Thana Turajane, M.D.(Hons.), Vorasilp Cheeva-akrapan M.D.(Hons.)
PP&GF Academy
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.
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 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.
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.
Plasma Rich in Growth Factors | Platelet-Rich Plasma | |
Treatment frequency | Each treatment cycle involves one to two injections, with six to twelve months between each cycle. | Each treatment cycle consists of three to five weekly injections with four to six months between each cycle |
Eligible patients | For all joint severity levels, ranging from grade 1 to grade 4. | Only for patients with grade 1 or 2 osteoarthritis. |
Components | Platelet, Growth Factors, and Protein network. | Only platelets. |