DEAR DR. ROACH: I’m planning on getting platelet-rich plasma (PRP) for my knee (due to arthritis and years of previous steroid/gel injections) as well as my large toe joint (due to a bone spur removal three years ago).
The most recent bone spur removal left very rough bone, causing periodic pain plus hyperesthesia in my toe. I am a 76-year-old male who is still active and not taking any regular medications. I do take ibuprofen prior to working out (pickleball, gym, biking and swimming).
What are your thoughts on this injection regimen, and why hasn’t the Food and Drug Administration approved it? Medicare won’t cover it. — C.H. ANSWER: A 2023 review of 40 published trials found PRP injections for knee arthritis to be no more helpful than other injections, including steroids, hyaluronic acid or saline (depending on the study). The FDA didn’t approve it because of a lack of convincing evidence that it is more effective than other treatments, and Medicare won’t pay for it because the FDA didn’t approve it.
I certainly have had some patients note a dramatic improvement after PRP injections, but I have had other patients have a dramatic improvement with steroid injections. An expectation that you are going to get better and, honestly, the high out-of-pocket cost tend to make people feel like this is a very useful procedure.
While this might be proven ultimately, the evidence right now does not support the treatment, specifically for knee arthritis. I have some colleagues who believe that PRP is helpful with some kinds of acute trauma (such as tendon damage), but the evidence isn’t strong enough yet for me to have an opinion.
I don’t have the expertise to recommend a cheilectomy (the removal of a bone spur from a joint), but my most trusted consultants don’t recommend this treatment lightly.
