Before PRP: what belongs ahead of the blood-based shot?

What should you tell the clinician?

Write down the day the soreness began and the motion that brings it on. Say whether the joint gets puffy, catches, gives way, or wakes you.

Bring any old X-ray and the diagnosis you were given before. Your notes don't need much detail; a few clear facts will do.

Which home care may be worth trying?

Choose stairs or a short walk, then notice your joint during it and the next morning. Change the distance or number of stairs slowly, and don't stack hard days together.

A brace, acetaminophen, or ibuprofen may help, but none is safe for everyone. Ask which choice won't clash with your health or other medicines.

What happens before treatment is discussed?

The clinician will ask about your health, medicines, past care, bleeding, and recent illness. Then comes the exam: bending the joint, checking the sore area, and testing strength.

After that exam, QC Kinetix may offer regenerative treatment options, which means non-surgical care that can include the PRP shot. It won't suit every person or cause of soreness.

When should the PRP visit wait?

A hot, badly swollen joint with fever needs care now, not a routine PRP visit. Drainage, redness that spreads, weakness, or loss of bladder or bowel control can't wait either.

If you've got an infection, trouble with blood clotting, or a blood thinner, call the clinic and the doctor who prescribed it. Only that doctor can tell you to stop the medicine.

Sources

1. The 2019 ACR/Arthritis Foundation osteoarthritis guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-management programmes, tai chi, cane use, tibiofemoral bracing, topical and oral NSAIDs and intra-articular glucocorticoid injections for knee OA. Its conditional recommendations cover balance exercises, yoga, CBT, acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol. Anything offered before a course of the strongly recommended options is being offered out of order.

   Kolasinski SL, Neogi T, Hochberg MC, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41142.

2. The OARSI non-surgical management guideline places intra-articular corticosteroids, intra-articular hyaluronic acid and aquatic exercise at Level 1B/Level 2 for KNEE osteoarthritis depending on comorbidity status, and specifically does NOT recommend them for hip or polyarticular osteoarthritis. Oral and transdermal opioids are strongly not recommended and acetaminophen is conditionally not recommended.

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

3. The Cochrane review of exercise for knee osteoarthritis found low- to moderate-certainty evidence that exercise probably improves pain, physical function and quality of life in the short term - but when the results were compared against established minimal important difference thresholds (12 points for pain, 13 for function, 15 for quality of life on 0-100 scales), the confidence intervals either did not reach those thresholds or spanned both important and unimportant improvement. Honest copy about exercise carries the same caveat honest copy about PRP does.

   Lawford BJ, Hall M, Hinman RS, et al. — Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2024. DOI: 10.1002/14651858.CD004376.pub4.

4. An 18-month randomized trial of diet and exercise in patients with knee osteoarthritis and overweight or obesity achieved a mean weight change of -7.7 kg (8%) versus -1.7 kg (2%) in the attention control group, and produced a statistically significant but small difference in knee pain whose clinical importance the authors described as uncertain.

   Messier SP, Beavers DP, Queen K, et al. — Effect of Diet and Exercise on Knee Pain in Patients With Osteoarthritis and Overweight or Obesity: A Randomized Clinical Trial. JAMA, 2022. DOI: 10.1001/jama.2022.21893.

5. The ESSKA-ICRS consensus applied the RAND/UCLA appropriateness method to 216 clinical scenarios for intra-articular PRP in knee OA. Only 84 scenarios (38.9%) were rated appropriate, 9 (4.2%) inappropriate and 123 (56.9%) uncertain. PRP was judged appropriate in patients aged 80 or under with KL grade 0-III osteoarthritis AFTER failed conservative non-injective or injective treatment; it was NOT considered appropriate as a first treatment, nor in KL grade IV (bone-on-bone) osteoarthritis, where 91.7% and 87.5% of scenarios respectively were uncertain.

   Kon E, de Girolamo L, Laver L, et al. — Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12320.

6. Medicare's national coverage policy covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only within an approved coverage-with-evidence-development clinical study. There is no Medicare national coverage for PRP in osteoarthritis or tendinopathy, which is why these injections are billed to the patient as cash-pay.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.