We often get the question when patients come in looking for nonsurgical treatment of osteoarthritis or a chronic tendon problem: “How do I choose between a platelet-rich plasma (PRP) and stem cell injection?”
First, let’s define the differences: PRP comes from your own blood and involves a simple blood draw from an arm vein. Stem cell injections are prepared after bone marrow or adipose (fat) tissue is extracted from a patient. Obviously, the PRP preparation is simpler, less invasive and lower risk for the patient. Venipuncture takes about 2-3 minutes, whereas obtaining bone marrow involves inserting a larger needle-like device into the iliac crest (bone at top/back of the pelvis) and takes about 10-15 minutes or longer. Obtaining adipose tissue from the lower abdomen is a more complex and time-consuming procedure, often requiring about 30-45 minutes.
Both types of injections have the potential to reduce pain by reducing inflammation and promote healing. PRP uses a variety of growth factors, while stem cells utilize mesenchymal signaling cells and may have a greater potential to regenerate tissue. That being said, we are often using these injections for osteoarthritis, which is a cartilage deficiency problem. At this time, it is debatable whether any type of injection can regenerate cartilage.
What about success rates? Well, the jury is still out regarding which option is better. The good news is that in the large majority of studies, both PRP and stem cell treatments result in less pain and better function. Soft tissue problems like tendons and ligaments often demonstrate an improved or healed appearance on imaging studies. Some studies suggest that PRP and stem cell injections produce equal outcomes in the treatment of knee osteoarthriitis, while some suggest stem cells have better results. For now, we are putting our eggs in the PRP basket exclusively. Why is that?
-PRP is less-invasive, lower risk and faster to prepare
-PRP has a longer track record of use and success
-Although neither are covered by insurance, stem cell injections tend to be 3-10x more expensive than PRP injections. Example: $1000 for PRP on the average versus $5000 for a stem cell treatment.
We often state that PRP injections are like buying a Honda: safe, reliable, and gets the driver from Point A to Point B quite well. Stem cell injections are like a Maserati: fancy, expensive and unique but don’t necessarily get you from Point A to Point B any better or faster.
In summary, we anticipate that the application of stem cell treatments in the U.S. will continue to expand as studies demonstrate increased success and safety, while preparation will become easier, and the cost will decrease. Until then, PRP will be our successful “go-to” orthobiologic injection.
