Increasing numbers of people aim to stay as active as possible in senior years; however, ageing inevitably involves osteoarthritis slowly developing in the joints, typically beginning with occasional pulling pain. Morning stiffness and starting pain become more intense, affecting everyday quality of life and normal activities. These symptoms of wear are the actual domain for platelet-rich plasma injections.
We still haven’t found out what exactly triggers osteoarthritis, but it does seem certain that not only worn out cartilage, but all the tissues in the joint play a role, with changes in cartilage structure and biological changes in the mucous membranes and the hyaluronic acid they produce. The joint capsule and attached ligaments stiffen. Changes in the underlying bone may be a primary causal factor.
The purely mechanical approach to osteoarthritis is outdated. Osteoarthritis is more than just the loss of articular cartilage with friction in the joint, and radiographic findings are not proven to be a reliable source of detailed diagnosis on the nature of the complaint in osteoarthritis patients.
Joint complaints, including their increasing manifestation as osteoarthritis, are due to complex damage to the joint’s homoeostasis and tissue reactions surrounding the capsule, ligaments and tendons, and muscles in the joint as well as the overall constitution of the body under static and dynamic stress loading. Nerve responses, humoral activity (cell-mediated tissue and fluid reactions), and matrix disruption (structural faults in connective tissue) should be taken into consideration in joint complaints and dysfunction.
The rheumatology treatment guidelines (AWMF, 2011) recommend immobilisation of the tissues mostly supported by pain relief and inflammation reduction (NSAIDs and cortisone). DMARDs (disease-modifying antirheumatic drugs) have proven highly important in the primary high-activity, inflammatory underlying disease by inhibiting destructive and excessive tissue reaction, and are effective due to current treatment options using autoantibodies against necrosis factors such as TNFα. However, most degenerative joint diseases do not respond to this type of treatment, which is too expensive and risky.
A new era of treatment has dawned in regenerative medicine. After mechanically supported joint protection with hyaluronic acid delayed the effects of joint degeneration to a limited extent for a long time, PRP application in the joint has been shown to be a highly efficient, minimally invasive method of promoting the body’s own regeneration powers. We currently use leukocyte-free PRP or PRGF products in all forms of osteoarthritis treatments, with highly favourable effects to be expected using conservative treatment in osteoarthritis grades I-III (Kellgren & Lawrence). Higher grades indicate surgery, also using regenerative treatment methods. Experience has shown virtually risk-free, lasting effects compared to the treatment options previously available. Complex adjuvant treatment of all structures around the joint and the coordination of the active joint control (personalised therapy) provide an important basis for lasting favourable outcomes (T2T – treat to target) by improving joint homeostasis, T2T for painless strength in everyday life and in sports.