The use of platelet rich plasma is still a relatively new treatment for orthopedic patients. However physicians are increasingly using PRP as an alternative to medication and surgery for patients with pain. Here are seven things orthopedic surgeons should know about bringing PRP to their practice.
1. Which patients are appropriate for PRP. Orthopedic surgeons should use PRP on patients who experience pain in their joints but do not have serious, traumatic injuries. Joseph Aiello, MD, a family and sports medicine physician at Alvarado Hospital in San Diego, has used it on patients from age 18-90 and at all levels of health, including patients with chronic conditions such as diabetes. However, there are some cases when PRP would be inappropriate. Dr. Aiello says PRP will not benefit patients with serious damage, such as large bulging discs in their backs or complete rotator cuff tears.
Patients who have serious cartilage damage, such as arthritis, and need a total joint replacement will not benefit from PRP, says C. David Geier Jr., MD, director of Medical University of South Carolina Sports Medicine.
2. PRP takes longer than other injections. Treating patients with PRP usually can take between 20 and 30 minutes from start to finish and the physician must be present the entire time, says Dr. Geier. The physician must draw the patient's blood and then spin it in a centrifuge, which takes between five and 10 minutes for separation of the red blood cells from the plasma. Then the physician extracts the PRP and injects it into the patient, who is sometimes under local anesthesia.
After the plasma is separated, the physician only has a few minutes to extract it from the centrifuge and inject it into the patient, which means there isn't time between initially drawing the blood and the PRP injection to see other patients. Dr. Geier says in the future, if a facility employs certified nurses or physician's assistants who can draw the blood and put it in the centrifuge, physicians could decrease the amount of time they spend on each PRP injection. Dr. Aiello uses this method for PRP injections in his office.
3. Injections are in the tendon. Orthopedic surgeons are typically injecting cortisone into the space between the joints to alleviate pain. However, PRP injections go right into the ligaments and tendons for healing support. Physicians must find the source of the pain and inject the PRP into the appropriate location.
4. Injection feels different to patients. Orthopedic patients are familiar with cortisone injections, which alleviates the joint pain for a period of time. PRP injections, on the other hand, are often painful for the patient and will not fully alleviate pain for several weeks, says Dr. Aiello. "Going through the PRP injection is like re-spraining or re-bruising the joint," he says. PRP promotes healing of the joint, which means the pain will subside when the healing process is complete, usually around six weeks after the injection, says Dr. Aiello.
5. Patients may need multiple treatments. Some patients may require two or three PRP injections before they experience the maximum decrease in pain, says Dr. Aiello. In his practice, about 80 percent of the patients feel at least 60 percent better after two treatments, he says. About 10 percent of his patients needed a third or forth injection. After the initial injection, Dr. Aiello conducts a six-week follow-up and determines whether additional injections are needed.
6. Insurance companies might not cover it. While some insurance companies may cover PRP injections, others will not, which can lead to an expense anywhere between $200 and $600 dollars or more out of pocket from the patient. Dr. Geier says initially patients raise questions about why they must pay that expense, especially with a procedure that may not alleviate their pain. However, he says most patients are willing to pay the expense once they understand why the insurance company will not pay for it. "The patient's I've had have been really willing to pay for PRP," says Dr. Geier.
When the insurance company doesn't pay for the injection, the practice must coordinate a system for the patients to either pay the material fee directly to the equipment company or to the practice, which will forward the funds along appropriately. Insurance will usually pay for the office visit and procedure fee, says Dr. Geier.
7. PRP is now accepted by most sports organizations. In the past, PRP was considered by some organizations, including the World Anti-Doping Agency, as an illegal, "performance enhancing" substance. After further consideration, the Agency has taken PRP off the list of prohibited substances due to a "lack of current evidence concerning the use of these methods for purposes of performance enhancement," according to its website. Professional and college athletic organizations such as the NFL and NCAA allow their players to receive PRP treatment.
Dr. Geier says that while PRP is often used to return professional athletes to the game quicker, it does not enhance their performance. Rather, PRP speeds-up the healing process. "It's performance enhancing in the sense that it helps you heal," says Dr. Geier. "But it won't help you get better than your baseline."
Read other coverage on PRP:
- PRP Use for Orthopedics: Updates and Standards
- PRP Best for Tendon Repair
- Appropriate Coding for Platelet Rich Plasma Injections
1. Which patients are appropriate for PRP. Orthopedic surgeons should use PRP on patients who experience pain in their joints but do not have serious, traumatic injuries. Joseph Aiello, MD, a family and sports medicine physician at Alvarado Hospital in San Diego, has used it on patients from age 18-90 and at all levels of health, including patients with chronic conditions such as diabetes. However, there are some cases when PRP would be inappropriate. Dr. Aiello says PRP will not benefit patients with serious damage, such as large bulging discs in their backs or complete rotator cuff tears.
Patients who have serious cartilage damage, such as arthritis, and need a total joint replacement will not benefit from PRP, says C. David Geier Jr., MD, director of Medical University of South Carolina Sports Medicine.
2. PRP takes longer than other injections. Treating patients with PRP usually can take between 20 and 30 minutes from start to finish and the physician must be present the entire time, says Dr. Geier. The physician must draw the patient's blood and then spin it in a centrifuge, which takes between five and 10 minutes for separation of the red blood cells from the plasma. Then the physician extracts the PRP and injects it into the patient, who is sometimes under local anesthesia.
After the plasma is separated, the physician only has a few minutes to extract it from the centrifuge and inject it into the patient, which means there isn't time between initially drawing the blood and the PRP injection to see other patients. Dr. Geier says in the future, if a facility employs certified nurses or physician's assistants who can draw the blood and put it in the centrifuge, physicians could decrease the amount of time they spend on each PRP injection. Dr. Aiello uses this method for PRP injections in his office.
3. Injections are in the tendon. Orthopedic surgeons are typically injecting cortisone into the space between the joints to alleviate pain. However, PRP injections go right into the ligaments and tendons for healing support. Physicians must find the source of the pain and inject the PRP into the appropriate location.
4. Injection feels different to patients. Orthopedic patients are familiar with cortisone injections, which alleviates the joint pain for a period of time. PRP injections, on the other hand, are often painful for the patient and will not fully alleviate pain for several weeks, says Dr. Aiello. "Going through the PRP injection is like re-spraining or re-bruising the joint," he says. PRP promotes healing of the joint, which means the pain will subside when the healing process is complete, usually around six weeks after the injection, says Dr. Aiello.
5. Patients may need multiple treatments. Some patients may require two or three PRP injections before they experience the maximum decrease in pain, says Dr. Aiello. In his practice, about 80 percent of the patients feel at least 60 percent better after two treatments, he says. About 10 percent of his patients needed a third or forth injection. After the initial injection, Dr. Aiello conducts a six-week follow-up and determines whether additional injections are needed.
6. Insurance companies might not cover it. While some insurance companies may cover PRP injections, others will not, which can lead to an expense anywhere between $200 and $600 dollars or more out of pocket from the patient. Dr. Geier says initially patients raise questions about why they must pay that expense, especially with a procedure that may not alleviate their pain. However, he says most patients are willing to pay the expense once they understand why the insurance company will not pay for it. "The patient's I've had have been really willing to pay for PRP," says Dr. Geier.
When the insurance company doesn't pay for the injection, the practice must coordinate a system for the patients to either pay the material fee directly to the equipment company or to the practice, which will forward the funds along appropriately. Insurance will usually pay for the office visit and procedure fee, says Dr. Geier.
7. PRP is now accepted by most sports organizations. In the past, PRP was considered by some organizations, including the World Anti-Doping Agency, as an illegal, "performance enhancing" substance. After further consideration, the Agency has taken PRP off the list of prohibited substances due to a "lack of current evidence concerning the use of these methods for purposes of performance enhancement," according to its website. Professional and college athletic organizations such as the NFL and NCAA allow their players to receive PRP treatment.
Dr. Geier says that while PRP is often used to return professional athletes to the game quicker, it does not enhance their performance. Rather, PRP speeds-up the healing process. "It's performance enhancing in the sense that it helps you heal," says Dr. Geier. "But it won't help you get better than your baseline."
Read other coverage on PRP:
- PRP Use for Orthopedics: Updates and Standards
- PRP Best for Tendon Repair
- Appropriate Coding for Platelet Rich Plasma Injections