PRP & Biologic Injections

Dr. Leo Zalikha offers PRP and select biologic injection options for appropriate patients. He is transparent about what the current evidence supports, what remains uncertain, and what patients can realistically expect.

PRP stands for platelet-rich plasma. Platelets are blood cells that contain growth factors involved in tissue healing and repair. PRP is created by drawing a small amount of your blood, processing it in a centrifuge to concentrate the platelets, and injecting that concentrated solution into the affected joint.

The theory is that delivering a high concentration of growth factors directly to the arthritic joint promotes anti-inflammatory effects and may slow or modify the disease process. PRP has been studied for knee osteoarthritis more than any other joint application.

• Blood draw: A small volume of blood (typically 15 to 60 mL) is drawn from your arm, similar to a routine blood test
• Centrifugation: The blood is placed in a centrifuge, which separates it into layers. The platelet-rich layer is isolated
• Injection: The concentrated PRP is injected into the joint using the same technique as a standard knee injection
• Post-injection: You may experience mild soreness for one to three days. Ice and rest are recommended. Anti-inflammatory medications are typically avoided for a short period after PRP to allow the intended biological response to occur

The entire process takes about 30 to 45 minutes in the office.

PRP for knee osteoarthritis has been studied in multiple randomized controlled trials and meta-analyses. The findings are generally encouraging but not uniformly conclusive:

• What the data supports:
  • PRP appears to provide pain relief and functional improvement in patients with mild to moderate knee arthritis
  • Several studies show PRP performing at least as well as hyaluronic acid, and some suggest it may provide longer-lasting relief
  • The anti-inflammatory and biologic effects of PRP are supported by laboratory and animal studies
• What remains uncertain:
  • The optimal PRP preparation method (leukocyte-rich vs. leukocyte-poor, number of spins, platelet concentration) is not standardized. Different preparations may produce different results
  • Whether PRP actually modifies disease progression (slows cartilage loss) or simply reduces symptoms is not yet clear
  • Long-term outcomes beyond one to two years are less well-studied
  • PRP appears less effective for severe (bone-on-bone) arthritis

Dr. Zalikha is honest about these nuances. PRP is a reasonable option for some patients, but it is not a miracle treatment, and expectations should be calibrated to the evidence.

Further reading: Does PRP really work for knee pain?

PRP is most appropriate for:

• Patients with mild to moderate knee arthritis who want to explore biologic options
• Patients who have tried cortisone and hyaluronic acid with limited or diminishing results
• Active patients who want to delay surgery and are looking for an alternative approach
• Patients who are engaged in a broader nonsurgical program including physical therapy and weight optimization

PRP is less likely to be effective for:

• Severe, bone-on-bone arthritis
• Patients expecting a permanent cure for their arthritis
• Patients who are not also addressing modifiable factors (weight, strength, activity level)

PRP injections are typically not covered by insurance, including Medicare and most commercial plans. The out-of-pocket cost varies by preparation type and is discussed during your consultation.

Other biologic injections may also be self-pay. Dr. Zalikha’s office provides clear pricing information before treatment so there are no surprises.