Caring Medical - Where the world comes for ProlotherapyPlatelet Rich Plasma Prolotherapy | Stimulating bone repair

Dr. David Woznica ProlotherapistDavid N. Woznica, MD

In this article we will examine the medical research concerning the effectiveness of platelet rich plasma therapy on stimulating bone growth and repair.

If you have questions about PRP and bone regeneration, you can get help and information from our Caring Medical staff.

In a study we often cite on this website Professor Tuhina Neog of Boston University School of Medicine, writing in the journal Therapeutic advances in musculoskeletal disease describes the “Clinical significance of bone changes in osteoarthritis.” Here are some of the points she made:

  • Bone changes associated with osteoarthritis is common, so it is not all about cartilage. The bone changes include subchondral bone attrition (wasting away).
    • Subchondral bone changes on MRIs show bone marrow lesions (swelling and deterioration of the bone marrow), are common.

Further in its desire to quickly repair and remodel itself to meet the challenges of degenerative joint disease, the bone increases its turnover rate and produces a far inferior bone with less mineralized than normal bone.(1)

So we have a changing joint environment where bone is degenerating and hurriedly being replaced by inferior bone. The whole joint degeneration process is in full process.

This is where researchers are now suggesting platelet rich plasma therapy as  means to not only repair bone degeneration, but also to help reverse the toxic healing environment.

Researchers publishing in the journal Expert opinion on biological therapy write:

  • Successful healing of large bone defects is a complicated phenomenon because the body’s natural ability often fails to effectively repair the large bone defects. (The body cannot generate enough inflammation to repair the bone.)

The researchers here are calling for new treatments  to increase the quality and accelerate bone healing. They conclude that: Platelet concentrates (PRP) in different forms can be considered an attractive option for such purpose because Platelets are a natural source of growth factors, and cytokines (the cells that comprise the healing signalling communication system), and other healing factors.(2)

Doctors in China have recognized this. Here is their research published in the Chinese journal of burns on how PRP can change a diseased healing environment into a regenerative healing environment.

  • Normal wound healing is a well-orchestrated process of inflammatory response, cell proliferation, and tissue remodeling.
  • However, this orderly and precise process is impaired in chronic wounds. A series of complicated pathogenic factors, including enhanced inflammatory response (too much uncontrolled inflammation), poor cell proliferation (the opposite of the healing inflammatory process of Prolotherapy), restrained angiogenesis (too many new blood vessels rushing inflammation into the area), restricted collagen deposition (no cartilage building or repair), and infection, contribute to the failure of healing of chronic wound.
  • The application of platelet-rich plasma (PRP) has been explored as a treatment for chronic wounds as it can balance wound microenvironment for promoting wound healing.
  • PRP can modulate the inflammatory mediators, growth factors, and cytokines, etc. to correct abnormal biological events and disorderly molecular environment of cell migration and proliferation, and thus promote wound healing appropriately.(3)

Bone regeneration studies

University researchers in Mexico have published new findings in PRP’s ability to regenerate bone. Writing in Gaceta médica de México the Medical Gazette of Mexico, researchers assess bone regeneration in mandibular (jaw) fractures, that were treated with PRP. The platelet-rich plasma treatments increased the bone intensity and density in the fracture trace allowing bone regeneration and recovery in shorter time than another group of patients in which it was not used. The study showed bone growth at between 3 and 5 weeks.(4)

Better than a nail

Doctors at leading Turkish research hospitals writing in the European journal of orthopaedic surgery & traumatology evaluated the effects of platelet-rich plasma on healing rates and healing time in the treatment of long bone nonunions treated by an intramedullary nail previously.

Long bone nonunions are broken bones that failed to heal properly. Surgical intervention including the use of nails to reset the bone during surgery is a standard treatment. Sometimes this fails and turns into the problem of a non-union of a broken bone. The next step usually is “Exchange nailing” for the failed bone healing. Old nail out, bigger new nail in.

The Turkish team then took 14 patients scheduled for the nail exchange and gave them PRP injections instead. They also exchanged the nail in 15 other patients as control.

The PRP patients recovered faster and achieved greater bone union  92.8% of the cases in PRP group to 80% of the nail exchange group.(5)

If you have questions about PRP and bone regeneration, you can get help and information from our Caring Medical staff.

1 Neogi T. Clinical significance of bone changes in osteoarthritis. Arthritis research & therapy. 2012 Mar 8;14(2):A3. [Google Scholar]

2. Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther. 2015 Nov 11.[Google Scholar]

3  Liu C, Zhang H. Advances in the research of promoting healing of chronic wound with platelet-rich plasma 2014 Oct;30(5):433-6.[Google Scholar]

4 Castillo-Cardiel G, Medina-Quintana VM, Lomelí-Enríquez M, Medrano-Muñoz F, Guerrero-Velázquez C, Contreras-López CK, Fuentes-Orozco C, Irusteta-Jiménez L, Michel-Espinoza LR, González-Ojeda A. Plasma rico en plaquetas y su efecto en la regeneración ósea en fracturas mandibulares. Ensayo clínico controlado. Gac Med Mex. 2017 Oct 20;153:461-7. [Google Scholar]

5 Duramaz A, Ursavaş HT, Bilgili MG, Bayrak A, Bayram B, Avkan MC. Platelet-rich plasma versus exchange intramedullary nailing in treatment of long bone oligotrophic nonunions. European Journal of Orthopaedic Surgery & Traumatology. 2017 Aug 1:1-7. [Google Scholar]

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