Platelet-rich plasma (PRP) injections

[Montecfo]

I have end stage osteoarthritis in one of my ankles. An ankle replacement is indicated, but the operation is much more challenging than other joints. I understand the success rate is 60-70 percent which seems pretty low. Failed ankle replacements can be redone, but you begin to be on a path toward fusion of the ankle, which means there is no longer a joint there. This can effect the gait and hasten knee and foot arthritis, which is not exactly clear sailing for me as it is.

I have been considering this for probably 10 years. Over that time I have gradually had ankle pain increase, range of motion decline, and had to curtail activities (no running, hoops or other cutting sports). Can still bike, hike, walk, and ski but there is more pain/swelling post.

As an interim measure, I'm considering one or more injections of platelet-rich plasma (PRP). Essentially the injection source comes from your own blood which they centrifuge to isolate the platelets and then inject them using a sonogram monitor into the joint. The idea is to stimulate your body's own healing/repair capabilities to improve joint function. It requires a couple of weeks of down time.

This procedure is more commonly done for knees and hips, and I'm curious how many folks have utilized it, and how successfully.

Thanks!

 

[SecondCor521]

Either I misunderstand the science or its hokum.

Platelets only function, as I understand it, is to help blood clot. And you generally don't want your blood clotting unless it's in the context of a cut/abrasion/bruise/similar. Blood clotting inside the circulatory system is a bad thing.

And taking the platelets out of your body and injecting them into a specific spot seems suspect to me as well. Your body already naturally has a thing called a circulatory system that your platelets flow through and that goes to every cell in your body.

I suppose there are some secondary effects when your blood does in fact clot where other blood products might get involved, but again blood clots in your ankles are usually considered a bad thing, not a good thing.

Have you asked your doctor(s) about this PRP thing?

 

[Montecfo]

Either I misunderstand the science or its hokum.

Platelets only function, as I understand it, is to help blood clot. And you generally don't want your blood clotting unless it's in the context of a cut/abrasion/bruise/similar. Blood clotting inside the circulatory system is a bad thing.

And taking the platelets out of your body and injecting them into a specific spot seems suspect to me as well. Your body already naturally has a thing called a circulatory system that your platelets flow through and that goes to every cell in your body.

I suppose there are some secondary effects when your blood does in fact clot where other blood products might get involved, but again blood clots in your ankles are usually considered a bad thing, not a good thing.

Have you asked your doctor(s) about this PRP thing?

The recommendation is from my orthopedist. She would do the harvesting and injection.

 

[6miths]

Either I misunderstand the science or its hokum.

Platelets only function, as I understand it, is to help blood clot. And you generally don't want your blood clotting unless it's in the context of a cut/abrasion/bruise/similar. Blood clotting inside the circulatory system is a bad thing.

And taking the platelets out of your body and injecting them into a specific spot seems suspect to me as well. Your body already naturally has a thing called a circulatory system that your platelets flow through and that goes to every cell in your body.

I suppose there are some secondary effects when your blood does in fact clot where other blood products might get involved, but again blood clots in your ankles are usually considered a bad thing, not a good thing.

Have you asked your doctor(s) about this PRP thing?

Yes you misunderstand the science. Although I am not saying it's not hokum. Platelets are important in clotting which most people think of as just plugging holes in blood vessels but also includes helping the body repair the damage that occurs. Because of this role, platelets contain growth factors that help connective tissue and vascular endothelium proliferate in order to repair.

There is some limited evidence of benefit in joints although AFAIK there are no high quality RCTs to date. One of my colleagues got into hot water for treating professional athletes, including Tiger Woods, with PRP. Turns out high profile athletes expect you to come to them and it is a pain to get licences to practice medicine all over the place!

 

[scrinch]

I had the same recommendation from my orthopedist for my right S-C joint which is arthritic and inoperable...periodic injections of PRP. So far I've cut way back on tennis and have just lived with the pain. I haven't tried the injections yet. I'm curious to see what experience forum members share with you.

Good luck with the ankle.

 

[Montecfo]

I had the same recommendation from my orthopedist for my right S-C joint which is arthritic and inoperable...periodic injections of PRP. So far I've cut way back on tennis and have just lived with the pain. I haven't tried the injections yet. I'm curious to see what experience forum members share with you.

Good luck with the ankle.

Thanks.

You know, if inoperable, what are your other options?

For me.trying to regain or quit losing activities.

It sounds like the PRP will do no harm except possibly lighten the wallet

 

[6miths]

Thanks.

You know, if inoperable, what are your other options?

For me.trying to regain or quit losing activities.

It sounds like the PRP will do no harm except possibly lighten the wallet

Probably pretty low risk. Highest risk is likely getting an infection into the joint secondary to the injection. Pretty uncommon.

 

[scrinch]

Thanks.

You know, if inoperable, what are your other options?

For me.trying to regain or quit losing activities.

It sounds like the PRP will do no harm except possibly lighten the wallet

The only options I was given were PRP and steroid injections, and they were both described as temporary fixes. No long term solution for my issue. The doc did say that very few insurance companies cover the PRP (that was in Feb 2020) so a lighter wallet is likely if you choose that way to go.

 

[Montecfo]

Yes any help is temporary with injections. Duration unknown if at all.

Ankle replacement is also not a permanent fix if at all. People often need revisions, and some get fusions. And they wear out.

I know a guy I met from a message board about ankle replacements. His path led to amputation. He is very active and happy.

 

[Montecfo]

I'm ok with insurance not covering.

 

[stargazer08]

PRP is widely used in the equine world. It is very successful.
I know of one person who used it for his daughter who was a high school drummer. She injured her shoulder. It got her back on the drums. Insurance didn't cover it.
I have suffered through ankle problems. I have flat feet. The left being worse than the right. I horribly protonate on my left and have no strength in it. I use Aircast Airlift PTTD braces. I have to add additional cushioning on the medial left side because my bones are so out of alignment. I'm not sure if ankle braces would help in your situation.

 

[mystang52]

I had a partial MCL tear in my right knee and after conservative treatment failed, got that PRP injection. It's been 8 years so I don't recall the recovery time exactly, but I believe I was back to running after 4 weeks. So, FWIW it was a wonder cure for me.

 

[Montecfo]

PRP is widely used in the equine world. It is very successful.
I know of one person who used it for his daughter who was a high school drummer. She injured her shoulder. It got her back on the drums. Insurance didn't cover it.
I have suffered through ankle problems. I have flat feet. The left being worse than the right. I horribly protonate on my left and have no strength in it. I use Aircast Airlift PTTD braces. I have to add additional cushioning on the medial left side because my bones are so out of alignment. I'm not sure if ankle braces would help in your situation.

I do use a brace at times. May need to get more aggressive about that.

Whenever I am walking a lot I wear these nice Oboz hiking boots with a nice rocker sole. But I can walk reasonable distances in slip-ons without pain. My x-rays look far worse than what the Dr..sees, thankfully.

I looked up your braces and those.look pretty aggressive. That might be something more to try.

Another thing that helps tremendously is heel.lifts so the bone spurs are taken out of play a bit it just seems I need higher lifts now.

Thanks.

 

[jam12]

I've been working with original Prolotherapy for over 10 yrs, in my shoulder and got some yrs of no pain and I've had some in my damaged OA knee and may eventually get PRP in that knee. Cost holds me back. We have a great MD in our town who does a huge business with PRP and Stem Cells.. People who are desperate, had failed surgeries, you name it.....

There are providers across the country and Europe.

 

[skipro33]

Do more research on joint replacement. I have a very good friend, a fireman, who fell off a roof and shattered his ankle. They wanted to take the foot, but he refused. After a few years of recovery and surgeries, they replaced his ankle joint. Recovery wasn't too long as I recall and last time I saw him was when we were surfing together. He was easily able to run on the beach, swim and surf the Southern California beaches as good as he ever could.

 

[jam12]

As I said I'm living with 10 yrs of a damaged RIGHT SIDE of my body from a hip replacement 10 yrs ago....no more knives to my body if I have anything to say about it...thanks.....

And PRP etc does work, but insurance does not pay and that is why people don't try and then stick with it, totally non invasive and many docs and surgeons could be put out of business if more did the PRP work......again thanks...

 

[Montecfo]

As I said I'm living with 10 yrs of a damaged RIGHT SIDE of my body from a hip replacement 10 yrs ago....no more knives to my body if I have anything to say about it...thanks.....

And PRP etc does work, but insurance does not pay and that is why people don't try and then stick with it, totally non invasive and many docs and surgeons could be put out of business if more did the PRP work......again thanks...

Strangely, it seems to me it should not be super expensive.

Have you thought of medical tourism to get more or more frequent treatments?