Indications Ideal patients are those who have failed other nonoperative modalities or are unable to tolerate NSAIDs, and suffer mild-moderate osteoarthritis. Patients with severe osteoarthritis can also benefit, but the effect is more moderate. Maximum benefit occurs when combined with a weight loss and quadriceps-strengthening program. PRP can also be used intra-operatively to improve microfracture outcomes for chondral defects. Benefits Patients can expect a 50% - 80% reduction in symptoms for 6 - 12 months with an 85% or greater response rate. A minority of patients will still have benefit at 24 months. Repeat injections can extend the beneficial effect, usually spaced six months apart. The side effect profile is low risk, with local pain at the injection site for 24 hours the most common complaint. The exact mechanism of PRP relieving osteoarthritis is uncertain, but likely alters synovicyte and chondrocyte metabolism via local mediators contained in platelets such as platelet- derived growth factor, transforming growth factor beta, fibroblast growth factor, insulin-like growth factor 1& II, vascular endothelial growth factor, epidermal growth factor, Interleukin 8, keratinocyte growth factor and connective tissue growth factor. Technique PRP is created using the patient’s blood, usually collected from the cubital fossae as an outpatient procedure. The intra-articular injection must be performed using meticulous sterile technique, with or without imaging guidance as needed. By using subcutaneous local anaesthetic initially, the intraarticular injection can be pain free. There are a variety of ways to create PRP, from using a simple plain tube and centrifuge, to expensive commercial systems. One of the difficulties in assessing PRP studies is the wide variation in these preparation techniques. Simple PRP preparations can be inexpensive to prepare, pipetting the plasma from a centrifuged plain blood collection tube, but this results in a variable or low platelet concentration, sterility issues, concentration of white cells and red cell cellular debris. Various closed sterile commercial systems exist that can produce much higher platelet concentrations while simultaneously removing white cells. White cells, such as neutrophils, can release local mediators once in the joint that have a potentially deleterious effect on the synovial cells. It appears that white cell depleted PRP gives better outcomes for knee osteoarthritis than white cell concentrated PRP, while interestingly the opposite holds true for tendinopathies. The best preparation method, PRP volume and number of injections are still under investigation. After the injection, patients are encouraged to apply ice intermittently and plan minimal activities the following day. Tendinopathies PRP also has a beneficial effect for some tendinopathies in randomised controls such as patella tendinopathy and tennis elbow, but somewhat inclusive results in other studies probably reflect a wide variety of preparation and application techniques. pm On Your Bike A recent study published in the Journal of Physiology stated that cyclists show very few signs of ageing when compared to their non-cycling counterparts. Scientists who analysed the physiological functions of more than 120 regular cyclists aged between 55 and 79 failed to find any of the obvious signs of ageing that they would normally observe among people of the same age. The volunteers – 84 men and 41 women – had to be able to cycle 100 kilometres in six-and-half-hours for men and 60 kilometres in less than five-and-a-half hours for women. Smokers, heavy drinkers and those with high blood pressure and other health conditions were automatically excluded. The super-fit group of elder cyclists were monitored in a laboratory for two days with a battery of tests to measure their cardiovascular, respiratory, neuromuscular, metabolic, endocrine and cognitive functions – in addition to bone strength and general health and well-being. General Hea lth 20 Pindara Magazine Autumn 2015
Pindara Private Hospital Magazine - Issue Four
To see the actual publication please follow the link above