Regenerative therapy (PRP)

What PRP is

A sample of your blood is drawn and spun in a centrifuge to separate its components. The platelet-rich fraction, concentrated well above normal circulating levels, is drawn off and injected into the target joint or tendon under ultrasound guidance.

Platelets carry growth factors involved in tissue repair and in regulating inflammation. The rationale is to shift the biological environment inside a degenerating joint away from a chronic inflammatory state. Because the material is autologous, there is no risk of allergic reaction to a foreign protein.

What it can and cannot do

It does not regrow cartilage. Any clinic telling you otherwise is overpromising. What the better evidence supports is symptomatic improvement, reduced pain and improved function, in mild to moderate osteoarthritis, with effects that can persist for months and in some patients considerably longer.

In advanced, bone-on-bone disease the benefit is small and often not worth the cost. We will tell you that at assessment rather than sell you a course, and will discuss arthroplasty referral instead where that is the sensible route.

Where we use it

• Knee osteoarthritis: the main indication, in mild to moderate radiographic grades
• Hip and shoulder degeneration: selected patients, always ultrasound-guided
• Tendinopathy: lateral and medial epicondylitis, gluteal and patellar tendinopathy that has failed a proper loading programme
• Plantar fasciopathy: where shockwave therapy and loading have not resolved it

Note the qualifier on tendinopathy. PRP is not a substitute for progressive loading; it is considered when a well-executed loading programme has genuinely been tried and has stalled.

The procedure

1. Blood is drawn, much as for a routine blood test.
2. The sample is centrifuged on site, this takes roughly fifteen to twenty minutes.
3. The target is identified on ultrasound and the skin anaesthetised locally.
4. The platelet-rich fraction is injected under direct ultrasound visualisation.
5. You rest briefly, then go home. Arrange for someone to drive you if a lower limb joint was treated.

Afterwards

Expect the joint to feel more sore for two to five days. This is an expected inflammatory response and not a complication, though it surprises patients who were not warned. Anti- inflammatory medication is generally avoided during that window, since suppressing the inflammatory response works against the mechanism, paracetamol and ice are used instead.

Relative rest for a few days, then a return to the prescribed loading programme. Improvement is gradual over four to twelve weeks rather than immediate; patients expecting the instant relief of a steroid injection are often disappointed at two weeks and pleased at ten.

Who should not have it

• Active infection, locally or systemically
• Blood disorders including significant thrombocytopenia or anaemia
• Active malignancy
• Anticoagulation that cannot be safely interrupted
• Pregnancy

Cost, stated openly

PRP is generally not reimbursed by insurers in Pakistan and is usually self-paid. You receive the per-injection cost and the recommended number of injections in writing before you commit, and we would rather you decline than proceed with unrealistic expectations.