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Bill Klaproth (Host): Platelet Rich Plasma therapy, or PRP therapy, is for patients with chronic tendon and joint-related problems. So what is it, and is it right for you? Here to talk with us about PRP therapy is Dr. Kenneth Mautner, a sports medicine physician at Emory Sports Medicine Center at Emory Healthcare. Dr. Mautner, thank you so much for your time. So first off, what is PRP and the PRP procedure?

Dr. Kenneth Mautner, MD (Guest): So as you explained before, PRP stands for Platelet Rich Plasma, and basically the idea behind PRP is that we draw a patient's own blood, and we send out the blood in a centrifuge machine, and we separate their blood into different components, and we collect their platelets concentrated in some plasma, hence the name, and inside those platelets are growth factors. And these growth factors are the way our body helps to heal injuries. For example, if you cut your skin and you are to release your internal platelets and growth factor from your body, they will go attach to the area of injury, and they will cause the growth factor to release, and eventually over time that will lead to healing of the skin.

And so over the last ten to fifteen years in orthopedic sports medicine, we've been using this same concept to help heal chronic joint and tendon problems.

Bill: This is really interesting. So we take the healing properties of the body, and we double, triple, quadruple them? How does that work? We really spin them up and then it goes back in the body and then it goes right to the portion of the body that needs healing?

Dr. Mautner: Yes, so for example, if someone has a common condition such as tennis elbow, which is basically a tendonitis on the outside of the elbow, lots of tennis players around the Atlanta community. As we get to be not as young as we once were in our thirties, forties, fifties, our bodies won't heal these tendon injuries that happen with repetitive overuse.

So the idea is we're taking a super-physiologic, meaning a concentrated form of these growth factors, more so than what we would normally tend to an area of an injury, and we're putting them with precision. We use an ultrasound machine to put the medicine right into the area of the injury, and when we do that, it'll jumpstart the healing cascade for an injury that hasn't been able to heal for sometimes months to years previously.

Bill: This is fascinating. So is this done on an outpatient basis?

Dr. Mautner: Yeah, it's completely an outpatient procedure, so it's not done in a surgery center, it's done in an office setting, and the whole thing from start to finish generally takes about thirty to forty-five minutes in my office.

Bill: And then how many procedures would a person need?

Dr. Mautner: That number can vary based on what we're treating. So I mentioned before something like tennis elbow or tendonitis in the elbow, and generally with one well-directed PRP treatment to the area, and the proper rest and rehabilitation, we have over a 90% success rate with treating these problems without any additional procedure needing to be done including surgery or other sorts of injections.

However, when you talk about folks who have arthritis- we see a lot of folks with arthritis, and we inject them with PRPs. PRP has a therapeutic effect on a knee that has arthritis, it can help reduce inflammation and swelling in the joint and reduce pain, but often there's some shelf life on that where maybe after nine or twelve months they might return. So the conversation of how many and how often really depends on the body part that we're treating.

Bill: And you said as people age, things take longer to heal, we understand this. So who is a good candidate for PRP therapy?

Dr. Mautner: So generally it's folks who have chronic tendon, ligament, or joint pain that hasn't improved with traditional treatments, and these usually include physical therapy exercises, sometimes traditional cortisone injections, medication, rest, or just time alone. And so if you've been dealing with a chronic injury for several months and it's hasn't really gotten better, and you can't do the sports or exercises that you normally would want to do, you might be a candidate for PRP.

Bill: So can you narrow this down just a little bit for us? As I mentioned, this is for people with chronic tendon and joint-related problems. Is it knees or hips? What joints and what tendons do you usually use PRP therapy on?

Dr. Mautner: So honestly, we treat things from head to toe. We don't do a lot of work in the spine area, but we- just to give a few examples, for tendons we do PRP in chronic rotator cuff tendonitis, we do it in the chronic elbow tendon, as I mentioned before. People who have what we call jumper's knee, or patellar tendonitis, or Achilles tendinitis which is common in runners. All of these treatments for those who have chronic issues with it can actually help the healing process.

As far as joints go, by far knee osteoarthritis is the most common joint thing we treat with PRP injections, but we treat ankles, and hips, and shoulders, and elbows occasionally as well. Certain joints such as the hip joint, for example, doesn't do as well as our knee joints do, but we still get some early care success, and we're just a little bit more discerning in those that we try the procedure on.

Bill: I know, this came into public conscious probably years ago with a basketball player I think that hurt his shoulder or something, and they went overseas to get this done. It was like, "What is this new therapy this person is doing?" It might have been Kobe Bryant, I'm not sure, it was very interesting. So how long can someone expect the results to last? I know generally it's chronic tendon and joint-related problems. Are there different efficacy expectations for each?

Dr. Mautner: Yes. So when we're treating a chronic tendon such as an Achilles, or plantar fascia, or an elbow tendonitis like I mentioned, our goal is actually to heal the tendon. If we can get that tendon to heal, they don't have a tendon problem anymore. And so it's not like a typical cortisone shot that kind of will mask the pain for a while and then it often comes back. These things can actually be curative to the tendon, and in fact, if you look at our patients at six months to a year who are doing very well, the reoccurrence rate of the problem is less than 5%.

When we're talking about joints though, joint pain like I mentioned has somewhat of a shelf life. If you have osteoarthritis in your joint and you've worn down some of the cartilage or the lining of the bone, which is what arthritis is, we get folks who probably get around a year of relief of pain with the PRP injection, and then it does have to be repeated sometimes. And of course results vary across different patients who are- sometimes for certain tendon injuries or joint problems, we may need to do two injections, or very rarely a third injection, but most of the time it's just a one-time shot and kind of follow their results.

I should have mentioned this before, but the other interesting thing about PRP is that unlike a cortisone shot where you feel better right away, with PRP remember we're harnessing our own body's ability to heal, we're stimulating a response in the tendon, and this response takes weeks to months to really formalize. And so this is not something that gets better quickly, and can often take three to six months to see total healing even after the injection.

Bill: Okay, that's good to know. So for someone listening to this who is experiencing that chronic problem and they're thinking, "Wow, this could be for me," but you mentioned earlier that generally insurance doesn't cover it. What are the general costs? Can you just kind of give us a ballpark so someone knows?

Dr. Mautner: Yes, generally around the Atlanta area, the cost of PRP are anywhere from $500 to $1,000, somewhere in that neighborhood. And then depending on where you're getting it done, or if you're getting multiple shots done, it might be a little bit cheaper than that, but that's the general ballpark.

Bill: And lastly, are there any risks involved in this? Someone may think, "Well they're taking my blood, they're getting the platelets out, and they're injecting it back into me." Can something happen? Are there risks with this?

Dr. Mautner: So the beauty of PRP is we're harnessing your own body's healing potential, so everything is your own blood. There's no chance of you rejecting your blood, or having any kind of allergic or adverse reactions to your blood.

Having said that, one of the first phases of healing is inflammation, and so with the PRP injection there is a significant increase in pain for the first few days after the shot because we are restarting that healing process, which means we are re-initiating some of that inflammation and irritation to the tissues. So it's common for folks to have pain for the first few days, but long-term complications are very rare. Certainly there's always risk of infection or typical procedural kind of risks, but those are extremely rare with the procedure we do. Once again, this is in the office, there's no incision, you're not being cut on. It's not surgery, it's really just taking a needle and injecting it precisely where the problem is.

Bill: So expect pain at the beginning, as you said, and if it's painful it probably means that it's working then, right?

Dr. Mautner: Interestingly maybe, maybe not. I mean some folks don't have a lot of pain and still do really well with it, but pain is a kind of normal first response after a PRP injection.

Bill: Well, this has been very interesting, Dr. Mautner. Thank you so much for your time today. For more information on PRP therapy, please visit emoryhealthcare.org/prp. That's emoryhealthcare.org/prp. You're listening to Advancing Your Health with Emory Healthcare. I'm Bill Klaproth, thanks for listening.