PRP therapy Surprise: a shot made from your blood

Why does the joint feel worse some days?

After years of use, a joint can feel stiff, tender, or swollen. The smooth surface inside it may be worn. A tendon connects muscle to bone like a sturdy cord, so its soreness often sits beside the joint instead of deep within it and may worsen when that muscle works. An old injury can also speak up after yardwork or a longer walk.

Note the hour the ache begins, along with the motion that brings it on. Let the doctor know if the joint catches, gives way, or wakes you. The exam checks movement and sore spots, while an X-ray shows wear inside the joint. You won't have to puzzle it out alone.

What can you do at home first?

Ease up on the chore that stirred the joint, but don't sit all day. Gentle movement often keeps stiffness from taking hold. Warmth may help before activity, while a cold pack may calm swelling afterward. Wrap either pack before it touches your skin.

Use exercises that your doctor or physical therapist has already shown you. Begin with an easy amount and see how the joint feels later. Stop if a movement causes sharp soreness, buckling, or heavy swelling. Steady work is plenty.

When is it time to have the joint checked?

It's time for an exam when the ache disrupts sleep, walking, dressing, or errands, and you'll want your X-ray plus a written list of every medicine. Expect questions about the sore spot, the motions that worsen it, and anything that eases it. The doctor will also check how the joint moves.

PRP uses a small amount of your blood to make a shot. Spinning the blood separates a portion with more platelets; these tiny cells send early repair signals after a cut. It doesn't help everyone, so ask about the limits before deciding. After the exam, QC Kinetix can discuss regenerative treatments, including nonsurgical concentrated PRP that its medical providers prepare from your blood and give there.

Sources

1. Medicare's national coverage policy covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only within an approved coverage-with-evidence-development clinical study. There is no Medicare national coverage for PRP in osteoarthritis or tendinopathy, which is why these injections are billed to the patient as cash-pay.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.

2. The devices used to spin PRP at the point of care are cleared by FDA as clinical centrifuges, product code JQC, a Class I device under 21 CFR 862.2050 - for example the Biomet GPS Platelet Separation Kit (K030555, cleared 2003) and the Harvest SmartPrep2 / SmartPrep Platelet Concentration System (K103340, cleared 2010). That clearance covers the equipment that separates blood. It is not an FDA approval of platelet-rich plasma as a treatment for osteoarthritis, tendinopathy or any other orthopedic condition, and copy must never blur the two.

   U.S. Food and Drug Administration (Center for Devices and Radiological Health) — 510(k) Premarket Notification database and Product Classification: JQC, Centrifuges (Micro, Ultra, Refrigerated) For Clinical Use, 21 CFR 862.2050. FDA accessdata (CDRH device databases), 2003.

3. In the RESTORE trial - the largest placebo-controlled PRP trial in knee osteoarthritis - 288 adults aged 50+ with symptomatic Kellgren-Lawrence grade 2-3 medial knee OA received three weekly intra-articular injections of leukocyte-poor PRP from a commercial system or saline placebo. At 12 months the mean change in knee pain was -2.1 points with PRP versus -1.8 with saline (difference -0.4; 95% CI -0.9 to 0.2; P=.17) against a minimum clinically important difference of 1.8, and the change in medial tibial cartilage volume was -1.4% versus -1.2% (difference -0.2%; 95% CI -1.9% to 1.5%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings do not support use of PRP for knee OA.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

4. The ESSKA-ICRS consensus applied the RAND/UCLA appropriateness method to 216 clinical scenarios for intra-articular PRP in knee OA. Only 84 scenarios (38.9%) were rated appropriate, 9 (4.2%) inappropriate and 123 (56.9%) uncertain. PRP was judged appropriate in patients aged 80 or under with KL grade 0-III osteoarthritis AFTER failed conservative non-injective or injective treatment; it was NOT considered appropriate as a first treatment, nor in KL grade IV (bone-on-bone) osteoarthritis, where 91.7% and 87.5% of scenarios respectively were uncertain.

   Kon E, de Girolamo L, Laver L, et al. — Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12320.