The two most popular and common injections we offer patients for knee osteoarthritis are platelet-rich plasma (PRP), utilizing a patient’s own blood, and hyaluronic acid injections, commonly known as the gel, rooster comb, or viscosupplement injections.
Let’s compare the two and discuss pros and cons of each:
Both would be considered “natural“ injections with PRP obviously coming from your own blood and hyaluronic acid is a substance already in your joint, but depleted in joints that have osteoarthritis.
We often describe PRP as that big 100,000 mile service you do on your car, and hyaluronic injections are more like the oil change. Thus, PRP is more comprehensive.
PRP Injections
PROS
-most effective long-term injection we offer patients. Benefits typically seen for 6–24 months, and then PRP can then be safely repeated when necessary.
-very likely disease–modifying, meaning we are stopping or slowing the deterioration of cartilage in the knee. These give patients the greatest opportunity to either delay or avoid knee replacement.
-other than weight loss, probably the best long-term medical and financial nonsurgical investment in the health of your knee.
CONS
-not covered by insurance. See our blog regarding this here
-works gradually, with greatest benefit likely seen 4-6 months after the injections.
-anti-inflammatories of any type as well as blood thinners need to be stopped before and after the PRP procedure for a specific period of time.
Hyaluronic acid Injections
PROS
-authorized by most insurance plans, meaning the cost of these is fully covered, partially covered, or can be applied towards your deductible.
-excellent safety profile.
-the majority of patients see a benefit, often for 4 to 12 months.
-like PRP, injections are not particularly painful when given into the knee joint under ultrasound guidance and only require a few days of rest afterwards.
CONS
-may have an indirect benefit on the long-term health of the knee joint, but are not considered “disease–modifying” like PRP.
-benefits of pain and swelling reduction along with functional improvements do not last as long as PRP.
-although they work a bit more rapidly than PRP injections, typically it takes 6 to 8 weeks after the final injection to see the greatest benefit.
-most brands require a series of 3–4 total injections, given one per week.
So many patients with knee osteoarthritis ask me the question “well, if I’m eventually going to require knee replacement, shouldn’t I go ahead and have it done now?”
Well, there’s not just one answer to that question, but here are some of my replies:
-Most knee replacements only last 15 to 25 years. After that, the implants start to loosen, creating pain, swelling or a sense of instability.
-Most patients are at higher risk for surgical complications at the time of a second surgery, known as a “revision,” simply due to their age and likelihood of having more significant medical conditions.
-Surgical techniques are improving with breakthroughs every two or three years. Robotically-assisted replacements and having replacements as an outpatient surgery are two recent examples. More advancements are sure to come.
-One should never base the need to have knee replacement on the appearance of the x-rays. Some patients with “bone-on-bone” arthritis have minimal pain and excellent function. These patients don’t need a replacement.
-What often produces the most pain is an unhealthy environment within the knee joint, some of which may be controlled with injections like platelet-rich plasma (PRP).
-We also believe that PRP may put a stop sign or at least a yellow light on cartilage deterioration. We do not make guarantees about cartilage regrowth, but if we can stabilize a patient’s current cartilage and slow or stop the deterioration, then we are slowing the process of osteoarthritis and perhaps delaying the need for knee replacement.
-For a joint condition like arthritis, we often think of PRP as a maintenance treatment, not just a one-time application. Much like the maintenance for your car, you don’t just take it to the mechanic once or twice and then get a new car. This is an ongoing process.
-Assuming a patient is in that 80% success group with PRP treatments, one should plan on likely having repeat PRP injections every 1 to 2 years. This is a great long-term investment in the health of your knee.
-Want to know more about PRP? Check out this blog:
In summary, for some individuals, knee replacement is inevitable, but there can be great value in delaying this surgery to increase the odds that it is required just once in a patient’s lifetime. For others, treatments like PRP can eliminate the need to have a replacement.
As always, let us know if we can be of assistance to you!
