Newer treatments for Knee osteoarthritis: Your own blood

Prof M S Dhillon, Head Deptt of Orthopaedic Surgery, PGIMER Chandigarh : In modern medicine, one of the most successfully treated degenerative diseases of the body is osteoarthritis, especially of the knee (more prevalent in India) and of the Hip (more common in the western world). There are many reasons for this, principal amongst these being the success of joint replacement. Replacing the joint is all very good, but the issue is trying to prevent the joint from wearing out so much that it needs replacement. There are patients who are still in the early stages of degeneration, in whom joint replacement is a distant option in the future, or it can be prevented. There are some who have associated medical diseases that preclude them from undergoing surgery; many have financial constraints, while some have social taboos. What can be done for this subgroup is the matter that I discuss today.

Last year I wrote a column in the Tribune on Vissco-supplementation; this consists of
synthetic “grease” that can be injected into the joints, either as one injection or a set of 3 injections;
this is widely used for a specific subgroup, and has the advantage of not only reducing friction inside
the joints, but also provides some essential components of the normal joint fluid. I have been using
this since 2001 with fairly good results, but only in well selected patients; knees that are severely worn
out do NOT benefit from this injection, and these patients should not get a false sense of hope. Today
I write about a newer type of injection i.e. Platelet Rich plasma (PRP). PRP is derived from your own
blood, after taking a sample from a vein; at PGI we use specialized protocols to concentrate the blood
by centrifugation and filtering, so that only your platelets are left behind. These platelets are rich in
growth factors and other normal constituents, that are excellent for promoting body tissue repair. While
not exactly stem cell therapy, this works on the principle of supplying large quantities of stimulants
for regeneration into areas where there is wear and tear, thus stimulating healing by the natural way.
This procedure has been used internationally in sportspersons after injury of tendons with very good
outcomes; I have been using blood products for Tendon overuse injuries in sportspersons since my days
in SriLanka, and there are many happy athletes who still thank me. The idea to use this inside worn
out knees came from a study from Spain, where it was used in cases of early osteoarthritis with fairly
decent outcomes in the short term. We started this work at PGI last year, and have now more than a
100 cases that have been injected, with good short term outcomes. The first U.S. study (of 14 cases only!
) of PRP in knee osteoarthritis appeared in the Dec 2010 issue of American Journal of Physical Medicine
& Rehabilitation, showing a positive report after 1 year. Once used primarily for famous athletes, PRP is
now making its way into the mainstream management of orthopaedic diseases!

So what is the down side? One, it is not confirmed in these knees whether actual repair will
happen, as not enough long term follow up is available, nor have these knees been operated upon. Two,
some cost is involved (around Rs 2000), which however is minimal as compared to other more expensive
therapies. Nevertheless the advantage is that there are no allergic reactions, as seen when synthetic
drugs are injected, since this injection is from your own blood. And even if there is no significant long
term gain, we have an adequate number of patients who say that short term pain relief is enough for
them to consider a second injection in the future. So for once, the Indian usage of a new therapy is
abreast, if not ahead of, international centers of repute.

For more information on this therapy pl give your quarries.