance. an equal number of these people refuse referral to the sports ortho that i give.

usually some BS excuse about wanting to keep seeing me, even after i tell them that PRP for tendonitis has good evidence. though this talk suggests that outside of the acute tendonitis, then use may be limited......

 

[oreosandsake]

when the tendon has degenerated into a mucinous sludge it is difficult.

TSCs are there, just like chondroblasts are there in your cartilage. the trust fund of them you were born with wont outlast super abuse. same with any end-organ disease. CKD4, end stage heart failure, full thickness ligament/tendon rupture

i think there's still a role for rehab and regen in chronic tendinopathy. also for joints, even when severe DJD, the synovium is biologically active. the fat pad is as well. you can affect the environment that the tissue is surrounded in. people saying that the PRP is too expensive are relying on medicare and insurance to pay for everything.

the blood is an incredible source of biologically active compounds that work, (surprisingly) on the body. and fortunately, it is really inexpensive to obtain them.

as an example of similar drugs.

Kineret which binds IL1
The cost for Kineret subcutaneous solution (100 mg/0.67 mL) is around $1,265 for a supply of 4.69 milliliters

Is Kineret covered by Medicare?
No. In general, Medicare prescription drug plans (Part D) do not cover this drug.

Remicade and humira which bind TNF-alpha?

Adalimumab (Humira)	40 mg	740.36
Infliximab (Remicade)	100 mg	$987.56
Infliximab (Inflectra)	100 mg	$$525.00

yes, there are things in the blood that can bind to and neutralize these. it would only make sense that the body would have a way to self-regulate itself. IRAP binds to IL1-b, A2m binds to TNF alpha.

when you have necrotic tissue and the body breaks down the dead tissue but spares the healthy tissue, it needs to know where to stop. there are cell surface markers that covalently bind to the collagenases to neutralize them.

 

[lobelsteve]

Conclusions​

PRP may be associated with pain and functional improvements but was not clinically relevant (inconsistent study- and patient-metrics). Additionally, PRP did not confer superiority when assessing knee-related structural changes.

The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis​

• Oliver C. Sax, DO MS
• Zhongming Chen, MD
• Michael A. Mont, MD
• Ronald E. Delanois, MD

Published:May 07, 2022DOI:Redirecting

 

[drusso]

Clin Orthop Relat Res. 2022 May 31. doi: 10.1097/CORR.0000000000002264. Online ahead of print.

No Benefit to Platelet-rich Plasma Over Placebo Injections in Terms of Pain or Function in Patients with Hemophilic Knee Arthritis: A Randomized Trial

Weifeng Duan 1, Xinlin Su 1, Ziqiang Yu 2 3, Miao Jiang 2 3, Lingying Zhao 2 3, Peter V Giannoudis 4 5, Jiong Jiong Guo 1 2
Affiliations expand

PMID: 35638918 DOI: 10.1097/CORR.0000000000002264

Abstract
Background: Hemophilic knee arthritis is one of the most common presenting symptoms of hemophilia, and its management continues to be challenging to practitioners. Preliminary research has suggested that platelet-rich plasma (PRP) may have short-term efficacy in the treatment of hemophilic knee arthritis, but evidence for this treatment is limited.

Questions/purposes: What is the effectiveness of PRP compared with placebo in (1) reducing pain and improving knee joint function (as measured by WOMAC, VAS, and Hemophilia Joint Health Score [HJHS]) and (2) improving quality of life (as measured by SF-36 scores) in patients with hemophilic knee arthritis through 24 months of follow-up?

Methods: This was a prospective, parallel-group, double-blinded, single-center, placebo-controlled randomized clinical trial that included participants from a tertiary care center starting January 1, 2019, with follow-up completed on November 30, 2021. Participants were older than 18 years and had hemophilic knee arthritis confirmed by MRI, and they were randomly allocated to interventions in a 1:1 ratio. The investigators were not informed of the randomization sequence generated by the computer. Patient groups were comparable with respect to age, gender, BMI, hemophilia type, and disease severity at baseline. Physicians delivered three sessions (one per week) of a standard intraarticular injection of PRP (n = 95) or placebo (n = 95). The rate of successful blinding was balanced across the groups, which was assessed by asking participants which injection they thought they had received. The primary outcome was the WOMAC score (range 0 to 96; higher scores indicate more pain and worse function; minimum clinically important difference, 6.4 points) over 24 months. Among the 190 patients assigned to PRP or saline injections (mean age 31 ± 7 years), 100% (190) of patients were men). There was no between-group difference in the proportion of patients who completed the trial; 97% (92 of 95) of patients in the PRP group and 94% (89 of 95) of patients in the placebo group completed the trial. The most common adverse events were injection site discomfort 8% (8 of 95) in the PRP group and 4% (4 of 95) in the placebo group. An intention-to-treat analysis was planned, but there was no crossover between groups. All patients were included in the analyses. With 95 patients in each group, the study was powered a priori at 90% to detect a difference in WOMAC score of 6.4 points, which was considered a clinically important difference.

Results: There were no clinically important differences in the mean WOMAC, VAS pain, HJHS, SF-36, and MRI scores between groups at any timepoint. Intraarticular PRP did not ameliorate function, symptoms, and quality of life in patients with hemophilic knee arthritis. At 24 months of follow-up, the mean difference between the PRP and placebo groups in the WOMAC score was -1 (95% CI -5 to 2; p = 0.42). The mean difference in the VAS pain score was -0.3 (95% CI -0.8 to 0.2; p = 0.19), in the HJHS was -0.6 (95% CI -1.4 to 0.1; p = 0.10), in the SF-36 physical component summary was 0 (95% CI -2 to 3; p = 0.87), and in the SF-36 mental component summary was -1 (95% CI -3 to 2; p = 0.64). The mean differences in the MRI scores of soft tissue and osteochondral subscore were 0.1 (95% CI -0.3 to 0.5; p = 0.59) and -0.3 (95% CI -0.7 to 0.1; p = 0.19), respectively.

Conclusion: Among patients with hemophilic knee arthritis, three intraarticular PRP injections, compared with placebo injections, did not improve hemophilic knee symptoms, function, and quality of life over 24 months. The results of this study do not support the use of PRP injections in patients who have hemophilic knee arthritis.

Level of evidence: Level I, therapeutic study.

Copyright © 2022 by the Association of Bone and Joint Surgeons.

 

[drusso]

hmmm... ACS more effective than PRP?

why havent you discussed ACS? it is a regenerative product.

I saw that. I don't have much familiarity with ACS and its cost is typically higher due to more intense tissue processing.

 

[Ducttape]

the good part - that is a pretty well done study. blinded, placebo controlled, randomized.

the bad part - no benefit.

the caveat - only in hemophiliacs. the question is whether this can be extracted to non-hemophiliacs.

and yes, i know someone will state that "oh they didnt get the PRP the way i get the PRP so its an invalid study", which is a Centeno marginal argument

 

[lobelsteve]

Good study. Not applicable. I have seen one hemophiliac patient since getting MD in 2000. And it was on PMR. Not knee pain.

 

[Ducttape]

i used to see a lot - mostly to see if i would "take over" their astronomically high doses of narcotics.

if i remember correctly, i think the worst i saw was methadone 60 a day along with oxycontin 80 twice daily and percocet 15s 4 a day for breakthrough

 

[drusso]

the good part - that is a pretty well done study. blinded, placebo controlled, randomized.

the bad part - no benefit.

the caveat - only in hemophiliacs. the question is whether this can be extracted to non-hemophiliacs.

and yes, i know someone will state that "oh they didnt get the PRP the way i get the PRP so its an invalid study", which is a Centeno marginal argument

I don't recommend PRP to hemophiliacs or sickle cell patients as part of my Evidence-based Regenerative Medicine practice. No data.

 

[Doctodd]

when the tendon has degenerated into a mucinous sludge it is difficult.

TSCs are there, just like chondroblasts are there in your cartilage. the trust fund of them you were born with wont outlast super abuse. same with any end-organ disease. CKD4, end stage heart failure, full thickness ligament/tendon rupture

i think there's still a role for rehab and regen in chronic tendinopathy. also for joints, even when severe DJD, the synovium is biologically active. the fat pad is as well. you can affect the environment that the tissue is surrounded in. people saying that the PRP is too expensive are relying on medicare and insurance to pay for everything.

the blood is an incredible source of biologically active compounds that work, (surprisingly) on the body. and fortunately, it is really inexpensive to obtain them.

as an example of similar drugs.

Kineret which binds IL1
The cost for Kineret subcutaneous solution (100 mg/0.67 mL) is around $1,265 for a supply of 4.69 milliliters

Is Kineret covered by Medicare?
No. In general, Medicare prescription drug plans (Part D) do not cover this drug.

Remicade and humira which bind TNF-alpha?

Adalimumab (Humira)	40 mg	740.36
Infliximab (Remicade)	100 mg	$987.56
Infliximab (Inflectra)	100 mg	$$525.00

yes, there are things in the blood that can bind to and neutralize these. it would only make sense that the body would have a way to self-regulate itself. IRAP binds to IL1-b, A2m binds to TNF alpha.

when you have necrotic tissue and the body breaks down the dead tissue but spares the healthy tissue, it needs to know where to stop. there are cell surface markers that covalently bind to the collagenases to neutralize them.

Great post

 

[drusso]

Pak J Med Sci

. Mar-Apr 2022;38(4Part-II):796-800.
doi: 10.12669/pjms.38.4.5558.

The effect of platelet rich plasma combined with celecoxib on knee function and pain in patients with knee osteoarthritis​

Mingjun Nie 1, Jianzhong Zhao 2, Guangcheng Zhang 3, Jiazhu Tang 4, Wei Zhu 5, Qing Zhang 6
Affiliations expand

• PMID: 35634627
• PMCID: PMC9121934
• DOI: 10.12669/pjms.38.4.5558

Free PMC article

Abstract​

Objectives: To analyze the immediate effect of platelet rich plasma, combined with celecoxib, on knee function and pain in patients with knee osteoarthritis.

Methods: The clinical data of 86 patients with knee osteoarthritis, treated in our hospital from January 2019 to January 2021, were analyzed retrospectively. According to the treatment records, patients were divided into a control group (n = 43, celecoxib) and a treatment group (n = 43, platelet rich plasma + celecoxib). The knee function, pain and clinical effect in the two groups were compared and analyzed using the Hospital for Special Surgery (HSS) knee score and the visual analog scale (VAS).

Results: The treatment group had a higher HSS score, and a lower VAS score compared to the control group (P<0.05). The clinical efficacy in the treatment group was higher than that in the control group (95.35% and 72.09% respectively, P<0.05).

Conclusions: Platelet rich plasma combined with celecoxib can promote the recovery of knee function and reduce pain in patients with knee osteoarthritis. This treatment combination also has a high immediate clinical effectiveness but needs further evaluation to find out the long term effects.
Keywords: Celecoxib; Knee function; Knee osteoarthritis; Platelet rich plasma; Retrospective analysis.

 

[nvrsumr]

I thought NSAIDs were a relative contraindication peri-injection of PRP? Others thoughts?

 

[Ducttape]

retrospective not blinded study.

does this study even make sense? doesnt centeno talk about the harms of NSAID?

 

[lobelsteve]

I thought NSAIDs were a relative contraindication peri-injection of PRP? Others thoughts?

NSAIDs increase risk of MI/CVA 31% if taken daily.
But if the study showed no benefit, it would be a different story.

 

[Dr. Ice]

For those interested

 

[oreosandsake]

1) celebrex doesn’t affect platelets

2) this study comes from china. Grain of msg

3) retrospective

odd study to even go back and dig for this data. I don’t expect celebrex to have a huge treatment effect.

 

[drusso]

NSAIDs increase risk of MI/CVA 31% if taken daily.
But if the study showed no benefit, it would be a different story.

Lies, Damn Lies, and Statistics - Regenexx @Ducttape @lobelsteve

 

[Ducttape]

this is why, to do a good study, you do a power analysis before you do the study.

which, to date, none of these retrospective PRP studies contain.

it is also why one cannot trust these retrospective studies - researchers will throw out data that is negative in order to obtain a positive result and post it so Centeno can congratulate them...