hey everyone dr jeff peng here how many prp injections should you get to treat knee arthritis
well this is an extremely common question so i want to share what our current medical literature
tells us as well as my own current thinking about this topic let's get started
now if this is the first time you are watching one of my videos my goal is to help each and every one
of you live an active and healthy lifestyle so if that's something you're interested in please
consider subscribing to my channel prp injections are catching on as a great treatment option
for all those who suffer from knee arthritis randomized controlled trials systematic reviews
and meta-analyses all show that people who get prp injections have better short-term and long-term
outcomes when it comes to both pain and function but the question remains how many injections does
it take to achieve those outcomes and then once we are successful in controlling symptoms do you
need to have additional treatments in the future i want to go over what current medical literature
tells us and then discuss how i've adapted that information into my own clinical practice the
first thing we need to do is to first understand how randomized controlled trials are conducted
everything needs to have an apples to apples comparison after all we can't make any real
conclusions if we compare three injections of medication a to only one injection of medication
b that is not an apples-to-apples comparison and because early clinical trials first compared prp
to hyaluronic acid researchers had to use the same protocol as hyaluronic acid and that's
three injections total spaced one week apart head-to-head trials comparing prp
to hyaluronic acid consistently show that prp gets better outcomes and from these early trials
many providers recommend a series of three prp injections not because one injection doesn't work
but because three injections at that time is all we had the data for so the next step would
be to conduct studies with only one injection would the same results hold true presumably
yes but it is still important to do a study to confirm the answer so this study
compared a single prp injection to a single hyaluronic acid injection while this study
compared a single prp injection to a single cortisone injection both studies confirmed
that the people who got a single prp injection had better outcomes than the people who got
hyaluronic acid or cortisone and the effects were sustained for long term the follow-up time period
was six months in the first study and one year in the second study okay so now we know people
who get a series of three prp injections can be expected to have good long-term outcomes
furthermore studies suggest that people who get a single prp injection can also expect improved
outcomes between six months and one year so now we want to ask are there any studies comparing
multiple prmp injections to a single prp injection and how does that affect short and long term
outcomes now things get slightly more complicated here remember we always want to be comparing
apples to apples in clinical trials and when you are doing a series of three injections of
one medication versus three injections of another medication it's easy to randomize participants and
not have them know which group they belong to but now we are asking a different question we
are asking if three prp injections outperforms one injection and it is impossible to blind
participants to knowing which group they are and they know how many times their knees get an
injection so this will definitely affect study results because now we're comparing apples to
oranges with that said it's still worthwhile to do the study to see what kind of information we get
this study found that three prp injections had better clinical results than one prp injection
in those with early osteoarthritis this is not that surprising it makes total sense that more
prp injections would do better than just one but this could also be reflective of patients
experiencing more interventions and thus expecting a better outcome again these findings could be a
direct result of the study design now much more interestingly the researchers found that three
prp injections were no better than one prp injection in those with severe osteoarthritis
and this is actually a fascinating finding because the previous conclusion of three injections being
better than one could be chalked up to study design flaws but not this finding the bias for
someone who only got one prp injection would be to feel slightly less improvement than someone
who got three injections but there was actually no difference there was no difference between the two
groups and those with severe osteoarthritis this should really impact how we counsel
our patients and perhaps we should not be saying everyone across the board needs three injections
rather we should probably be individualizing treatment and constantly reassessing how many
prp injections each person needs okay so that's what the medical literature shows and for most
people with early knee osteoarthritis it would actually be great if we could just recommend a
series of three injections for every patient but we also need to be cost conscious not everyone
who is getting prp treatment can have it 100 covered under the funding of a clinical trial
many people are paying out of pocket for these treatments so what i've done is to try to adapt
our current understanding of medical literature while also being cost conscious for my patients
this study suggests that maximum effects of a prp injection can be expected within four to six weeks
after one injection and this is the exact time period i use for follow-up after one injection
i have all of my patients fill out a symptom sheet the day we perform the injection and then again at
their four to six week follow-up period i can then subjectively ask my patient hey how are you doing
i can also objectively track how they're doing and then we decide together how do we want to proceed
do they want another injection were they feeling so much better that one injection is all they
need at that point in time by doing it this way i found that patients essentially fall into three
big categories at their follow-up appointment the first category consists of 10 of patients that are
doing extremely well they feel almost no pain and objectively their symptom sheet scores report 85
or more improvement i tell these patients wow you've had such a dramatic improvement that one
injection is all you need at this time the second category consists of another 10
of patients these are usually the people with advanced severe bone on bone arthritis
they tell me hey doc i just don't feel too much improvement their symptom scores also tell the
same story no difference i told these patients that's too bad i'm glad we tried but it seems like
prp didn't do much for you i'm more than happy to try another injection because it might help
but usually the arthritis is so advanced that chances are it won't work i let my patients decide
how they want to proceed or if they want to talk to a joint replacement surgeon the remaining 80
of patients fall into the third category these people are doing anywhere between 20 to 85 percent
improvement they definitely notice a difference after one injection and have noticeably more
strength and mobility i tell these patients you've had great results with one injection chances are
you're going to continue to have success and even more improvement with a second injection i use the
same process at each additional follow-up visit and what i found is that most people end up with
around two injections very rarely does someone need only one injection and less commonly does
someone need all three prp injections the goal of setting up follow-up visits like this is to try to
be maximally cost conscious while also trying to achieve the best clinical outcomes these
treatments can be costly depending on where you live and after we achieve symptom control with prp
injections i tell people to continue to work on exercise therapy and load management these are the
best long-term treatments for continued success in everyone who suffers from knee arthritis the goal
of taking an aggressive multimodal treatment plan for arthritis is to prevent arthritis flare-ups
each flare-up can come with more pain swelling locking clicking catching and the goal is to
reduce the amount of flare-ups that you can continue to live an active and healthy lifestyle
this is also why i recommend booster injections around the one year mark regardless if you are
having pain or not and if you do have a flare-up the sooner you get in for a booster injection
the better current evidence suggests that prp is just so much better and so much safer than
any other medical treatment we currently have for knee arthritis and until more insurances start to
cover these injections this is the protocol that i use to help as many people as i can of course
all of this may change as our understanding of prp and our understanding of arthritis evolves
and if you do have other questions regarding prp injections chances are you can find them in my prp
questions and answers video that you can check out next you can also leave questions
in the comments below and i'll do my best to answer all of them thanks for watching