What are PRP injections and orthobiologic therapies?

Patients often search for ways to avoid a knee replacement. Typically, the search starts with cartilage restoration options; that is, replacing worn-out cartilage with new cartilage. Unfortunately, some patients have arthritis changes and are not candidates for knee biologic restoration. For patients in this situation who still want to avoid knee replacement, Orthobiologic injections may offer an alternative. 

With OrthoIndy’s OrthoBiologics Program, we offer a potential “bridge” between biologic knee restoration and (artificial) total knee replacement. At OrthoIndy, we offer platelet-rich plasma (PRP) injections and tissue and/or cell therapies. 

Orthobiologics have been around for more than 30 years but under different terminology. The term ‘stem cells’ came into common use after Dr. Arnold Caplan’s earlier work showed some ‘immature’ cells could be induced in the lab to form other tissues (fat, bone, muscle, fibrous tissue, cartilage).  

Dr. Caplan has shown that these cells do not actually regenerate these tissues outside of the laboratory setting. However, the name “stem cells” has stuck in the minds of patients and doctors alike.

Ultrasound Optional Guidance for Knee Injections 

While experienced knee surgeons and physician assistants can perform accurate knee injections, the option of ultrasound guidance is available. This noninvasive technique allows visualization of the injection needle precisely within the joint capsule. 

Platelet-Rich Plasma (Autologous Conditioned Plasma®) Knee Injection 

Platelets are one of the first biologics to reach an injury. Their first function is to participate in sealing the injury with a clot. During the blood clot formation, they release over 1,500 biologically active proteins, including growth factors and “signaling” factors that call in the patient’s own adult cells to aid in the repair process. 

Blood is obtained from a peripheral arm vein and then centrifuged to separate the blood components. Red blood cells are removed, resulting in a concentrated number of platelets in the remaining plasma, hence the term platelet-rich plasma, or PRP for short. 

There are many ways to prepare PRP. The type of PRP we use, Autologous Conditioned Plasma®, has been shown in a recent scientific study to diminish symptoms of knee osteoarthritis. It is administered in the same manner as other knee injections with local skin anesthetic. 

Download the guide to PRP Injections

ReNu® Amniotic Fluid Cells and Amniotic Membrane Knee Injection 

Human amniotic fluid and tissue are typically discarded at birth. However, the fluid and tissue are rich with cells and biologic factors that have been used successfully for many years to promote wound healing. The fluid and membrane are donated by healthy mothers at birth. The fluid and membrane are then cryopreserved allowing the cells to potentially return to function upon thawing. 

Although amniotic fluid with cells and amniotic membranes are promoted by several companies in the United States, ReNu® is the only product that has published articles on safety and efficacy for knee osteoarthritis. OrthoIndy research participated in the original study (published in the Journal of Knee Surgery, 2015) and led a multicenter trial of this promising product. The trial was completed with the positive results published in the Journal of Knee Surgery, 2019. 

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Bone Marrow Concentrate Knee Injection 

Bone marrow harvesting for reparative cells has been performed for many years. The number of adult tissues and cells actually make up a very small number of the total cells obtained during aspiration. In the past, much of what was aspirated from within the bone was largely peripheral blood. OrthoIndy utilizes a new tool for harvesting, which minimizes the amount of peripheral blood within the aspirate.  

The device, a Marrow Cellutions® cannula, uses a new patented instrument that allows the harvest to contain a high number of reparative cells without requiring centrifugation. However, bone marrow aspirate can be concentrated. Currently, the most common applications at OrthoIndy are in the OR to augment bone stress fracture reaction healing and meniscal healing. 

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Lipogems® Microfragmented Fat™

Lipogems® is a minimally invasive procedure gently harvests your fat tissue from your abdomen and then is cleaned and concentrated to an optimal size for injecting into your orthopaedic issues. For those that suffer from multiple orthopaedic issues your own Microfragmented Fat may be injected into multiple sites in the same setting.  There is minimal downtime, shorter recovery, and minimal risk of complications compared to major invasive surgery.  Since you are using your own tissue, there is less likelihood of rejection or infection. Lipogems has strong scientific evidence with over 70 publications performed by leading institutions and researchers.

Some techniques involve enzymatic digestion and centrifugation of fat to obtain the vascular portion. Lipogems®, on the other hand, involves minimal manipulation of the tissue and is FDA cleared for use in orthopaedics and arthroscopic surgery as opposed to enzymatic and centrifugation techniques

Through mechanical emulsification (thorough mixing) of the tissue, the size of the fat clusters is reduced. Sterile saline is employed during processing to wash and rinse the tissue, which reduces inflammatory impurities, such as oil residue and blood. This allows maintenance of the native adipose tissue microenvironment containing the microvasculature with attached reparative cells. These small adipose microspheres with their microenvironment can then be injected into the knee using standard injection techniques. 

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How much do platelet-rich plasma injections and orthobiologic therapies cost?

To be clear, most insurance programs, Medicare and Medicaid label these treatments as “experimental/investigational” and do not pay for these treatments. Consult with your Health Savings Account (HSA) adviser, as prescribed medical treatments may be allowed for payments from your HSA account. Prepayment is necessary depending on the injection. 

More information about orthobiologic treatments