Understanding Osteoarthritis

Osteoarthritis becomes more common as we age and can significantly affect both physical and mental health. Symptoms vary but typically include weakened thigh muscles, joint inflammation, diminished joint fluid quality, and the breakdown of cartilage. These changes can lead to discomfort and, in some cases, joint deformity, dramatically impacting quality of life. While osteoarthritis can affect many joints, it most frequently targets the knees, hips, and shoulders.

Current Treatment Options

Osteoarthritis management includes a spectrum of treatments, ranging from oral medications and physical therapy to joint injections with steroids or hyaluronic acid (available in a single weekly injection for 5 consecutive weeks in every 6 months). In cases where these treatments don't provide sufficient relief, arthroplasty (joint replacement surgery) may be considered, usually during advanced stages of the condition. However, due to longer life expectancies and a growing interest in active lifestyles, surgical interventions are best timed to optimize outcomes and reduce the reliance on medications.

Biotechnology's Role in Osteoarthritis Treatment

Biotechnology is revolutionizing treatment through regenerative medicine, which aims to maintain natural tissues and organs as long as possible. Since 2010, the US FDA has approved platelet-rich plasma (PRP) for osteoarthritis treatment. In Thailand, osteoarthritis biotechnology has been advancing since 2013, focusing on cells, platelets, and growth factors. Initially, PRP was used for early-stage osteoarthritis (KL1 and KL2), requiring weekly injections for 3-5 weeks and follow-up treatments every 4-6 months. More advanced stages still required surgical solutions. It was estimated that surgery rates would increase by 5-10% annually. Orthobiologics are now pivotal in cartilage regeneration, reducing inflammation naturally, and promoting joint lubrication. PRP has gained traction for its safety, efficiency, and reduced injection frequency, offering promising long-term outcomes.

Plasma Rich in Growth Factors (PRGF)

With ongoing research since 2013, PRGF has become viable for treating moderate to severe osteoarthritis, helping to avoid unnecessary surgery. Derived from a patient's own blood, it undergoes a sophisticated triple spinning process, yielding a plasma teeming with growth factors. These factors are instrumental in sustained healing. Following the spinning process, platelet concentration is significantly enhanced (by 3 to 4 times), while white blood cells should be monocyte-predominant to reduce inflammation1. The fibrin complex serves as the protein component, anchoring growth factors for an extended duration of the plasma rich in growth factors' efficacy. Typically, the benefits of each injection persist for nine to twelve months. Studies by Turajane et al. have verified its safety2. Initially, this treatment parallels the effectiveness of steroid injections, but from two months onward, it surpasses steroid therapy, maintaining superior results up to twelve months3. The treatment has been shown to reduce the necessity for surgery by 76% to 87.5% over two years4 and to obviate the need for surgery in 70% to 80% of patients during a three-year follow-up period5. The preparation technique earned a patent for its intellectual property in 2019. It was honored with the innovation prize by the Thai Hip & Knee Society in 2021. Owing to its growing acclaim, the method has been disseminated to orthopedic specialists across twenty regional hospitals in Thailand, benefiting over 2,500 patients with this plasma technology.

Indications for Plasma Rich in Growth Factors Treatment

1. Suitable for patients with osteoarthritis grades 1-4 who are not candidates for surgery.
2. For patients unresponsive to intra-articular steroid injections.
3. For patients unresponsive to intra-articular hyaluronic acid injections.
4. For patients who have not seen improvement with oral medication or physical rehabilitation.
5. For patients who cannot take oral medications due to adverse treatment interactions.
6. For patients contraindicated for NSAIDs due to conditions like heart, kidney, or gastric diseases.

Contraindications for Plasma Rich in Growth Factors Treatment

1. Current infections.
2. Disorders affecting platelets.
3. Patients below the age of 16.
4. Pregnant individuals.
5. Cancer patients actively undergoing chemotherapy.
6. Arthritis without a determined cause.
7. Presence of complete meniscal or cruciate ligament tears, or loose bodies within the joint.

Post-Treatment Recommendations for Plasma Rich in Growth Factors

1. Joint discomfort may occur typically within 1-2 days post-treatment; manage with prescribed medication and apply cold compress for 15 minutes as needed.
2. Begin fixed arc quadriceps exercises after 48 hours.
3. Resume normal daily activities immediately.
4. Refrain from strenuous activities for at least 5-7 days post-treatment.

Fixed Arc Quadriceps Exercise

1. Sit with your knee at the chair's edge.
2. Extend your leg forward (without bending the ankle joint), hold for 100 seconds, then switch legs.
3. Perform this 3-5 times daily.

Distinguishing PRGF from PRP

FAQs

1. Pre-Treatment Guidelines:
        - Ensure adequate rest before your appointment.
        - Skip high-fat meals before the blood draw.
        - Discuss blood thinners like aspirin or warfarin with your doctor; you may need to discontinue them 3-5 days prior.
        - Postpone treatment if menstruating.
        - Wait a minimum of 2 weeks post-blood donation before undergoing this procedure.
2. Treatment Frequency:
        - Typically, 1-2 injections per cycle.
        - Cycles range from 6-12 months up to 3 years.
3. Treating Both Knees:
        - Simultaneous treatment of both knees is possible if the discomfort level is equal.
4. Post-Treatment Care:
        - Refrain from high-intensity activities, including extensive walking, for 2-3 days.
        - Avoid exercise for 5-7 days.
5. Expected Results Timeline:
        - Pain reduction typically occurs from 3 days to 3 weeks.
6. Treatment Duration:
        - Preparation of Plasma Rich in Growth Factors (PRGF) takes about 1 hour.
7. Contraindications:
        - Not recommended for individuals under 15 years, pregnant women, patients with platelet disorders, or active chemotherapy patients.
8. Post-Treatment Driving:
        - Driving is permissible, but having someone accompany you is advisable.
9. Impact on Surgery:
        - The treatment can potentially negate the need for surgery in 70-80% of cases, varying by condition severity.
10. Managing Post-Treatment Knee Pain:
         - Mild discomfort is expected and manageable with prescribed medication and 15-minute intervals of cold compression.
         - Persistent pain warrants a consultation with your doctor.

References

1. Turajane T, Cheeva-Akrapan V, Saengsirinavin P, Lappaiwong W. Composition of Platelet-Rich Plasma Prepared From Knee Osteoarthritic Patients: Platelets, Leukocytes, and Subtypes of Leukocyte. Cureus 15(3): e36399. DOI 10.7759/cureus.36399
2. Turajane T, Sriratanavudhi C, Saengsirinavin P, Chaweewannakorn U, Lappaiwong W, Aojanepong J. Safety and clinical efficacy of platelet rich growth factors (prgf) in managing knee osteoarthritis after failed conservative treatment: evidence from real practices. J Southeast Asian Med Res. 2019, 3:1.
3. Turajane T, Saengsirinavin P, Sriratanavudhi C, Larpaiwong W, Aojanepong J. A prospective, randomized, controlled trial comparing clinical outcomes of intraarticular platelet plasma concentrate and growth factors versus corticosteroid injections in the treatment of knee osteoarthritis. Bank Med J 2021; 17.
4. Turjane T, Saengsirinavin P, Sriratanavudhi C, Cheeva-akrapan V, Larpaiwong W, Aojanepong J. Outcome of using platelet, plasma and growth factors as an orthobiologic derivative to avoid invasive surgical procedures for treating knee osteoarthritis among elderly patients. J Southeast Asian Med Res 2022, 6
5. Cheeva-Akrapan V, Turajane T. The 36-Month Survival Analysis of Conservative Treatment Using Platelet-Rich Plasma Enhanced With Injectable Platelet-Rich Fibrin in Patients With Knee Osteoarthritis. Cureus 15(3): e35632. DOI 10.7759/cureus.35632