Summary

Knee pain is a common condition among seniors, with advancing age. There can be various conditions causing knee pain, one of them being Arthritis. There are various treatment options for knee-pain, including medication, surgery and physiotherapy. Platelet-rich-plasma injections are a relatively newer option, and offer hope to lot of seniors with debilitating knee-pain. In this article, we will learn more about this therapy.

Introduction to Knee Pain

Our knees are one of the most important joints in the body. They help bear our weight, help us sit, stand, bend, walk, jump and run. Considering that the knee has to flex and bend several times in a day, it has to be built robustly with multiple components. So, the knee-joint is a complex structure, anatomically speaking.

The thigh bone (femur) and the shin bone (tibia) meet at the knee-joint. There is a bony plate at the front of the knee-joint called the patella, which can be easily felt. There are tendons, ligaments, cartilage, muscles and nerves at the joint, all of which work in perfect coordination with each other, to ensure smooth movement of the knee-joint.

Like with any other part of the body, the knee-joint is also prone to a wide range of ailments and conditions. While some are age-related, some have other causes. They include ACL injury, fracture, torn meniscus, knee bursitis, patellar tendinitis, iliotibial band syndrome, dislocated kneecap, hip or foot pain, gout and pseudogout. Then there is arthritis which causes significant knee-pain and impaired movement. Again, arthritis is of three types – rheumatoid arthritis, osteoarthritis and septic arthritis.

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Also Read: The different types of Joint Injections in treating Joint Pain

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Treatment options for knee-pain

Knee-pain is not a new ailment and has been around since ages. So various treatment options have evolved with time.

Non-surgical options

• Bracing
• Injections and Infusions
• Lifestyle Modifications
• Nutraceuticals
• Pain Medications
• Physical and Occupational Therapy

Surgical options

• Total knee replacement
• Complex or revision knee replacement
• Kneecap replacement (patellofemoral arthroplasty)
• Uni-compartmental (partial) knee replacement

Each option has its own pros and cons. Some are painless, some are painful. Some require extended hospitalization; some require a few days of hospitalization only. Some are expensive, some are cost-effective. Some come with side-effects, some have no side-effects.

PRP Therapy lies at the junction of all these options. Being minimally invasive, the therapy is painless. It is light on the pocket, does not require hospitalization (it’s an outpatient or clinical procedure) and finally, it does not have any side-effects or risks. That explains its increasing popularity since it was first attempted in the early 2000s. While this therapy cannot be used for all the above-listed conditions, it is being increasingly preferred for knee-pain caused by arthritis.

What is Platelet Rich Plasma (PRP)?

Human blood is made of four key components. Red-blood-cells, white-blood-cells, platelets, which are all cellular components suspended in the fourth component, which is the liquid called plasma. These components can be separated using various techniques.

Platelets, also called thrombocytes, are produced in the bone-marrow and they play an important role in clotting of blood. They also contain growth factors which are proteins that may be helpful in healing injuries by helping in regeneration of lost or damaged tissue. This precise nature of platelets is being harnessed for treating various ailments in the body.

Platelets are separated along with the plasma from RBCs and WBCs using centrifuging. This creates a substance called platelet-rich-plasma (PRP) which has a concentration of platelets in plasma. PRP is being used to enhance cosmetic procedures for skincare, to treat male-pattern baldness, to stimulate the growth of transplanted hair, and to relieve pain in joints such as the knee-joint.

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Also Read: Knee Pain: Causes and Treatment

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How is PRP Therapy for knee-pain done?

• The doctors will draw a small amount of blood from the patient’s arm.
• The blood-sample is put through a centrifuge which will help separate and concentrate platelets along with plasma and growth factors.
• The residual RBCs and WBCs are injected back into the patient’s body.
• The PRP is injected into the patient’s knee-joint to stimulate growth of damaged tissue.
• The patient is on local anaesthesia and a mild sedative to minimize discomfort.
• Multiple injections, spaced 4 to 6 weeks apart will be given to cause a long-term reduction in pain.
• It may take as many as 3 months before the effects start to show.
• The pain-reducing effect of the therapy can last up to 12 months, or in some cases up to 24 months.
• The therapy can then be repeated.
• Even after five years, and multiple PRP therapies, if there is no significant improvement in knee-pain, a knee replacement may be required.

How effective is PRP Therapy for knee-pain?

One of the key attributes of PRP is that it helps to change the chemical environment of the knee-joint. Studies have shown that PRP sends the chemical signals required to turn-off inflammation that is harmful to the extracellular matrix in the knee-joint.

Stem cells produced in the bone marrow of the body play a vital role in cell-repair and regeneration. However, with time, stem-cells can get bogged down by oxidative stress and their cell-signalling can become weak. This happens to stem-cells native to the knee-joint too. PRP injections help boost or energize the cell-signalling of stem-cells in the knee-joint. This helps accelerate the repair and regeneration of tissue there.

A research study published in the medical journal – Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders – in 2013, showed that PRP, Prolotherapy and bone-marrow aspirate support cartilage growth and repair (called chondrogenesis) by enhancing the presence of pro-chondrogenic microenvironmental factors.

Another study conducted and published in February 2021 showed that, PRP was proven to stop the chondrocytes catabolic activity, which is the breakdown and death of cartilage cells. This is vital for the reduction of the death rate of chondrocytes, which in turn helps reduce the loss of cartilage matrix secreted by cartilage cells.

The reason orthopaedic doctors are recommending PRP treatments for the knees can be gathered from a study published in February 2021 in the journal International Orthopaedics. As many as 667 persons were covered in the study.

• 1% of the persons could delay their total knee replacement by more than 1.5 years, with the average delay being 5.3 years.
• 7% of the persons did not undergo total knee replacement in the five-year follow-up period.

Outlook

Being a relatively new therapy, PRP for knee-pain has as many sceptics as supporters. While some persons in some studies could achieve a significant reduction in knee-pain, some showed marginal reduction. MRI studies showed that many persons demonstrated cartilage growth in the knee-joint while some did not. These are the reasons; the medical community is divided over the therapy.

However, a study conducted in 2021 study showed that PRP Therapy for knee-pain was successful 60% of the time. The success rate depends on various factors. The severity of damage to the knee-joint, the age of the person, the number of PRP injections given, the method of administering PRP to the knee-joint, all these affect the outcomes. That is precisely why, intense research is ongoing to arrive at the right frequency of injections, the right amount of PRP to be injected and the right concentration of platelets in the PRP. Needless to say, once these factors are standardized, the success rate will only keep increasing with time.

If you or anybody dear to you is suffering from knee-pain due to arthritis, PRP Therapy must be given a chance. There are no risks or side-effects and you could as well be in the 60% success rate group, thereby reducing the need for a knee-replacement surgery.

If you or a loved one is experiencing knee pain due to arthritis, consider exploring PRP Therapy as a potential solution. With no significant risks or side effects, PRP offers a promising alternative for pain relief and improved joint function. At Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our expert team is ready to guide you through this innovative treatment to help enhance your quality of life.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

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