What do people ask about sore joints?

Sources

1. A randomized controlled study of 111 patients aged 18-65 with hip osteoarthritis compared three weekly ultrasound-guided injections of PRP, hyaluronic acid, or both. PRP had the lowest VAS at every follow-up and beat HA significantly at 6 months (mean VAS 21 vs 44). But the WOMAC advantage present at 2 and 6 months was NO LONGER significant at 12 months, and the combination arm did worse than PRP alone.

   Dallari D, et al. — Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study.. The American journal of sports medicine, 2016. DOI: 10.1177/0363546515620383.

2. The PRIMA trial randomized 100 patients with ankle osteoarthritis to two ultrasound-guided intra-articular PRP injections or saline placebo. AOFAS scores improved 10 points with PRP (63 to 73) and 11 points with placebo (64 to 75); the adjusted between-group difference over 26 weeks was -1 (95% CI -6 to 3, p=0.56). The authors state the results do not support using PRP for ankle osteoarthritis. The evidence for a biologic in one joint does not transfer to another.

   Paget LDA, et al. — Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients With Ankle Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.16602.

3. A systematic review and meta-analysis of randomized trials found that augmenting arthroscopic rotator cuff repair with platelet-rich plasma reduces the retear rate and improves clinical function scores, whereas platelet-rich FIBRIN gives no clinically meaningful benefit - with the authors cautioning about the small number and heterogeneity of studies. The shoulder's best biologic evidence is for PRP used ALONGSIDE a repair operation, not as a substitute for one.

   Peng Y, et al. — Efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: A systematic review and meta-analysis.. PM & R : the journal of injury, function, and rehabilitation, 2023. DOI: 10.1002/pmrj.13049.

4. A pairwise and network meta-analysis of 18 randomized trials in rotator cuff TENDINOPATHY found corticosteroid helps at 3-6 weeks but not beyond 24 weeks, while PRP and prolotherapy may yield better outcomes in the long term (over 24 weeks) - with the authors warning that heterogeneity requires cautious interpretation. Tendon and joint-surface problems do not behave the same way, and a shoulder page should not borrow knee-OA evidence.

   Lin MT, et al. — Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials.. Archives of physical medicine and rehabilitation, 2019. DOI: 10.1016/j.apmr.2018.06.028.

5. The evidence overview underpinning the 2020 EULAR recommendations on intra-articular therapies pooled 29 quality-appraised systematic reviews. Hyaluronic acid showed a small effect on pain and function in KNEE OA but not in hip OA or shoulder capsulitis; intra-articular glucocorticoid showed small effects in knee OA and on function in hip OA and shoulder capsulitis; PRP showed benefit in knee OA but NOT in hip OA, and mesenchymal stem cells behaved similarly. Overall conclusion: most intra-articular therapies exert SMALL effects and are well tolerated.

   Rodriguez-García SC, et al. — Efficacy and safety of intra-articular therapies in rheumatic and musculoskeletal diseases: an overview of systematic reviews.. RMD open, 2021. DOI: 10.1136/rmdopen-2021-001658.

6. FDA states plainly that no stem cell, exosome, stromal vascular fraction, umbilical cord blood, Wharton's jelly or amniotic-fluid product has been approved for the treatment of ANY orthopedic condition - it names osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain individually. The only FDA-approved stem cell products in the United States are cord-blood-derived blood-forming stem cells for disorders of the hematopoietic system, and there are currently no FDA-approved exosome products.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA, 2020.

7. A cross-sectional study contacted 273 of 317 US centres offering direct-to-consumer stem-cell therapy, posing as a 57-year-old man with knee osteoarthritis. The mean advertised price of a unilateral same-day stem-cell knee injection was $5,156 (SD $2,446), and centres claimed a mean clinical efficacy of 82% (SD 9.6%) - a figure with no support in the published evidence. The gap between the quoted number and the trial data is the single most useful thing a patient can be told before a consultation.

   Piuzzi NS, et al. — The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.. The journal of knee surgery, 2018. DOI: 10.1055/s-0037-1604443.

8. Medicare's National Coverage Determination covers autologous platelet-rich plasma ONLY for chronic non-healing diabetic, pressure or venous WOUNDS, and only under Coverage with Evidence Development inside an approved clinical research study. There is no Medicare coverage pathway for PRP as a treatment for osteoarthritis or any other joint indication, which is why these injections are quoted as cash prices.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2012.

9. The RESTORE trial - a participant-, injector- and assessor-blinded RCT of 288 adults aged 50+ with symptomatic medial knee OA (Kellgren-Lawrence 2-3) - compared three weekly intra-articular PRP injections against saline placebo, with co-primary endpoints of 12-month knee pain and medial tibial cartilage volume on MRI. PRP did not beat placebo on either. It is the single best-designed test of the specific claim that PRP changes joint structure, and it was negative.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

10. A four-arm, multicentre, single-blind phase 2/3 randomized trial of 480 knee OA patients (KL II-IV) compared autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction and allogeneic umbilical-cord-tissue mesenchymal stromal cells against a corticosteroid injection control. At 12 months NONE of the three orthobiologic injections was superior to another, or to the corticosteroid control, and none of the four groups showed a significant change in MRI osteoarthritis score from baseline. No procedure-related serious adverse events occurred.

    Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial.. Nature medicine, 2023. DOI: 10.1038/s41591-023-02632-w.