One newer option you might hear about is biologics. These are typically injected into the joint and have a biological effect, designed to either provide some temporary relief or potential short-term repair.

Note: You should consult an orthopaedic surgeon prior to getting any injections as there can be an increased risk of infection if you have an injection too close to surgery.

Here are some common biologics you might read about:

Platelet-Rich Plasma (PRP):

Platelet-Rich Plasma is taken from the patient’s own blood. The blood is drawn and then put in a machine that spins at high speed (centrifuge) to condense the platelets together. The platelet-dense fluid is then taken and injected into the areas that need help healing.

How would PRP help my joint?
Using PRP for conservative treatment of osteoarthritis is still somewhat new. Still, the early science suggests that PRP contains growth factors and proteins (in addition to the platelets) that may potentially help grow tissue and aid in the healing process. 7  There is at least some science to support the idea that PRP injections may also reduce pain in patients suffering from knee osteoarthritis, specifically. 7

I have heard that PRP is not FDA approved- is it safe to use?
It is true that PRP injection is not FDA approved for the treatment of osteoarthritis, but the reasons are a bit complicated. The FDA regulates the transplantation of human cells, tissues, and cell and tissue-based products (HCT/Ps). Simply put, the FDA does not think PRP injections are in this category (and therefore, not eligible for FDA regulation). However, the FDA did clear PRP for some other orthopedic uses (primarily blending it into bone grafting mixtures).

So, what does this mean for you? Well, since the FDA cleared PRP for other related uses, many doctors believe PRP is an acceptable ‘off-label’ treatment for osteoarthritis. However, you should be aware that since PRP is not approved for osteoarthritis, it is typically not covered by insurance.

As far as risks are concerned, since PRP is obtained from your body, many doctors consider it a low risk/minimally invasive treatment, and most scientific studies have been supportive. 7,10,11

Hyaluronic Acid (HA):

Hyaluronic Acid is something that your body normally creates that helps lubricate your joints and reduce swelling, but sometimes there is not enough in your joints. HA injections can be a good option for patients who cannot take or respond well to anti-inflammatories such as NSAIDs. Although your body does naturally make HA, the injections you receive for treatment are a manufactured product, currently sold under the following brand names:

  • Euflexxa
  • Hyalgan
  • Orthovisc
  • Monovisc
  • Supartz
  • Synvisc, Synvisc-One
  • Triluron

Are HA injections FDA approved?
Yes, the above-listed injections are approved for the treatment of osteoarthritic knee pain.

Are HA injections safe?
Yes, in randomized, controlled trials examining HA injections, the risk of adverse events appears to be low. 8, 11

PRP + HA:

Sometimes, your doctor may advise that you receive both PRP and HA injections, and there have been some recent studies that have found that using the combination of both can be more beneficial than using each alone. 9

What is available at FOI?

If you are interested in learning more about conservative treatment options for your hip or knee, you can make an appointment online or by calling: 813-978-9797

 

PHYSICIANS AT FLORIDA ORTHOPAEDIC INSTITUTE THAT USE BIOLOGICS

PRP & HA

Alavi

Bagen

Baker

Garcia

Garlick

Gasser

Grayson

Hess

Lyons

Mighell

Miranda

Morse

Palumbo

Pappou

Sellman

Watson

Yi

PRP ONLY

Doarn

Epting

Gustke

Infante

Maxson

Mir

Nydick

 

 

 

 

HA ONLY

Bernasek

Chaudhry

Donahue

Echols

Frankle

Sanders

Shah

Stone

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References

1. https://aaos-annualmeeting-presskit.org/2018/research-news/sloan_tjr/
2. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019; 393: 647-654.
3. Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019; 393: 655-663.
4. Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2018;13(1):170. Published 2018 Jul 6. doi:10.1186/s13018-018-0871-5
5. Simental-Mendía M, Sánchez-García A, Vilchez-Cavazos F, Acosta-Olivo CA, Peña-Martínez VM, Simental-Mendía LE. Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Rheumatol Int. 2018 Aug;38(8):1413-1428. doi: 10.1007/s00296-018-4077-2. Epub 2018 Jun 11. PMID: 29947998.
6. Roman-Blas JA, Castañeda S, Sánchez-Pernaute O, Largo R, Herrero-Beaumont G; CS/GS Combined Therapy Study Group. Combined Treatment With Chondroitin Sulfate and Glucosamine Sulfate Shows No Superiority Over Placebo for Reduction of Joint Pain and Functional Impairment in Patients With Knee Osteoarthritis: A Six-Month Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial [published correction appears in Arthritis Rheumatol. 2017 Oct;69(10 ):2080]. Arthritis Rheumatol. 2017;69(1):77-85. doi:10.1002/art.39819
7. Johal H, Khan M, Yung S-H P, Dhillon MS, Fu, FH, Bedi A, Bhandari M. Impact of platelet-rich plasma use on pain in orthopaedic surgery: A systematic review and meta-analysis. Sports Health. 2019; 11(4):355-366.
8. Cooper C, Rannou F, Richette P, Bruyere O, Al-Daghri N, Altman RD, Brandi ML, Basset SC, Herrero-Beaumont G, Migliore A, Pavelka K, Uebelhart D, Reginster J-Y. Use of intraarticular Hyaluronic Acid in the management of knee osteoarthritis in clinical practice. Arthritis Care & Research. 2017; 69(9): 1287-1296
9. Zhao J, Huang H, Liang G, Zeng L, Yang W, Liu J. Effects and safety of the combination of platelet-rich plasma (PRP) and Hyaluronic Acid (HA) in the treatment of knee osteoarthritis: A systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2020; 21: 224.
10. Franchini M, Cruciani M, Mengoli C, Marano G, Pupella S, Veropalumbo E, Masiello F, Pati H, Vaglio S, Liumbruno GM. Efficacy of platelet-rich plasma as conservative treatment in orthopaedics: A systematic review and meta-analysis. Blood Tranfus. 2018; 16:502-513.
11. Chen Z, Wag C, You D, Zhao S, Zhu Z, Xu M. Platelet-rich plasma versus Hyaluronic Acid in the treatment of knee osteoarthritis. Medicine. 2020; 99:11(e19388)