We frequently get asked about the difference between regenerative cellular therapy and platelet rich plasma (PRP) therapy. The two treatment are often combined, which adds to the confusion. PRP therapy is very fast and straightforward. The patient is in and out of the office in an hour, with little downtime - maybe a little bit of joint stiffness for a day or two.
Regenerative cellular therapy is a longer visit- usually 4-5 hours, although most of that is sitting around waiting for the isolation to be performed in the lab. The patient will have a couple days of downtime due to soreness in the area the fat was harvested.
To do a PRP treatment, the physician takes 4 tubes (about 2 tablespoons) of the patient's blood. The blood is processed in a laboratory on site, and the red and white blood cells are discarded, leaving platelets, growth factors and plasma. As many platelets as possible are concentrated in the desired amount of plasma, creating PRP. The PRP is then injected into the affected joint.
The regenerative cell procedure is a little more involved:
1) Obtain a few tablespoons of fat via a mini-lipo (takes about an hour, done while patient is fully awake and made comfortable with mild oral pain medication and local anesthesia)
2) Draw blood as for PRP treatment above
3) Laboratory isolation of PRP from blood and regenerative cells (SVF or stromal vascular fraction) from the fat (takes about 2 hours, meanwhile patient is reading/watching TV)
4) Inject into the joint the regenerative cells, PRP and, if the patient is not a professional athlete for whom testing may be an issue, human growth hormone (HGH) to accelerate healing. (5 minutes)
There are some variations. At the end of the isolation, we suspend the regenerative cells in 2-10ml of PRP (depending on the joint size) before injecting them. You can also suspend the cells in saline solution, but we think the PRP works better.
The analogy typically bandied about is "The regenerative cells are the grass seed, the PRP is the fertilizer". I haven't seen any good studies that show that this is true, but this protocol seems to work very well and has an established track record of safety. These treatments are cutting edge medicine and we are comfortable with that part, but we like to do it in the manner that has a history of obtaining good results. We like to do two additional PRP booster treatments on our regenerative cellular patients, at one month and two months after the initial stem cell treatment.
The regenerative cells are the most important part of the procedure though - not the PRP.
We think PRP is good for potentially accelerating and improving healing in acute injuries. For instance, I crashed on my mountain bike a month ago and partially dislocated my shoulder- it made that sound like when you pull a drumstick off a chicken. It hurt a great deal and didn't move very well. I have been getting weekly PRP shots into my shoulder capsule and I think they have helped me heal much more quickly, and other physicians have seen the same thing in their patients.
But PRP doesn't seem to help as much for arthritis or degenerative changes; for these conditions most people would recommend regenerative cell therapy. In this case the PRP is merely an adjunct to the main modality of treatment.
(Written by Matthew)