we are in the middle of a monumental shift in how we view and treat osteoarthritis surgeons
used to tell people to just deal with the pain they gave advice like you know you're ready for
a hip replacement when you're crawling back into the office and that left people thinking well that
sounds terrible and hold on what am i supposed to do in the meantime am i really supposed to
take tylenol and advil every day and the tragic answer to that in many cases was yeah but that
mindset is so archaic we need to be more proactive we need to treat the underlying disease bone on
bone is not inevitable a hip replacement is not inevitable so how can we treat osteoarthritis how
do we slow down the progression all the while also treating pain treating stiffness treating
loss of function well it turns out hip injections may actually be one really good way of doing that
hey everyone dr jeff peng here hip injections are an excellent way to treat and manage symptoms
related to hip osteoarthritis and for the longest time we have been using cortisone injections to
help do that cortisone is a steroid it is a very strong pain medication and it is a very strong
anti-inflammatory medication it will help reduce symptoms but the effects are usually short-lived
usually on average about three months the bigger concern is we are realizing that multiple
cortisone injections are actually problematic cortisone is chondrotoxic meaning it weakens the
articular cartilage and what is osteoarthritis arthritis is the loss of cartilage so while
cortisone injections do work they do help reduce symptoms they come with a rather significant
trade-off in potentially increasing your risk of developing more arthritis so now you're thinking
well that doesn't sound great how come no one told me that before well these studies are relatively
new and it does take time for new information to propagate through the medical community
so if cortisone injections have long-term negative effects what are our other options for the longest
time the only other option was hyaluronic acid injections hyaluronic acid is a substance that
is naturally produced in our joints it acts as a lubricant and it does have anti-inflammatory
properties pharmaceutical companies have synthetically made hyaluronic acid which we
can now inject into joints and patients seem to do very well with these injections especially if it's
covered by insurance but the data is mixed this randomized controlled trial compared hyaluronic
acid injections to placebo injections they found that people who got hyaluronic acid injections
did have significant and clinically relevant improvements in pain and function for six months
however there was no statistical difference between hyaluronic acid and a placebo injection
and this is where ortho biologics come in ortho biologics such as platelet-rich plasma fall
under the category of regenerative medicine platelet-rich plasma injections used to be
considered experimental and were only available to the top athletes as well as in clinical trials
tiger woods kobe bryant raphael nadal alex rodriguez all of these all-time great athletes
used platelet-rich plasma injections to help them speed up their recovery from injuries now prp
injections have become widespread and are used to treat professional athletes ncaa college athletes
the industrial athlete weekend warriors and pretty much anyone who wants to live
a healthy and active lifestyle but are held back or limited by painful conditions
in fact the use of prp injections is quickly becoming first-line therapy in the treatment
of knee osteoarthritis randomized control trials and systematic reviews show that prp injections
are superior to cortisone injections hyaluronic acid injections and placebo injections in the
treatment of knee osteoarthritis but what about their use in the treatment of hip osteoarthritis
are we able to make that logical leap that if it works really well for knee arthritis it's
going to work really well for hip arthritis this randomized control trial compared prp injections
to hyaluronic acid injections they found that intra articular prp injections offer a significant
clinical improvement in patients with hip osteoarthritis without any relevant side effects
the benefit was significantly more stable up to 12 months this systematic review and meta-analysis
looked at how prp injections did when compared to cortisone and hyaluronic acid injections for the
treatment of hip osteoarthritis they found that cortisone injections are recommended as the most
efficient agent in hip osteoarthritis patients in the short term moreover prp is reported to
have the highest rank for pain relief for up to six months so far so good clinical trials do show
that prp injections help with symptoms related to hip osteoarthritis but what can it do for the
progression of arthritis can prp injections delay the need for a hip replacement surgery
this study looked to answer that question they found that intra-articular hip injections of
prp in patients with hip osteoarthritis resulted in an improvement in womac scores
with womac measuring pain stiffness and function as well as with hip range of motion at six months
and they also found that prp injections delayed the need for a hip replacement surgery and let me
explain how we think prp injections slow down the progression of hip osteoarthritis and delay the
need for a hip replacement surgery osteoarthritis is caused by the progressive loss and wear and
tear of articular cartilage and every time the articular cartilage cells get injured or damaged
they release a bunch of toxic enzymes and proteins into the joint the cartilage damage is what causes
the pain and the stiffness and the inflammation and the swelling that people with arthritis are so
familiar with and the problem with all of this is that all of those toxic enzymes and proteins go on
to weaken the remaining healthy cartilage cells so over time you lose more and more cartilage
resulting in more arthritis and what platelet-rich plasma injections can do is to introduce a huge
amount of platelets and growth factors into the joint to change the internal environment going
from a toxic inflammatory environment to one that is more neutral and one that is more normal and by
keeping the environment of that joint controlled we can hopefully slow the progression of arthritis
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on twitter @jeffreypengmd and i write on my blog at jeffreypengmd.com thanks and see you next time