Stem Cell Therapy vs PRP Injection – Which is better? Platelet rich plasma injections and stem cell injections are revolutionizing the way we treat orthopedic problems. Both have been shown in clinical trials to provide excellent pain relief and reduction of symptoms related to symptomatic knee osteoarthritis. However, there have been no trials directly comparing adipose derived stem cell injections to PRP. Until now. Which one is better? Stem cells or PRP injections? Let’s find out.
Video Transcript:
Platelet-rich plasma injections and stem cell injections are revolutionizing the way we treat orthopedic problems.
Both have been shown in clinical trials to provide excellent pain relief and reduction of symptoms related to symptomatic knee osteoarthritis.
However, there have been no trials directly comparing adipose derived stem cell injections to platelet-rich plasma, until now.
Which one is better? Stem cells or PRP injections?
Let’s find out.
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Okay, so those who suffer from knee arthritis know that it can be incredibly painful and disabling. Non-operative treatment methods include exercise therapy, oral anti-inflammatory and pain medications, topical medications, and injection therapy.
We’re very quickly moving away from steroid injections because of multiple studies showing that cortisone damages cartilage and accelerates arthritis. And that’s why we’re moving to orthobiologics.
I’ve covered PRP injections extensively for the treatment of symptomatic knee arthritis. There are multiple randomized control trials comparing PRP to placebo, PRP to steroids, PRP to hyaluronic acid, and PRP wins consistently.
We know it works and people see amazing symptomatic relief, but what about stem cells? In theory, stem cells should provide even more symptom relief. At least that’s how it’s advertised by many healthcare providers and is also why it costs so much more than PRP injections.
Specifically adipose derived stem cells are becoming a promising alternative because the harvesting process obtains an extremely high number of cells called pericytes. Especially when compared to other sources such as bone marrow.
I’ve discussed other clinical trials showing that adipose-derived mesenchymal stem cells provide symptom relief to those suffering from knee arthritis, but there are no randomized control trials comparing adipose stem cells to PRP. And that’s what this study tried to do.
This is a randomized controlled trial comparing adipose derived stem cells to PRP for the treatment of symptomatic knee osteoarthritis. Patients were randomized to either get a single injection of adipose MSCs or a single injection of PRP.
They were evaluated by clinicians blinded to the treatment allocation at one month, 3 months, 6 months, 12 months, and 24 months. They were evaluated using pain and functional scores for knee arthritis.
The study participants also had MRI imaging to evaluate for arthritis progression at 6 months, 12 months, and 24 months. The researchers found that the adipose derived stem cell group had statistically significant improvements in all clinical scores except one.
Interestingly they found that there were no differences between arthritis severity and clinical outcomes. Meaning people with mild arthritis and people with severe arthritis both had similar improvements. However, they did find that younger patients had much greater improvements in their scores when compared to older patients.
Similarly the researchers found that the PRP group also had statistically significant improvements in all clinical scores except one. They found that patients with mild osteoarthritis had much better improvements in scores compared to those with more severe arthritis. This would be consistent with the results from other clinical trials as well as systematic reviews and meta-analyses.
Similar to the adipose stem cell group, younger patients also did much better than older patients. So now comes the interesting part.
We know both groups improved compared to their baseline, but how do they compare to each other? Which one is better?
The researchers reported that comparative analysis of pain and functional scores did not show statistically significant differences between adipose derived stem cell therapy and PRP injections. To reiterate, there were no differences in pain and functional outcomes between PRP and adipose derived stem cell therapy at any time point in the study.
When the researchers did subgroup analyses they found that patients with mild osteoarthritis had better outcomes, but that there were no differences between adipose and PRP.
The only difference they found was for those with moderate and severe arthritis. Those treated with adipose stem cells had better improvements in one of the functional scores at six months compared to PRP, but at 12 months and 24 months these effects were no longer different.
In terms of imaging outcomes; X-ray and MRI studies did not show any deterioration in arthritis severity at 6 months, 12 months, and 24 months of follow-up for both treatment groups. There was no statistically significant differences between the two groups.
The authors conclude that both adipose derived stem cells and PRP provided a significant and similar clinical improvement up to 24 months of follow-up in patients with symptomatic knee osteoarthritis.
So here are my thoughts on this study. We already know PRP is an excellent treatment option for knee arthritis, but many healthcare providers counsel their patients that stem cells are much better and lead to significantly better outcomes.
This study suggests otherwise. In fact, in another video I reviewed another randomized control trial that compared PRP injections to bone marrow stem cell injections. That study also had similar results to this one. PRP produce similar benefits to stem cells.
So not only does PRP produce similar outcomes, it is significantly cheaper and significantly easier to obtain. It’s just a simple blood draw. No fat harvesting, no bone marrow harvesting. Just a routine blood draw.
I will point out that there may be one indication for both bone marrow and adipose stem cells and that’s for people with severe arthritis. We know PRP works really well for those with mild to moderate arthritis, but this study suggests that stem cells may be the better option for those with severe arthritis. However, when compared to PRP the results were only better at the six month mark and no different at 12 months or 24 months.
So what can we take away from all of this? PRP is still my go-to ortho biologic treatment of choice for symptomatic knee arthritis. Young or old, mild or severe arthritis, it will still be my go-to treatment because the data to support its use is by far the most robust and by far the most effective.
To top it all off it is also the most cost effective. For those with more severe arthritis, I would still try PRP first. You may need more frequent booster injections, but chances are you will still get good symptom relief.
If PRP ever starts to become less effective, and you are still wanting to avoid a knee replacement surgery, then it may make sense to consider stem cell therapy at that time.