Maintain optimal performance using your own platelet cells to treat arthritis, tendonitis, bursitis
Platelets are our front line of defense against blood loss, infection and tissue repair. Customized platelet rich plasma (PRP) from your own blood placed into areas of damage such as joints, tendons and other painful areas stimulate this reparative process better than many common treatments. Cellular healing uses proprietary methods not available at any other treatment center to enhance the healing potential of platelet rich plasma at the lowest cost possible.
An explanation of why we use platelets and how we process them.
The reasons behind what makes this treatment safe, effective, and suitable for you.
Get a better understanding of the procedure and what to expect during treatment.
Specific ways PRP can benefit patients with arthritis.
An overview of this specific therapy, explained in a way that is comprehensive and concise.
Discover if you’re a candidate for therapy by reading about the conditions it can treat.
What to expect in terms of pain both during and after treatment.
A general idea of the amount of time between the procedure and expected results.
Understand ahead of time how much this procedure costs.
Within your own blood there are many different cells which help maintain good health. Some of these cells provide vital oxygen, such as your red blood cells. Other cells play a role in helping you fight infections, and still others help your body parts maintain optimal performance.
The cells we would like to use for platelet rich plasma (PRP) injections are called platelets. Platelets are not actually whole cells, but rather fragments of cells, as they have no nucleus. Because platelets are not cells, they look flat like plates, and hence bear the name “platelets.” Platelets have numerous important functions in your body, and the easiest way to remember what they do is to look at a scab.
When you have a scrape, or cut or have an injury, you normally bleed. If you did not stop bleeding, chances are you would probably die in a few hours. Luckily, platelets are activated following any bodily trauma, and can change shape to help adhere to the area of trauma while releasing special alpha granulating growth factors. This cause the bleeding to slow down and form a clot, which eventually becomes a scab. Within this scab are millions and millions of platelets releasing growth factors through alpha granules, in order to produce nature’s best protection against infection and the promotion of the healing process.
Platelets not only help to form the clot which becomes the scab; they also signal other healing mechanisms in your body to speed up the process.
However, the problem with platelets is they are not typically found in a normal joint. For example, there are no platelets found in the synovial joint fluid; in fact, the only time we see platelets within a joint is when there is serious injury to the joint and bleeding occurs. The problem with bleeding within your joint is that not only do you have the platelets, but you also have the red blood cells; and when the red blood cells die within your joint, pain and stiffness increase.
The main idea behind platelet rich plasma is to remove all (or a good portion of) the red blood cells, and use the yellow-colored plasma portion of your blood to stimulate the healing process. There are numerous different methods and techniques to separate out the red blood cells from the plasma, but the most popular method is the use of gravity.
If we took your blood, placed it into a test tube and set it upright on a table overnight, eventually, the red blood cells would fall to the bottom and the plasma would rise to the top. Unfortunately, some of the cells would die due to them being out of the human body for an extended period of time. However, if we sped up this process through the use of high gravity fields, we could separate these cells into three distinct gravity layers known as the high, medium, and low gravity layers.
The high gravity layer is where the red blood cells will be pushed. This is normally at the tip of the test tube. The low gravity layer would find its way to the top; this is sometimes known as platelet poor plasma (PPP). The middle layer is a scrumptious collection of platelets, growth factors and some important proteins necessary for the healing cascade. This middle or mid-gravity layer is sometimes referred to as the “buffy coat” layer. Within this buffy coat, we find many of our platelets nicely packed together in a soup of plasma proteins for the perfect healing recipe. Even within this buffy coat, we have different layers of healing factors we can customize to concentrate and harvest in order to provide you with an optimal healing cocktail for your specific condition.
The platelets and the other proteins found in this buffy coat may help reduce the chemical imbalance in your damaged joint, as well as in other areas of chronic inflammation. This can include tendons, ligaments, and wounds.
The release of the growth factors found within the platelets include:
In summary, platelet rich plasma is not just platelets - it is a combination of growth factors and important proteins which not only prep the area for repair, but also deliver important growth factors into areas where they cannot reach.
This healing cascade can be used for:
There are four very easy steps involved in performing a PRP injection. These steps are:
Cellular Healing uses different types of platelet rich plasma formulations for the specific condition being treated at the time; not all PRP is the same, and we are the only center in the area where we can tailor the PRP to your specific condition. We also use a specially designed double-spin technique, which significantly increases the number of platelets delivered as well as eliminates some of the harmful, pro-inflammatory products found in your blood.
The blood is taken to a specially designed device used to help separate the platelets from the heavy red blood cells and the very light plasma. This is done using a medical grade, high-speed centrifuge, which creates an artificial high-gravity field allowing the blood to move into three distinct layers based on the high gravitational field created.
Once the centrifugation is completed, we remove each layer using either a specialized tool called a pipette, or a special tube designed to separate each layer. The entire process takes approximately 20 to 30 minutes to complete.
Once the platelet rich plasma layer is obtained, the joint, tendon, or damaged area can be injected immediately. Our staff will have you lay on your back and locate the ideal injection area by performing a quick exam. The injection area is normally numbed with a local anesthetic such as lidocaine.
Once the area is numbed, we can inject the finished product into the area with mild to no pain. We do ask that patients lie still for several minutes to allow the injection ample time to form a small clot within the area and slowly release the growth factors. Clotting does not cause any significant pain, but it does allow the alpha granules to be released over a 2 - 6 week period. Patients can resume all normal activities the very next day, and we will ask you to return in 6 - 8 weeks to check your progress.
The growth factors and proteins found in platelet rich plasma may help with the pain and loss of function commonly associated with arthritis.
Earlier studies performed in Italy on the use of platelet rich plasma for arthritis of the knee revealed some promising results for arthritis of the knee. Dr. Elise Kon from the Rizolli Orthopedic Clinic in Bologna, Italy followed over 100 patients for over one year, and found that all parameters of knee function and pain improved but these injections would lose their effect over time.
Researchers from many other respected institutions such as Rush University, Cornell, and the Hospital for Special Surgery also found some benefits of using platelet rich plasma in basic science studies as well as animal studies and suggested that the positive findings were not just due to the platelets, but the other bioactive components. Some further studies were developed to compare PRP to common treatments and determine which treatment was superior; one study compared an injection of a steroid to platelet rich plasma and found that the PRP patients had superior reduction in pain and improvement in function for longer periods of time.
Italian researchers compared PRP to the very commonly administered hyaluronic acid injections sometimes known as rooster comb or chicken fat injections. Over 120 patients were given either the hyaluronic injection or PRP, and followed for six months. The PRP patients had superior outcome scores, and PRP even worked very well in severe forms of arthritis. This finding was repeated over and over in other studies; a review of these studies lead researchers to conclude that “PRP is a viable treatment for knee OA, and has the potential to lead to symptomatic relief for up to 12 months.”
This finding was confirmed with another meta-analysis of over 551 studies, concluding, “This study suggests that PRP injection is more efficacious than HA injection and placebo in reducing symptoms and improving function and quality of life. It has the potential to be the treatment of choice in patients with mild-to-moderate OA of the knee who have not responded to conventional treatment.”
Not only does PRP reduce the pain of arthritic joints, but one study demonstrated that PRP increased the muscle strength of the treated knee, as compared to a placebo treatment in the other knee. Researchers found that the PRP treated knee had significantly more strength than the knee which received an injection of normal saline.
Given all of this evidence, keep the following in mind: no matter what other people tell you, PRP has significant evidence of being proven useful in the treatment of osteoarthritis when compared to commonly accepted treatments! Even when we compare the results to alternative methods of treating arthritis such as prolotherapy, PRP appeared to have a longer lasting positive effect.
The platelets and the surrounding fluid called plasma work together to reduce harmful chemicals and simultaneously increase beneficial biochemical reactions. The net result is a healing environment.
Platelet Rich Plasma works in two ways:
Taiwan researchers found that platelet rich plasma injections lead to continual reduction of harmful biochemical products in the knee, as well as an increase in the biochemical markers which promote healing and anti-aging. This same decrease in harmful chemicals was found in a trail in the United States and appeared to be linked to a greater positive response. This means that when PRP reduced these harmful chemicals, there was a better reduction of pain and increase in activities.
This finding was further confirmed by German researchers who found the same anti-inflammatory effect of platelet derived growth factors in an experimental model of rheumatoid arthritis.
Unlike other conventional treatments for arthritis, PRP seems to have a double-edged sword approach by both reducing the harmful substances from your joint while also increasing the beneficial substances over a period of time. This could potentially slow down the progression of the arthritis and protect the joint.
This mechanism was looked at in a study evaluating serial MRIs of knees given a PRP injection over a year’s time. In it, 73% of the participants revealed no further degenerative changes.
I, Dr. Loniewski, have had been utilizing platelet rich plasma since 2005, and have applied this treatment on thousands of patients over the past 13 years or more. Most (but not all) of these patients responded positively.
I will only recommend PRP and the special customized type of PRP if I have some evidence that this would be beneficial for the patient in question. Every person is not a candidate; we must look at each prospective patient as unique, with special needs and conditions which require a customized approach.
When we look at the current body of peer reviewed published studies and articles, we find a growing list of orthopedic conditions where PRP may provide at least short or mid- term benefit. The following is a very brief review of some of the studies evaluating PRP.
This is not an exhaustive review, and many more articles are available. These studies are intended to provide you with a body of scientific knowledge, since this is not generally accepted standard of treatment by most board certified orthopedic surgeons.
Patients must consider that we are providing them with a one-sided review of these results. In addition, new supporting and conflicting studies may appear daily; we are only presenting from the body of literature available at the time of the development of this web site.
Shoulder
Elbow
Wrist
Lower Back
Hip
Knee
Foot and Ankle
This is a question many patients ask, and it is something we take very seriously. Our staff tries to reduce the discomfort of this procedure as much as possible by offering many different modalities and options. Fortunately, PRP is a fairly painless procedure by nature, and is similar to providing blood for a laboratory test and receiving a standard joint injection. Our staff normally anesthetizes the area to be injected with a small amount of a local anesthetic, while also using ethyl-chloride spray - a spray which temporarily “freezes” the topical area to reduce any discomfort.
With both procedures, most patients do not notice substantial improvement until approximately 6 - 8 weeks following treatment. However, some patients may notice improvement in as little as two weeks! In our clinical experience, there is a progressive reduction of pain and restoration of function; every patient is unique and special, and the recovery can vary for each one.
Although there is substantial evidence that Platelet Rich Plasma (PRP) is safe and effective, there is not currently a Medicare procedure code for this treatment. As such, no standard insurance carrier covers this procedure.
If you have a health sharing plan such as Medi-share™, PRP may be covered as the cost of this procedure is much lower than other therapies. Most health sharing plans are affiliated with a religious organization, and you must choose this rather than Affordable Care Act (ACA) sanctioned plan. In addition, if you have a health spending account, the expenses associated with this procedure may be offset by these accounts. Cellular Healing is constantly looking for methods to reduce treatment cost while improving the outcomes of this procedure. Overall, our costs have been reduced substantially over the past few years, and we now proud to have some of the lowest priced PRP treatments in the area! Our PRP injections begin at just $500.
If you would like to learn more about these plans, please click on our services page or call 810-299-8552 for an immediate consultation.
1. Customizing PRP. Not all orthopedic conditions or patients are the same. Many physicians who do not fully understand this therapy use one single formulation to treat all orthopedic conditions. This would be akin to treating all infections with the same antibiotic; yes, you may be successful some of the time, but not as successful as you should be! For this reason, the team at Cellular Healing will look at your specific condition and tailor a customized PRP treatment protocol to meet your unique needs. Only Dr. Loniewski offers customized platelet rich plasma treatments tailored to condition specific requirements, and our staff is trained in at least four different PRP methods. We use different temperatures, spin speeds, spin times, and extraction techniques to enhance certain growth factors and reduce other harmful components. The fact is, no other center in the area offers these options.
2. Enhancement of the healing response. The team at Cellular Healing can properly prepare you for the optimal treatment with clear guidelines and protocols. We also offer complimentary treatments to optimize your healing response. These treatments include low level laser, whole body vibration, homeopathic injections, nutritional testing, and good old-fashioned TLC
3. Experience. Dr. Loniewski has more experience with platelet rich plasma than any other physician or health center in the Midwest. He has completed over 4,000 PRP procedures since 2005 and has acted as a consultant for many companies developing this technology. He has conducted research on the use of platelet rich plasma for use in joint replacement surgery, as well as arthritis of the knee. Dr. Loniewski has been a nationally recognized expert in this area over the past decade, and recognizes what conditions will respond to this therapy. Most importantly, he recognizes those conditions which may not respond. Using his extensive knowledge and unparalleled concern for patient care, he can determine which form of PRP is the most appropriate treatment to optimize your outcome.
¹ Alves R1, Grimalt R1. A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification. Skin Appendage Disord. 2018 Jan;4(1):18-24. doi: 10.1159/000477353. Epub 2017 Jul 6.
² Lai F1, Kakudo N2, Morimoto N1, Taketani S3, Hara T1,4, Ogawa T1, Kusumoto K1. Platelet-rich plasma enhances the proliferation of human adipose stem cells through multiple signaling pathways. Stem Cell Res Ther. 2018 Apr 16;9(1):107. doi: 10.1186/s13287-018-0851-z
³ Fitzpatrick J1, Bulsara MK2, McCrory PR3, Richardson MD4, Zheng MH5. Analysis of Platelet-Rich Plasma Extraction: Variations in Platelet and Blood Components Between 4 Common Commercial Kits. Orthop J Sports Med. 2017 Jan 3;5(1):2325967116675272. doi: 10.1177/2325967116675272. eCollection 2017 Jan.
⁴ (Frizziero A1, Giannotti E, Oliva F, Masiero S, Autologous conditioned serum for the treatment of osteoarthritis and other possible applications in musculoskeletal disorders. Br Med Bull. 2013;105:169-84. doi: 10.1093/bmb/lds016. Epub 2012 Jul 4.)
⁵ (Roche PA1, Pizzo SV. Analysis of thiolester bond cleavage-dependent conformational changes in binary alpha 2-macroglobulin-proteinase complexes Arch Biochem Biophys. 1988 Nov 15;267(1):285-93. )
⁶ Kon E1, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. doi: 10.1007/s00167-009-0940-8. Epub 2009 Oct 17.
⁷ Boswell SG1, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012 Mar;28(3):429-39. doi: 10.1016/j.arthro.2011.10.018. Epub 2012 Jan 28.
⁸ Forogh B1, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on kneeosteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016 Jul-Aug;56(7-8):901-8. Epub 2015 Jul 14.
⁹ Cerza F1, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012 Dec;40(12):2822-7. doi: 10.1177/0363546512461902. Epub 2012 Oct 25.
¹⁰ Campbell KA1, Saltzman BM2, Mascarenhas R3, Khair MM2, Verma NN2, Bach BR Jr2, Cole BJ2. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
¹¹ Kanchanatawan W1, Arirachakaran A2, Chaijenkij K3, Prasathaporn N4, Boonard M5, Piyapittayanun P2, Kongtharvonskul J6. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1665-77. doi: 10.1007/s00167-015-3784-4. Epub 2015 Sep 19.
¹³ Wu YT1, Hsu KC, Li TY, Chang CK, Chen LC. Wu YT1, Hsu KC, Li TY, Chang CK, Chen LC. Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis. Am J Phys Med Rehabil. 2018 Apr;97(4):248-254. doi: 10.1097/PHM.0000000000000874.
¹³ Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Zamanabadi MN, Alebouyeh MR. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clinical Interventions in Aging. 2018;13:73-79. doi:10.2147/CIA.S147757.
¹⁴ Chen CPC1, Cheng CH2, Hsu CC3, Lin HC1, Tsai YR1, Chen JL4. The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol. 2017 Jul;93:68-72. doi: 10.1016/j.exger.2017.04.004. Epub 2017 Apr 20.
¹⁵ Cole BJ1,2,3,4,5, Karas V6, Hussey K1, Pilz K1,5, Fortier LA7. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis Am J Sports Med. 2017 Feb;45(2):339-346. doi: 10.1177/0363546516665809. Epub 2016 Oct 21.
¹⁶ Tohidnezhad M1, Bayer A2, Rasuo B1, Hock JVP1, Kweider N1, Fragoulis A1, Sönmez TT1,3,4, Jahr H5, Pufe T1, Lippross S6. Platelet-Released Growth Factors Modulate the Secretion of Cytokines in Synoviocytes under Inflammatory Joint Disease. Mediators Inflamm. 2017;2017:1046438. doi: 10.1155/2017/1046438. Epub 2017 Nov 19.
¹⁷ Halpern B1, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med. 2013 May;23(3):238-9. doi: 10.1097/JSM.0b013e31827c3846
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