PRP Injections from an experienced Sports and Rehabilitation Specialist

Clearwater, Tampa and Saint Petersburg Florida Area.

Dennis Lox M.D. has practiced in the greater Tampa Bay Florida community for over 20 years, combining his skills in sports, orthopedic, musculoskeletal injuries and arthritis treatment to thousands of patients. Located conveniently in Clearwater near the airport and beaches and easy access to Tampa and St. PPicture1etersburg

Platelet-Rich-Plasma (PRP)  for Joint Pain and Injury

 

Platelet-Rich-Plasma or PRP is a regenerative medicine procedure that uses the patients own blood (autologous therapy) to achieve a healing response. This occurs through a natural process by incorporating the growth factors found in the blood platelets.

PRP is not new. It has been utilized in medicine for decades in a variety of applications, yet has seen a surge in popularity as well known athletes such as Tiger Woods, Alex Rodriguez, Hines Ward, Rafael Nadal and Kobe Bryant have made headlines with this therapy. It has been used in periodontal procedures, wound therapy, plastic surgery and even as treatment for baldness.

Joints Commonly Treated         pictue 2

  • Hip
  • Ankle
  • Spine
  • Shoulder
  • Elbow
  • Wrist and Hand
  • knee

 

 

Wrist and Hand Pain

Disorders of the hand including arthritis, TFCC tears, and chronic sprains can be treated.

 

Arthritis

Degenerative and Rheumatoid of most joints

 

Avascular Necrosis

Avascular necrosis (AVN) or osteonecrosis of many joints have been treated. It may be treated in combination with stem cell therapy, as are either injuries.

 

Joint Surgery Alternatives

Regenerative therapy may often be sought as an alternative to surgery. Prior failed surgery and alternatives to joint replacement surgery are frequent conditions were regenerative therapy with platelet-rich-plasma or PRP are implemented.

 

The Science Behind PRP

The principle behind the use of platelet-rich-plasma (PRP) in jointpicture3 pain and problems is that by concentrating the blood and separating out the platelets the power of the growth factors that are part of the body’s own natural healing response can be concentrated and delivered to areas that can not achieve this response without assistance. Our joints have limited blood supply, in contrast to our skin which is highly vascular. If we sustain a superficial wound such as a cut, the blood clots via the action of the platelets in our blood releasing clotting factors in a cascade of events that stops bleeding. For years the function of platelets were mostly thought of in this way as clotting factors.

The platelets, however are much more sophisticated and have several components alpha and dense granules.The alpha- granules contain a variety of the coagulation factors as well as the growth factors, cytokines, chemokines, and adhesion proteins necessary for tissue repair. Dense granules contain factors necessary for platelet aggregation. These include ADP, calcium, and serotonin. It is the cell activation of platelets that result in the release of granular contents and the cascade of events that occur afterwards that are the desired properties to be utilized in PRP therapy. Joints that are relatively avascular (lacking good blood supply) must have the platelets concentrated and delivered as a therapeutic injection to achieve the healing effects that would normally occur in a vascular area such as the skin. In other words, mother nature needs help to heal our joints after trauma or as we age and develop arthritis. By delivering a highly concentrated platelet-rich-plasma or PRP inside the joint wecreate a healing environment.

picture 4A small quantity of the patients blood is drawn, it is centrifuged andthe subcomponents are separated as the blood will separate in layers after being spun in the centrifuge. The desired platelet component is retained and then ready for injection. picture 5This is done in a sterile fashion, and as the blood products are from the own patient there are no issues with rejection, or disease transmission. The physician determines the appropriate amount to inject based upon the joint and the associated injury or problem involved. Experience is highly important not only for accuracy, but in reducing post injection discomfort. This can be minimized by technique. Dr. Lox has successfully treated a variety of joint disorders from relatively small hand joints, spine, hip, shoulder, ankle, and knee problems.

Dr. Lox stresses the need for individual treatment as each patient has unique needs and goals that must be incorporated for optimal improvement.

Athletes wishing to return to specific sports must be evaluated not only by injury or problem, but suitable time table for optimal return to their sport. This often is optimized with post procedural care to expedite recovery. There are numerous therapeutic measures Dr. Lox incorporates in this strategy to facilitate this.

Though research has not been thoroughly evaluated, several studies have shown PRP to be superior to hyaluronic acid injections (joint lubricants) and corticosteroid injections. It is the experience of Dr. Lox that these procedures are useful, however not curative. It is the intent of pursuing regenerative medicine strategic therapies to retard degeneration and promote healing, not merely to temporarily ameliorate the symptoms.

Stages of Healing

There are three stages of healing that occur following platelet activation.                                       picture 6

  • Inflammation
  • Proliferation
  • Remodeling

 

The Inflammatory Stage

Typically lasts two to three days. In this phase platelets are aggregated, clot retraction and coagulation occur. Cytokines and growth factors are released. Signaling from these cells direct tissue healing responses and recruit progenitor and stem cells to the site. By the seventh day fibroblasts are the most abundant cell type and are responsible for collagen deposits and the extracellular matrix formation.

The Proliferative Phase

This occurs and peaks normally at days 5 to day 15, and may last up to a month. Cells differentiate and new blood vessels are formed. Fibroblasts begin to differentiate.

The Remodeling  Phase

This phase may last a year as tissue fully repairs itself. During this phase collagen matures and strengthens.  Immature collagen is replaced with type I collagen and the new blood vessels that were formed disappear.

These stages of healing vary and different patients will experience different symptoms during the recovery process after PRP is injected. It appears that many factors are responsible for the varied response between patients. picture 7Some patients are quick responders with resolution of symptoms in as little as a week, while others require a second or third injection to boost the effects. Some physicians perform a series of 3 PRP injections in monthly intervals. Dr. Lox has found that this is often not needed if appropriate initial steps in treatment are provided and adherence to treatment recommendations are strictly followed. Growth factors factors found in PRP include TGF-B, BFGF, PDGF, EGF, VEGF, and IGF-1 as well as many others.

These growth factors in conjunction with other signaling proteins work in concert with undifferentiated progenitor cells or stem cells in a very structured micro-enviroment referred to as the cell niche to coordinate the healing response. A structured matrix or scaffold facilitates this process. Research has shown the relationship between these factors optimizes tissue healing  Incorporating this knowledge and targeting growth factors from PRP, and stem cells that are conducive to that micro-enviroment, along with a scaffold matrix to adhere to optimizes the natural healing process in joints.

picture 8

A thorough understanding of this complex process is essential. Research remains as  an incomplete understanding of why some animal and human research cannot achieve complete recovery in every instance. What has been demonstrated clearly, is that prior models of treatment for joint pain and disorders were not successful treatment  measures. Surgery may correct a structurally problem to a degree yet cannot prevent post-traumatic arthritis. Indeed surgery and trauma increase the incidence of future arthritis. It is through the use of biological and regenerative treatment procedures including stem cell therapy that the future of medicine for joint therapy is poised. Surgery is not capable of regenerating joint tissue.

 

Studies have shown post-operative regenerative therapy is capable of replacing loss cartilage volume. Therefore the use of growth factors from PRP and stem cell assisted regenerative therapy is a viable alternative to surgery in some cases including joint replacement. Patients who have undergone unsuccessful surgery for knee meniscus or shoulder pain have found improvement with these treatments. Indeed the FDA trials with knee arthritis and stem cells were done a week after knee meniscal surgery. The control group was surgery with hyaluronic acid. Naturally, cartilage regeneration cannot occur with surgery or joint lubrication. This was shown clearly in 1 and 2 year MRI scans. The stem cell group did reveal individuals with cartilage regeneration at these intervals. Elucidating the need for a regenerative strategy.

picture 9

 

Regenerative medicine is an exciting field and the future will alter our treatment patterns. 30 years ago a meniscal tear may have been treated with an open surgical procedure and the entire meniscus was removed for recalcitrant knee pain. This accelerated the arthritis process and complete meniscetomy was replaced with small arthroscopic incisions to trim and remove parts of the knee cartilage and meniscus. Some surgeons are now incorporating PRP into the surgical site to improve healing, diminish postoperative pain and hasten recovery. The natural shift for the future will be to minimize structural change with surgery and repair by healing tissues with regenerative techniques as a means of diminishing post-traumatic arthritis. In this light, patients will wish to seek alternatives to surgery for joint pain, looking instead to a healing approach that will keep father time at bay for as long as possible.

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Dennis Lox M.D. Excellence and Experience in PRP TherapyServing Tampa-Clearwater-St. Petersburg Florida

Dr. Dennis Lox serves patients in the greater Tampa Bay area, including, Clearwater, St. Petersburg, Tampa, New Port Richey, Sarasota, and Spring Hill. He has been pleased to accommodate the needs of patients throughout Florida, the United States, the Western Hemisphere, and Europe, as well. Located in the 33765 and 33765 areas, our offices can be reached at (727) 462-5582 (Clearwater) and (727) 817-1909 (New Port Richey). Call to schedule your visit today.