Joey Wahler (Host): They're used to treat sports injuries, utilizing a patient's own blood plasma to relieve orthopedic pain. So, we're discussing platelet-rich plasma injections or PRP. Our guest, Dr. Rex Gido. He's a physician with Guthrie Sports Medicine and Orthopedics.

Host: This is Medical Minds, conversation with Guthrie experts. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Gido. Thanks for joining us.

Dr Rex Gido: Hi, Joey. Thanks for having me.

Host: Great to have you aboard. So first, for those that don't know, what exactly is platelet-rich plasma? And in a nutshell, we'll get into some more details in a moment, but how is it used to provide that pain relief?

Dr Rex Gido: Well, thank you for asking. So, platelet-rich plasma, or PRP as it's most commonly known, is a type of orthobiologic injection. It essentially entails doing a blood draw on a patient and processing that blood through a centrifuge system, which will then separate the blood into certain layers and gradients, and then taking the layer that has the most platelets and injecting it back into an area in question.

Host: So when we talk about this type of a procedure, around how long has it been around? And how much have you seen the use of this grow during the time you've been practicing?

Dr Rex Gido: So, it actually started around, if I'm not mistaken, probably around the 1970s or so. And it started with some applications in dentistry. And then, in the early 2000s, they were starting to use it for hair loss and alopecia. And then after that, the applications in human usage just sort of started to increase.

Host: And so, what kind of growth have you seen in recent years? Is this being used more than it had been?

Dr Rex Gido: Oh, yes. I would say that in the past decades, people have learned more about it. People in the orthopedics sphere are using it more and more as a non-surgical adjunct to treating musculoskeletal disorders.

Host: Gotcha. So, what sports injuries are most commonly treated with these PRP injections?

Dr Rex Gido: So, there's a wide range, for usage of PRP. Oftentimes it's for tendon issues, like tendinopathies. Most research out there is showing a lot of promise with tennis elbow and its counterpart, golfer's elbow. You can also use it for tendon issues around the knee, tendon issues around the elbow, like the UCL, the ulnar collateral ligament. And actually, there are some physicians out there who are using PRP for arthritis even in the knees and the hips, shoulders and ankles. So, there's a wide variety of usage.

Host: And so, what happens during a PRP procedure and how long does it typically take?

Dr Rex Gido: So, the challenge with PRP overall is that it depends on the system that somebody is using. Typically, it's a bedside ultrasound. Certain manufacturers will only draw like a certain amount of blood. But if one was going to go through with doing PRP, if you can get more blood draw, that would lead to higher platelet concentrations. And typically, higher platelet concentrations lend themselves to better outcomes. From start to finish, I can usually do a PRP probably about 20 minutes, the whole procedure, including like discussing things with the patient and using an ultrasound machine to be more accurate with placing the PRP.

Host: And so, how many PRP injections until someone usually can expect to feel some results? And how long does that pain relief last once it's obtained?

Dr Rex Gido: Good question. So from my standpoint, as well as from the majority of those who do PRP, if the formulation contains the right amount of platelets, one injection should be enough to produce some new collagen deposition, new remodeling that patients might not need subsequent treatments. That being said, I can repeat PRP for my patients in six months afterwards. But if all goes well, I would prefer to just do one injection.

Host: And you mentioned remodeling. Let me ask you to follow up on that because you're talking here, of course, about what's going on internally with the blood. In a nutshell, in layman's terms, if you will, what actually is happening during that process that's making this all work? Why does it make us feel better?

Dr Rex Gido: So, the platelet portion of the blood that's centrifuged contains growth factors and components called cytokines. Those guys stimulate the healing process and cause an acute inflammatory phase within the first week or so. After that acute inflammatory phase, we call the proliferation phase. During that phase is when new cells come in, new blood vessels are being formed. If there's a wound, it starts to contract. And that can take about a week to a month to continue. After that is when other types of tissue like collagen and fibroblasts really start to form and remodel. And that process itself, we're not entirely sure how long it can last for, but from like a month to a year plus, that research is still ongoing, but that's essentially the simplified version of how PRP works.

Host: Gotcha. And then, the other thing you mentioned that I wanted to ask you about is you said, if you have the makeup that you need to make it all happen, is anyone not a candidate for this procedure based on that?

Dr Rex Gido: So, patients who have underlying blood dyscrasias or issues with their blood in terms of like leukemia, cancer, those who get a reaction to the PRP where it doesn't work, that might be a candidate for not repeating the PRP. But typically, we try to sort of look at the background and see if there's any underlying issues with their platelets, their red blood cells, their white blood cells, you know, their overall health in general from the blood standpoint. And if there's issues there, then we have an extensive conversation on whether or not it's an appropriate treatment plan.

Host: Understood. So that notwithstanding, when it does work as expected, how well do these injections work? What's the success rate? What kind of results can people expect?

Dr Rex Gido: So, there are some pretty moderate to high research showing that PRP can be very helpful for tendon issues. Nothing is a hundred percent, but there is really, really strong promise for, at the very least, tennis elbow treatment with PRP. But I should definitely reinforce the fact that this should be an adjunct to the other treatments like physical therapy, home exercise program and use of anti inflammatories, because it can be an expensive endeavor.

Host: I'm going to ask you more about that in a moment. First, you mentioned nothing is 100%. Of course, we know this about almost all medical procedures. So, what are the risks of PRP injections?

Dr Rex Gido: The risk of PRP injection are injection site pain. One of the reasons for using PRP with ultrasound is because you want to be accurate with where you're going to target. Sometimes you can have an injury by putting in the needle that you're going to use to administer and you can cause some tissue damage that way. So, injection site pain. You can cause bleeding anytime that you're putting in the needle. Nerve injury, but other than the risks that you would acquire from getting like a cortisone injection, for example. There isn't much that we have found currently with current research that shows that PRP has much of an adverse reaction because we are trying to use the native cells that a patient has already.

Host: Okay. Now, you mentioned that this procedure is typically used in conjunction with other treatments, one of which is taking anti-inflammatories. How would you compare the use of PRP with taking an anti-inflammatory medicine like an opioid? Might doing this make you less reliant on something like that, for instance?

Dr Rex Gido: So, I think one of the benefits of trying PRP is that it can serve as an alternative pain-relieving factor once the acute inflammatory process has resolved. Now, we live in a time where opioid medications are less widely used because we found that there are increased risks to that. And if you take into consideration the amount of medications that people end up taking for maintenance, there can be a lot of drug interactions that sort of go by the wayside that we don't pay attention to also. So by using a patient's natural blood cells and essentially trying to promote the healing process when a situation has hit a plateau, that can help them be less reliant on opioid medications if something were to heal a little bit better.

Host: A couple of other things. You alluded earlier to the significant cost of PRP. Does insurance typically cover this therapy?

Dr Rex Gido: Unfortunately, I have yet to come across an insurance that will cover PRP. So typically, it is an out of pocket expense for patients.

Host: And in summary here, doc, what would you tell our listeners about the quality of life they can expect after being treated with PRP? You've mentioned tennis elbow, golf elbow. If I say to you, "Hey, if I go through all these procedures with PRP, can I start whacking the ball around on the tennis court or the golf course like I used to?" what do you say?

Dr Rex Gido: I would say that, again, PRP is used in conjunction with a lot of other things, so physical therapy, et cetera. But when administered in the right location, with ultrasound guidance, with the proper amount of platelets, there's research that shows that patients can hope to achieve a significant reduction in their tendon and joint pains when PRP can work for them.

Host: So in a nutshell, another weapon, if you will, in the battle against orthopedic pain, yes?

Dr Rex Gido: Yes, I would say so.

Host: Well, folks, we trust you're now more familiar with PRP injections. Dr. Rex Gido, thanks so much again.

Dr Rex Gido: Thank you, Joey. Thanks for having me.

Host: Thanks for hopping aboard. And for more information, please visit guthrie.org/sportsmed. Again, guthrie.org/S-P-O-R-T-S-M-E-D. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to Medical Minds, conversation with Guthrie experts.