Most joints in the body can be injected. We currently are able to help with:

Osteoarthritis is a debilitating and progressive condition which is characterised by the slow, painful ongoing destruction of cartilage in the joint, as well as inflammation and damage to the tissues surrounding the joint. There is no cure for osteoarthritis and the treatment currently is aimed at managing the symptoms for as long as possible, which includes weight loss, physiotherapy, exercise and injections such as steroid or hyaluronic acid.

Any joint can be affected by osteoarthritis but it is most common in the knee, hip, thumb, ankle and spine.

Detailed information about osteoarthritis can be found on the internet and is widely and freely available. Please see – www.versusarthritis.org or www.nhs.uk.

In healthy cartilage, there is an equilibrium between some enzymes called Matrix-Metallo-Proteinases (MMPs), the chondrocytes (the cells responsible for the cartilage maintenance) and the substance of the cartilage (matrix). This equilibrium is essential in ensuring that the cartilage remains healthy.

In osteoarthritis, it has been found that the MMPs are working too hard which causes an imbalance and results in the breakdown of the matrix of the cartilage.

Once the cartilage is damaged through OA, the degenerative process starts and is progressive. The end stage is when the joint is completely destroyed and can no longer function, resulting in pain, stiffness and swelling. This is usually the time that patients are considered for joint replacement surgery.

There is now lots of evidence available (see evidence) to show that PRP has a beneficial effect in osteoarthritis. PRP is highly effective in reducing inflammation and furthermore, helps to slow down and stop the progression of osteoarthritis by downregulating the effect of the MMPs. This is the opposite to the effect of steroid injections which have commonly been used for this condition. The PRP helps to improve the function of the chondrocytes (cartilage cells) and the production of healthy matrix, as well as reducing the effect of the MMPs.

We aim to reduce the symptoms of osteoarthritis and preserve the cartilage that is remaining in the joint.

Depending on the extent of the damage to the cartilage, the degree of osteoarthritis can be graded as can be seen below in the example of knee arthritis. 

PRP injections can be used in the early, mild and moderate stages where evidence supports benefit, however, is not appropriate to have PRP treatment when the joint has severe changes.   

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PRP works best in grade I-III. It is not effective in grade IV.

No, PRP doesn’t regenerate or grow back new cartilage. It helps to maintain the cartilage that you have left in your joint, thereby significantly delaying the requirement of joint replacement surgery.

This is why we would not offer PRP to patients with advanced osteoarthritis. It has been shown that PRP works best to maintain the remaining cartilage and therefore it is only offered to patients with early, mild and moderate changes and not severe joint changes when all almost all the cartilage is already lost.

You may have heard a lot about “stem cell” treatments that can regenerate cartilage. We would advise strongly against pursuing this type of treatment at this point. There are a number of clinics that have sprung up in recent times that are offering this type of treatment, but unfortunately there is currently no strong evidence to suggest that cartilage can be regenerated by a simple injection into the joint. These treatments also cost many thousands of pounds (usually £6000 +) and we would advise caution.

The orthopaedic community has been using steroid injections for decades, and this still has a role to play when PRP can’t be used. However, steroids have been shown to upregulate MMPs and their action, causing them to work harder and break down the cartilage even faster. This then in fact accelerates OA and results in joint replacement surgery even faster.