by : Edward G. Loniewski, DO, FACOS, FAOAO
A new treatment combining the cushioning and lubricating effects of hyaluronic acid (HA) and the growth factor delivery of platelet rich plasma (PRP) provides hope for patients looking to avoid surgery, even if previous treatments failed.
A recent study published in the International Journal of Clinical Rheumatology provides longer term evidence of the effectiveness of this combination treatment in patients who failed previous hyaluronic acid therapy. [1] Previous trials of the combination therapy hyaluronic acid and platelet rich plasma have shown superior results for patients with osteoarthritis of the knee[2] and rotator cuff tears[3] compared to placebo, hyaluronic acid or PRP alone. However, this is the first study proving that even if the patient had failed HA treatments, they would still benefit. In this French study, 77 patients who failed a previous treatment of HA for the knee were offered 3 treatment combinations of the enhanced PRP combining this with a dose of HA. All of the participants were followed very closely over a 4 year period with a Western Ontario and McMaster University Arthritis Index (WOMAC) and Visual Analog Scales (VAS). They used two methods to determine who responded, the first is a universal standard mandating that patients had to demonstrate a minimum of 20% improvement in the WOMAC scores and a 10 mm reduction in the VAS pain marking. A second, stricter criteria for response was also used where there had to be a minimum 50% improvement in the WOMAC and 20 mm reduction in the VAS. At the end of the study period, 94% of the patients had a positive response and even with the significantly stricter criteria 83.6% of the patients had a positive response.
In addition, 79% of the patients were able to avoid any surgery to their knees over this 4 year period. However, there did seem to a drop off of patient satisfaction scores over time. Over 80% of the patients reported they were satisfied with their results after 2 years. This dropped down to 50% at 4 years. As far as side effects from the treatment were concerned, there were no serious side effects reported and 13.25% reported minimal to moderate inflammation to the joint and only one lasted over 6 hrs. Some issues with this study are the fact that these treatments were provided over a long period of time at 60, 180 and 270 days which may not be practical with most patients. In addition, this is an uncontrolled and unblinded study which reduces the validity of the results. However, it does show that this treatment is able to provide long term relief even in patients who have failed previous hyaluronic acid therapy and also help them avoid surgery.
One of the best facts about this enhanced PRP is the fact that this may be one of the best values in cell based therapies. Many insurance carriers such Medicare, Blue Cross and Etna do cover hyaluronic acid therapy for knee arthritis. Thus, a major portion of the cost of this therapy is a covered benefit. The platelet rich plasma is usually not a covered benefit and thus, this very effective and safe therapy could cost as little as $500. There may be copays or deductibles and these should be investigated prior to starting treatment. If you require this for a joint other than a knee, the cost may be higher. But, compare this to other traditional treatments such as a joint replacement with costs over $40,000 and a complication rate between 3-16% and over 6 weeks of therapy and time off work, Enhanced PRP may be one of the best values in orthopedic care.
Thus, if you have failed previous hyaluronic acid treatments such as Supartz™, Synvisc™, Euflexxa™, Orthovisc™ or Monovisc™, or if you are facing the choice of a surgery for your aching joints, Enhanced PRP combining the soothing, cushioning and lubricating properties of hyaluronic acid and the growth factor benefits of platelet rich plasma (PRP) may be a very economical, effective, safe and value enhanced treatment. You can find out more by visiting our website or you can call 810-299-8552 to schedule a face to face consultation. You can also contact us on-line. Remember, “These are Your Cells for Your Healing.”
REFERENCES
[1] Jean-Luc Renevier1*, Jean- François Marc2, Philippe Adam3, Nicolas Sans4, Jacques Le Coz5 & Ivan Prothoy6“Cellular matrix™ PRP-HA”: A new treatment option with platelet-rich plasma and hyaluronic acid for patients with osteoarthritis having had an unsatisfactory clinical response to hyaluronic acid alone: Results of a pilot, multicenter French study with long-term follow-up. International Journal of Clinical Rheumatology (2018) Volume 13, Issue 4
[2] Yu W, Xu P, Huang G, Liu L. Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis. Exp Ther Med. 2018;16(3):2119-2125.
[3] Cai YU, Sun Z, Liao B, Song Z, Xiao T, Zhu P. Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears. Med Sci Sports Exerc. 2019;51(2):227–233. doi:10.1249/MSS.0000000000001781