PRP injection vs. Synvisc One (knee)

[GeezerSteve]

Gotta decide soon. Chronic arthritic pain in left knee, ROM limited by acute pain. TKR will happen eventually, hoping to get a few years before that.

Sports medicine doc will shoot me up with cortisone next couple weeks. Taking a course of Mobic in the meantime. Touring the next 4 days. Gonna hurt but I gotta get out there.

Per doc reco, after the cortisone, my options are PRP injection and Synvisc One. I saw this thread. And ticketchecker's post "PRP in both [knees] last year and that was way better then synvisc."

Synvisc might be covered by insurance. PRP will be $650 out of pocket (HSA eligible I hope). SM doc and his partner (my bud, a GP) seem to favor PRP.

Thoughts? Thanks

[buttahflake]

I'm pretty much bone on bone in both knees. Ruptured patella tendons both sides and a life long skier. Synvisc didn't do much of anything. And the procedure was somewhat painful. Huge gauge needle right to the knee.
Ymmv

[rod9301]

I have grade iv in my left knee since 2003. Synvisc twice a year, and I do all my sports without pain.
Synvisc lubricates, so it delays tkr.

BTW, stay Away from Cortisone, nothing but problems.

I had promised injections, but for tendon issues.

I don't think it will do anything for you.

Doctors love it, because it makes them money.

BTW, it worked for tendonitis for me.

[ticketchecker]

I did synvisc like 3 or 4 years in a row, didn't really get much out of it. I did feel like the straight PRP gave me something, albeit still temporary.

When I had the stem/PRP cocktail was where I got the most relief. Big $$ tho, I had a buddy that was selling the stem kits and got a freebie while I was in the shop for acl repair.

If synvisc is covered give it a try.

Buttah is right about the needle, fack me that smarts

[GeezerSteve]

Ortho said it's too late for Synvisc to do me any good. PRP is not covered by my HC insurance (and it might be too late for that too). So I got a cortisone shot and it has worked great to quiet down the inflammation. For the first time in a year I'm able to sleep through the night without being awoken several times by knee pain. Pain has greatly subsided but the knee still feels very unstable, feels like it's on the verge of buckling. Brace helps a bit.


Total knee replacement is inevitable. Ugh

[plugboots]

Three injection Visco supplementation did not work for me, it just felt "looser". Doc says TKR is in my future as well

[splat]

Do the PRP!!!!!!!!!!!!

[jackstraw]

My buddy did Synvisc a few times. The last time his leg swelled like a balloon and he was in severe pain. Not sure if the Dr fd up or he just had an allergic reaction. Of course you know the latter was told to have been the issue.

If I skip more than 2-3 days without pedalling, my knees begin to ache. I try to hit the stationary for 10-15 minutes of no resistance if I don't have time for anything more that day. So far that has kept my knees happy.

[RCC55125]

I've had both.
Synvisc lasts 6 months tops and would have to be done again.
PRP lasts no longer, maybe less. However, with PRP you may get some healing but maybe not.
Synvisc and PRP can be done together.
As ticketchecker said, stem cell therapy with PRP usually gives the most relief. It was the best for me but everything was out of pocket. Even though it was expensive, for me, it was worth it.

[splat]

Three injection Visco supplementation did not work for me, it just felt "looser". Doc says TKR is in my future as well

Stem cells.

[sb]

Had PRP done last year on right knee, 93 ACL repair.

Worked well for me and still feels good a year later. Not a cure mind you but good improvement. YMMV

[Patarero]

Bumping for more experiences with PRP (supartz). My doc proposed this avenue.

[SkiLyft]

Bumping for more experiences with PRP (supartz). My doc proposed this avenue.

Heads up,

PRP is not the same as Supartz. Supartz is hyaluronic acid which is a viscous substance that is injected into the knee. PRP made by drawing your own blood then centrifuging it down. Once separated into layers the office will draw off the platelets and inject that back into your knee.

The evidence for PRP injections specifically in the knee is really good and has out performed hyaluronic acid!


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[auvgeek]

Here's my layman's take:

The evidence for PRP to heal ligaments and tendons is pretty good. I've been told 30%-40% more effective healing power than prolo therapy. PRP sometimes takes multiple rounds (3 rounds is a number I've heard a lot), but it does stimulate healing in ligaments and tendons. I've heard very mixed things about it's ability to heal an injury to the joint space (aka cartilage/meniscus damage).

Stem cells, OTOH, are more likely to help in the case of injury/damage to the joint itself, like cartilage damage (including arthritis). Not a guarantee it will work, obviously, but more likely than PRP. And it will also be better for ligament and tendons than PRP. But stem cells have the obvious drawback that harvesting them from bone marrow, typically drawn from the iliac crest IME, is a lot more invasive than drawing blood for PRP.

One doctor's theory is that PRP stimulates the stem cells already in your body -- it's like a catalyst for healing. So PRP works well if there are enough active stem cells at the injury site to heal the injury. If there aren't enough stem cells for healing, that's when you need to inject stem cells to enable the healing. I'm not a doctor, and I don't know if this theory makes any sense physiologically but the doctor is nationally if not world renown for his work on regenerative medicine so I'm hopeful I'm not spewing garbage.

I chose to go PRP a few weeks ago for my knee issues. Unexplained knee pain on the medial side, clean MRI -- no obvious damage to the ligaments or cartilage or meniscus. None of the people I've seen (5 PTs, 4 knee surgeons, 3 sports medicine docs, and 2 regenerative medicine docs) really knows what's up with them, so I chose the least invasive route: PRP in all ligaments and tendons, and the doc even threw some into the joint space on the off chance it helps. I guess we'll see in a few months whether there is any improvement. I figure, other than the risk of infection, there's little downside to PRP except the money.

My wife had a very bad ankle from two ground falls climbing. She is in her early 30s, her surgeon says her ankle looks like someone in their 70s based on amount of cartilage, and her ankle-specific PT said her ankle was the least stable she's ever seen. MRI was inconclusive for full tears, but every one of the 5 ankle surgeons we say recommended a full ligament reconstruction or ankle replacement. We pushed to have a stem cell injection first because it's so much less invasive and we figured worst case we throw some money away. Even the stem cell doc didn't really think it would work since it had been over a year since the injury and he typically did injections combined with some kind of surgery. But 1.5 years after 1 round of stem cell injections into all of her ankle ligaments and also into the joint space, and I'd say it was a success. Her ankle is not and likely will never be the same as it was pre-injury, but it's biomechanically stable and she can ski again. And so far, it keeps getting better. Running for exercise is still a no-go, but she can hike and ski tour just fine. Did 5k vert after work the other night.

[LightRanger]

My wife had a very bad ankle from two ground falls climbing. She is in her early 30s, her surgeon says her ankle looks like someone in their 70s based on amount of cartilage, and her ankle-specific PT said her ankle was the least stable she's ever seen. MRI was inconclusive for full tears, but every one of the 5 ankle surgeons we say recommended a full ligament reconstruction or ankle replacement. We pushed to have a stem cell injection first because it's so much less invasive and we figured worst case we throw some money away. So 1.5 years ago, she had 1 round of stem cell injections into all of her ankle ligaments and also into the joint space. Her ankle is not and likely will never be the same as it was pre-injury, but it's biomechanically stable and she can ski again. And so far, it keeps getting better. Running for exercise is still a no-go, but she can hike and ski tour just fine. Did 5k vert after work the other night.

What'd she break in the climbing falls? Calc fracture by any chance?

[auvgeek]

What'd she break in the climbing falls? Calc fracture by any chance?

Nope. First fall, she broke off the os trigonum -- that was missed on the MRI/XRay, so it bounced around in the joint space tearing up cartilage before her ankle swole up "randomly" due to an osteochondral lesion, and then the lesion and os trigonum fragments were surgically operated on/removed 3-ish years later. She fell again about 9 months after that surgery and damaged cartilage and tore all ligaments. So cartilage damage is the primary problem for her. As you know, cartilage doesn't regenerate and there's no real "cure" for it. Aside from stem-cell injections, current practice is to have a surgeon do an exploratory surgery and cut out or shave down any irregularities. Our thought was you can't get that back, just like you can't make ligaments longer after they've been reconstructed to be shorter, so might as well try a stem-cell injection first. She is hypermobile in almost every joint, and we really didn't want a ligament reconstruction that would cut down her ROM even more than it was already. She has about 22 degrees passive dorsiflexion in her uninjured ankle and about 9 degrees in her injured ankle.

She's decided she's not leading anywhere near her limit anymore, which is more than fine with me. She likes skiing a lot more anyway.

Hope this helps. My guess is a calc fracture would be associated with cartilage damage, so a stem-cell injection into the joint space might help.

[LightRanger]

Yep. 10-4.

I'm three years out from a calc fx that was minimally-displaced, so they didn't want to screw it. But I'm developing OA in that joint and want to put off any kind of permanent fix (i.e. subtalar fusion) as long as possible. Been thinking about stem cell injection as a possible option.

Thanks for the input.

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[auvgeek]

Yep. 10-4.

I'm three years out from a calc fx that was minimally-displaced, so they didn't want to screw it. But I'm developing OA in that joint and want to put off any kind of permanent fix (i.e. subtalar fusion) as long as possible. Been thinking about stem cell injection as a possible option.

Thanks for the input.

I can provide more info, including the doc who did hers, via PM if you want. I think cost was around $3500 out of pocket, which was much less than what we were quoted from other clinics we saw. She chose to do with out any local topical anesthetic because we read a journal paper that said most anesthetic agents could lice stem cells and we wanted as much potency as possible. I could tell it hurt like a mother, but she made through just fine.

[LightRanger]

Yes please! That's definitely way cheaper than I've been seeing.

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[mooseknuckles]

The way PRP works is by signaling the healing cells. Its not a direct actor. There is very good long term data for PRP in ligament and tendon injury. Stem cells procedures on the other hand are direct actors. You are putting the cells required for healing and regeneration right where they need to be. There is good evidence for stem cells in shoulders, knees, hips, ankles. The best evidence for stem cells in the knee is actually a subchondral injection where they have actually shown cartilage regeneration. The keys to stem cells working are where they are taken from and how many are there. You have to have autologous (from your own body) stem cells. These fetal cells etc just don't have evidence. Fat cells actually have the best ability to differentiate into the types of cells we want but it requires significant manipulation of the fat cell and the FDA regulations prohibit this. Not only do you need autologous cells but you also need a high concentration. You really need to research who is doing this procedure as well. Since it is a cash based procedure every tom dick and harry wants in on it. You need someone with experience in injecting under X-ray and ultrasound. The average cost for these is $3k-$10k so it is a significant investment.

[SkiLyft]

PRP has much more (high quality) evidence which is why your insurance will cover it. But seriously be super careful with stem cell injections.

Specifically with knee injections there has only been 6 studies (last time I checked). The studies did show improvement with no adverse reactions however they were level III and level IV evidence which is quite poor. Also their funding was suspect and a high level of bias was likely involved.

Another word of caution — drug companies are driven by MONEY!! So any study that was funded by said pharma will only be published if the results favor the drug company. In that same token they will not publish a study that showed adverse effects. So I would take those 6 studies with great caution.

[SkiLyft]

Double post

[XXX-er]

https://www.cbc.ca/news/health/osteo...fety-1.5327102

not as safe as believed ?

[powdork]

^but that's just for straight up corticosteroid injections. I got about 5 of those before I realized I was getting more benefit from the lidocaine than I was from the steroid.

[XXX-er]

hey its just some random trivia i read while drinking coffee this am which seemed relevant to Gimp central so ... talk amongst yourselves eh