Can platelet-rich plasma (PRP) injection replace knee replacement surgeries?

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Osteoarthritis of the knee is a very common cause of disability in the elderly population. Male and females are equally affected, and quality of life is significantly compromised. Mild cases are managed with exercises and paracetamol like drugs. But in severe cases, knee replacement surgery may be needed. Replacement surgeries are costly, have significant morbidity and not liked by many patients.

The most common reason for knee replacement surgery is pain that’s not resolved or controlled by conservative management like oral medicines and physiotherapy. Thus, the foremost necessary goal for total knee replacement surgery is pain relief. However, it is said that pain might persist or worsen in a significant number of patients even when the total replacement of knee is done properly. Prevalence of pain after knee replacement surgery is high, and it is around twenty. Pain might persist or worsen in 14-36% patients after other joint replacement surgery too. Excluding the persistence of pain, there are risks related to physiological state and surgery in patients compromised with comorbidity.

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However, the most significant disadvantage of total knee replacements is its high cost that is especially important for developing countries. Even though the cost of knee replacement surgery has been slashed, still it’s beyond the reach of the majority of Indians. Other recent studies conclude that several total knee replacement surgeries are superfluous and in one study showed that total knee replacement surgeries were inappropriate. Total knee replacement surgeries are increased by many folds and most significant reason could be the higher sum of money gain.

Pain is that the most significant reason for replacement surgeries and there are many choices for managing pain aside from oral medicines or physical therapies. Intraarticular steroid injection (depo methylprednisolone or triamcinolone) and high molecular weight hyaluronic acid injection gives good results but have disadvantages of short-run results or effective solely in early stages. Radiofrequency ablation is another effective treatment choice for knee pain in osteoarthritis of the knee that is even effective in advanced degenerative arthritis, however, it doesn’t have any regenerative property of chronic knee osteoarthritis.

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Injection of platelet-rich plasma which is extracted from the patient’s own blood is a sort of regeneration therapy that reduces pain and promote healing of degenerated tissues. Traditional joint metabolism is altered in degenerative arthritis there is increased destructive metabolism and the anabolic process is weakened. PRP has several growth factors that decrease destructive metabolism, improves the anabolic process and promotes chondrocyte proliferation and remodeling.

Synoviocytes are activated with PRP injection and it will increase mucopolysaccharide secretion and build far better and favourable surroundings within the joint. With these changes, there is a decrease of pain, growth of degenerated cartilage and improvement joint function when PRP injection is done in osteoarthritis of the knee.

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Thus, with the advent of PRP injections in the knee joint, we may see less number of total knee joint replacement surgeries in the future. But to comment on whether PRP injection can replace the replacement surgery or not, we need much more researches and more evidence. But we hope that it may be possible.

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