PRP injections Mesa: platelet-rich plasma made from your blood

Why does my joint ache?

A worn joint may stiffen after you sit for more than a few minutes during the day. The stiffness doesn’t always last once you begin moving, though aching may return after a busy afternoon. Swelling or a grinding feeling can make the whole area feel tight. Shoulder soreness often worsens overhead, while hip or knee soreness may worsen on stairs.

What can I try at home?

Cut back on the task that stirred the joint, but don’t spend the whole day still. Gentle movement can keep stiffness from making daily chores harder. Walk briefly, or move the sore joint through a comfortable bend before straightening it. Cold may ease swelling after activity, while warmth can help before you move.

Start with less effort than usual. If soreness rises as you move, stop and rest the joint. Your doctor can tell you whether a brace or medicine is safe.

When is it worth a visit?

Arrange a regular exam if the ache comes back or begins to disturb sleep, walking, or getting dressed. A doctor can check the joint for tenderness, swelling, and weakness. Wear may appear on an X-ray, but it can’t prove that wear causes every ache. Seek prompt care for fever, sudden weakness, a joint that has changed shape, or trouble bearing weight after injury.

Sources

1. A systematic review of 105 clinical PRP studies in orthopaedics published 2006-2016 found that only 11 (10%) described the preparation protocol clearly enough for another investigator to repeat it, and only 17 (16%) reported any quantitative metric of the final PRP composition. The authors concluded that the current reporting of PRP preparation and composition does not allow the PRP products actually delivered to patients to be compared between studies.

   Chahla J, Cinque ME, Piuzzi NS, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. Journal of Bone and Joint Surgery (American), 2017. DOI: 10.2106/JBJS.16.01374.

2. The DEPA classification was built because platelet and leukocyte counts alone do not describe an injection. Applied retrospectively to 20 published PRP preparations, the dose of injected platelets ranged from 0.21 billion to 5.43 billion - a 25-fold spread. No device recovered more than 90% of the platelets in the blood drawn, and most preparations were contaminated with red blood cells: only three of the devices reached a purity score corresponding to more than 90% platelets relative to red cells and leukocytes.

   Magalon J, Chateau AL, Bertrand B, et al. — DEPA classification: a proposal for standardising PRP use and a retrospective application of available devices. BMJ Open Sport & Exercise Medicine, 2016. DOI: 10.1136/bmjsem-2015-000060.

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.