Thoughts/experience/research about PRP therapy vs knee replacement?

September 12, 2022 7:43 PM

Before the pandemic, my father -- 75M, ~275lbs. -- had pain in his knees that was attributable to a lack of cartilage around the kneecap. The phrase "bone grinding on bone" was used. One knee was replaced surgically, but the pandemic delayed the other. Now someone has recommended Platelet-Rich Fibrin/Platelet-Rich Plasma as an alternative, and I want to know whether this is horsehit or not.

I have to admit my bias -- this recommendation came from a distant family member who I consider to be at best a ditz and at worst an idiot. When my father told her he was thinking about scheduling his long delayed second knee replacement, she started talking to him about PRP/PRF and she would. Not. Shut. Up. About it. I literally left the room because she was shouting down the phone line about the miracle of this procedure so loudly I could hear it from where my dad was holding the handset.

She swore up and down that it works miracles and prevents people from needing surgery, that she knew just the people in our area to send him to, and that he should get this done before too much time passes. My father is easily cowed by other people who claim to know things that he doesn't, and he's also internet-illiterate. So it falls to me to hunt down information, and I decided to start with AskMe:

1) Has anyone here used PRF/PRP as a substitute for knee surgery? How did you fare? What was your recorvery after the procedure?
2) Is there any reliable research about the effectiveness vs. surgery, especially in seniors?
3) Is this all just a bunch of crystal-waving mumbo jumbo?

Thank you in advance!

posted by The Pluto Gangsta to Health & Fitness (7 answers total)

Best answer: It was recommended to me once by a reputable source for some ankle issues I was having (inflammation and tendinopathy though, not lack of cartilage) and while it seemed promising from the peer- reviewed literature I looked into independently, it was still experimental and thus not covered by insurance (and $$$$). I tried the insurance-covered option first and it worked so….

So in sum I don’t think it’s hocus pocus but I think it has specific applications.

It may also continue to hover in the experimental uninsured space for some time because it’s already marketable without fda approval - there’s nothing illegal about that and it doesn’t make much sense for a company to go through all the expense of getting fda approval when it’s already legal to market and enough people will pay for it even without insurance.

I would ignore your intrusive relative and have your dad ask a trusted medical professional (including one who doesn’t sell this treatment) to get the best idea of whether there’s evidence this treatment would be best for me and also worth the out of pocket cost.
posted by Tandem Affinity at 8:15 PM on September 12, 2022

Best answer: Not a knee so I don't know how relevant, but I am missing a chunk of cartilage in my big toe. After a couple of years of misery finally I could barely walk so had PRP in it (private pay because of course insurance doesn't cover it) and it totally fixed it. That was about six years ago now. It was just an injection under local anesthetic and it felt like a lot of internal pressure for about a day (lots of fluid inside the joint) but that barely qualifies as "recovery." The results took a month or so to kick in. This was at the University of Washington so no, not a bunch of crystal-waving mumbo jumbo.
posted by HotToddy at 8:45 PM on September 12, 2022

Best answer: I work in this field (chronic disease epidemiology with a focus on orthopaedic surgery) and I think the answer to your question #2 is: we simply don't know as there is not enough evidence. However here are a few pieces of information that might help.

Approximately 30% of people present with bilateral knee osteoarthritis (OA) at the time they have their first knee replaced (ie the second knee is already damaged when they first seek medical care), and 40% of people who have one knee replaced go on to have the second knee replaced within 8 years. So there may be an element of inevitability in all of this for your dad.

Here is a single, moderately-sized randomized, placebo-controlled trial of PRP versus placebo injection for knee osteoarthritis (OA). Authors' conclusion:

"Among patients with symptomatic mild to moderate radiographic knee OA, intra‐articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months. These findings do not support use of PRP for the management of knee OA. "

And here is a systematic review and meta-analysis of 17 studies that found PRP is helpful for pain after a total knee replacement, but not for non-surgical management of knee OA.

Authors' conclusion: "This systematic review demonstrated no long-term statistically significant improvement in patient validated outcomes and secondary outcomes both in patients with knee OA or following TKA for OA. However PRP has been shown to have short to medium-term benefits in pain control after TKA and activities of daily living in patients with OA."

And here a research group has conducted a cost-effectiveness analysis of PRP (as a possible mechanism to delay TKA) versus going straight to TKA and found that TKA is slightly more cost-effective. The main problem they identify is that it is not known whether PRP actually works ie actually improves pain and thereby actually delays the need for TKA.

* TKA = total knee arthroplasty = total knee replacement

Feel free to memail if I can help you with any of the research.
posted by lulu68 at 10:09 PM on September 12, 2022 [5 favorites]

Best answer: I had PRP a few years ago to try to delay a THR and it did nothing and set me back a high three figures USD out of pocket. The subsequent hip replacement was very effective and insurance paid 100%. Apparently there are a small number of studies that it may have some usefulness with knees in some people, but nothing conclusive yet. If you’re already bone on bone I would expect it not to work. In my non-professional opinion I think PRP is throwing money down the drain.
posted by matildaben at 11:27 PM on September 12, 2022 [1 favorite]

Best answer: I did this a year ago for my knee. It didn't work for me. Fortunately it was covered by insurance.
posted by pangolin party at 7:10 AM on September 13, 2022

Best answer: I didn't have PRP, but I had hyaluronic acid injections in my knees. Studies show comparable results. I've had about a 75% reduction in pain and substantial improvements in mobility. So it might be worth asking about that, too.
posted by decathecting at 5:48 PM on September 13, 2022 [1 favorite]

Response by poster: Thanks for the input, everyone. I spoke to my father, he's disappointed but not very surprised. He's been too timid to bring up the subject with his joint doctor but now he'll at least discuss it as a pre-op or post-op possibility for pain management or recovery.
posted by The Pluto Gangsta at 4:54 PM on September 17, 2022