A regenerative approach to orthopedic problems.

Although PRP can help many orthopedic issues, having an accurate diagnosis from a health care provider is important. As part of our standard PRP service, Dr. Neu will do a history and exam to ensure the correct diagnosis—and that PRP will be helpful for that condition. Ultimately, the success of PRP treatment relies on many factors.

PRP solution is derived from the patient’s own blood & mixed with a small amount of heparin (blood thinner). So, the solution itself, excluding a rare allergic reaction, is very low risk. As with any injection, there is some pain during and after the procedure. The risks of damage or infection to the injected area is very low given small needle size.

With our PRP kit, we need to draw approximately 50 mL of whole blood drawn from the patient’s arm vein. This is larger than a typically lab test amount, but much less than when “donating” blood.

The level of pain from the injection largely depends on the area and individual. We take several steps to minimize discomfort, but, some level of pain is expected during the injection. Some people will feel more pain in the region for a few days afterwards.

In total, including consultation, we expect a PRP injection will take approximately 60-90 minutes. The process of drawing blood and processing can take 30-45 minutes. Once solution is collected the injection procedure itself is quite quick.

PRP is not a treatment for immediate relief. It will take at least a few weeks before any type of “healing” can occur. Some improvement in pain may be expected within 3-4 weeks, but it can take 6-12 weeks with more chronic issues.

This will vary upon each condition and individual. In some cases, like an injury, one PRP injection can help heal the tissue enough to have years of relief. With other conditions, like osteoarthritis, getting PRP a couple times per year may be needed for ongoing healing and relief. We do not recommend getting PRP injections in a single area more often than every 4 months.

We do not contract with any insurance plans or third-party payers. Patients will be responsible for paying 100% of the cost of the procedure upfront. We can provide a receipt but do not help with any type of claim related to insurance.

Yes, as a medical service in a doctor’s clinic, your FSA/HSA account should consider this procedure as an eligible expense.

Several categories of medications can interfere with PRP therapy. We recommend discussing any medication(s) you take with the prescribing health care provider(s). Sometimes, these medications can be safely stopped or held, but every situation is unique. Specifically, these categories of medications cannot be taken before the PRP procedure:

- NSAIDS: All NSAID medications (ibuprofen, naproxen, meloxicam, celecoxib/Celebrex, diclofenac, indomethacin) We recommend not taking these medications for AT LEAST 7 DAYS PRIOR to the procedure. We recommend avoiding NSAIDS after the procedure for at least 1-2 weeks; although longer may be helpful.

- ASPIRIN OR OTHER ANTI-PLATELET MEDICATIONS: Aspirin, clopidogrel/Plavix, and other anti-platelet medications. If taking any of these medications, stopping them should be discussed with your prescribing provider(s). If deemed reasonably safe, this medication should be held for at least 7 days prior to the procedure. We recommend avoiding NSAIDS after the procedure for at least 1-2 weeks; although longer may be helpful.

"Steroid" (corticosteroid) medications can treat a variety of inflammatory and orthopedic conditions. If taking any steroids routinely, we recommend discussing discontinuation with the prescribing provider. When reasonable and safe, we recommend not taking any oral steroids (Prednisone, etc.) for at least 2-3 weeks prior a PRP procedure. Injectable steroids (triamcinolone, methylprednisolone, bethamethasone, etc.) can last for 5-30 days in the body so need to be avoiding for 1-3 months prior to the procedure.

Most patients are able to return to usual activities (walking, housework, light work, etc.) the day following the procedure. We recommend keeping activity light—no exercise, including running, jumping, etc.—for at least 72 hours. Returning to more athletic activity depends on the type and site of problem and injection. With chronic tendon injuries, we recommend a exercise rehab program with slow return to activities over 1-3 months.

PRP PROCEDURE INSTRUCTIONS

Before the procedure:

MEDICATIONS: Several categories of medications can interfere with PRP therapy. We recommend discussing any medication(s) you take with the prescribing health care provider(s). Sometimes, these medications can be safely stopped or held, but every situation is unique. Specifically, these categories of medications cannot be taken before the PRP procedure:

- NSAIDS: All NSAID medications (ibuprofen, naproxen, meloxicam, celecoxib/Celebrex, diclofenac, indomethacin) We recommend not taking these medications for AT LEAST 7 DAYS PRIOR to the procedure.

- ASPIRIN OR OTHER ANTI-PLATELET MEDICATIONS: Aspirin, clopidogrel/Plavix, and other anti-platelet medications. If taking any of these medications, stopping them should be discussed with your prescribing provider(s). If deemed reasonably safe, this medication should be held for at least 7 days prior to the procedure.

- ANTI-COAGULANTS/BLOOD THINNERS: Any "blood thinner" medication (Coumadin, Eliquis, Xarelto, Plavix, Pradaxa, others). The conditions for which these medications are used vary. So, we recommend discussing the stopping of these medications with the prescribing provider. In many case, the risk of stopping the medication will not be worth the risk.

- CORTICOSTEROIDS: "Steroid" medications can treat a variety of inflammatory conditions. If taking any steroids routinely, we recommend discussing discontinuation with the prescribing provider. When reasonable and safe, we recommend not taking any oral steroids (Prednisone, etc.) for at least 2-3 weeks prior a PRP procedure. Injectable steroids (triamcinolone, methylprednisolone, bethamethasone, etc.) can last for 5-30 days in the body so need to be avoiding for 1-3 months prior to the procedure.

HYDRATION & FOOD: We recommend staying well hydrated always, but especially in the days prior to procedure. Eating normal, healthy meals the day of the procedure is fine--no fasting is required.

ALCOHOL: We recommend no consumption of alcohol for at least 2-3 days prior to the procedure.

ACTIVITY: Normal levels of activity and light exercise are fine in the weeks or days prior to the procedure. However, we would recommend against more intense or painful activities for at least 3 days prior to the procedure.

After the procedure:

NORMAL PAIN & SWELLING: After your treatment, there is a chance you’ll experience some mild to moderate pain or discomfort at the injection site. This is normal for up to 2-3 days. If needed, you can manage pain with cool packs and acetaminophen (Tylenol).

CLEANING & BATHING: We recommend cleaning the injection site with soap and water while showering once per day. A small bandage with ointment should be kept for 2-3 days. We advise no soaking (bathing, hot tubs, swimming) for 2-3 days after the procedure.

ACTIVITY & EXERCISE: On day 0-3, we recommend keeping physical activities and exercise light. However, gentle full range of motion of the treated area is encouraged and helpful. After 3 days, you can slowly increasing back to normal levels of activity and exercise week to week.

MEDICATIONS:

The same medications that cannot be taken prior to the procedure, should be held for some period of time after the procedure. This gives the best chance for the PRP therapy to work. If being prescribed these meds, please discuss timing of restarting them with your provider. For best results, we recommend holding these medications post-procedure:

- NSAIDs, aspirin, and other anti-inflammatory medications/supplements for at least 2-4 weeks post-procedure. Limiting or avoiding these for even longer (several months) may be helpful in the healing process.

- Systematic steroids for 6-8 weeks post-procedure

- Anti-coagulants/blood thinners: Discuss length with the prescribing provider.

ALCOHOL: We recommend no consumption of alcohol for at least 2-3 days after the procedure.

We book appointments at least 21 days out to ensure all pre-procedure instructions are followed closely.

Yes. We can generally get 10 mL of PRP solution from a single blood draw & kit. Larger joints or soft tissue areas will require 4-5 mL of solution, but smaller ones can be 1-2 mL. We can use the entire PRP solution in one session.