PRP Use for Orthopedics: Updates and Standards from AAOS

Laura Dyrda -   Print  |
Surgical solutions using platelet rich plasma have recently begun making headway in orthopedic surgery, and physicians should have a good understanding of the how the technique works before using it, according to reports published in AAOS Now.

For orthopedic use, the physician harvests the venous blood and transfers it to the centrifuge. After the centrifuge processes, the physician extracts PRP according to device instructions. After cleansing the injection site, the physician administers local anesthesia (if necessary) and uses real time image guidance and sterile technique to inject the PRP.

When using PRP, the physician can have a centrifuge in the operating room that utilizes different levels of automation and platelet concentration techniques. Once the blood is in the centrifuge, processing usually takes between 15 and 20 minutes and a sterile barrier may be necessary, depending on automation and centrifuge processing protocols. The current recommendations state that the platelet concentration should be raised between four and six times above the baseline concentration.

The major components of PRP include transforming growth factor-beta, platelet-derived growth factors, insulin-like growth factor, vascular endothelial growth factors and fibroblast growth factor-2, which stimulate the proliferation of mesenchymal cells. These factors stabilize tissue during initial stages of tissue repair, though they can lead to fibrous connective tissue and scar formation.

Physicians thinking about using PRP in their practices should consider the time commitment it takes to learn and employ the technique, insurance coverage and informed consent, according to a report. The American Medical Association recently introduced a new category III CPT code for performing PRP injection procedures which includes harvesting the blood, spinning the blood and injecting the plasma. It can only be used when PRP is performed separately from the patient procedure.

More recent studies suggest that PRP could significantly improve tendon repair. Currently available data suggests that PRP could enhance soft tissue repair, particularly for tendons and wound healing.

Read "Practical guidelines for using PRP in the orthopaedic office."

Read "Update: PRP in Orthopaedics."

Read other coverage on the AAOS:

- AAOS: Vertebroplasty Ineffective in Treating Spinal Fractures

- AAOS Approves New Clinical Guidelines on Diagnosing Periprosthetic Infections

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