Regenerative Medicine Procedures, Platelet-Rich Plasma (PRP) Therapy
Regenerative Medicine and Stem Cells 101
This article continues to answer questions related to Regenerative Medicine and Stem Cell 101. In this section, you can learn who performs stem cell treatment, the procedures involved, platelet-rich plasma, the role of the FDA, insurance coverage and sample cost information.
What types of specialists perform stem cell treatment or therapy?
LMK: Outside of bone marrow transplantation in the treatment of certain types of blood cancer (eg, oncologist directed), autologous (the patient’s) adult mesenchymal stem cell transplantation (or infusion) has been used by both orthopaedic medicine and interventional pain specialists to help repair muscle/tendon injuries and replenish cartilage (eg, osteoarthritis).
What does stem cell treatment—the procedure(s) involve?
LMK: The procedures associated with stem cell treatment involve strict sterile techniques. This means the physician, and his team takes every precaution to keep the patient and the entire process free from infectious elements. Patients are sedated as needed for comfort.
Stem cell treatment or therapy consists of three steps:
- Harvesting/retrieving stem cells from bone marrow using a special instrument called a trochar (or trocar). The physician uses real-time x-ray (eg, fluoroscopy) to guide the trochar into the proper position and then aspirates (collects) the stem cells from the bone marrow.
Fat cells are collected using liposuction.
- The stem cells are concentrated and mixed with autologous (the patient’s) growth factors that are obtained from the patient’s own blood plasma. This is performed in an on-site laboratory.
- Using ultrasound or fluoroscopic guidance, the stem cell-growth factor mix is injected into the precise anatomical site.
Each step takes about an hour, meaning the entire procedure usually takes three hours.
What is platelet-rich plasma (PRP)? How is it used?
LMK: Platelet-rich plasma is obtained from the patient’s own blood. In the laboratory, a centrifuge is used to separate the proteins from the cellular elements in the blood.
Some physicians retrieve the PRP alone from the patient, and after processing it, inject the platelet-rich plasma without stem cells, assuming the patient’s own stem cells will respond and bring about accelerated healing. Other physicians prefer to retrieve both PRP/growth factors and autologous stem cells at the same time and inject the mixture.
Are there specific areas of the body that can be treated?
LMK: Commonly treated areas include the shoulder joint (eg, rotator cuff/tendon tear), torn ligament within the knee, elbow, ankle or hip joint. More recently, attention has been given to repair of degenerated or injured intervertebral discs with the spine.
A double blind, randomized study showed that injection of platelet rich plasma (PRP) when compared with a control injection in single and multiple degenerated spinal discs, proven by discography, PRP was superior in providing the patient pain relief and increased function.1 The procedure involves the injection of platelet-rich plasma (PRP). PRP may include autologous (the patient’s) adult stem cells.
Are there risks related to adult stem cell/PRP treatments?
LMK: As with any medical procedure, there is a potential risk for complication or unsatisfactory outcome. Practically speaking, risks in any invasive procedure include infection and/or inadvertent injury.
Several factors can improve overall success of stem cell treatment.
- Physician’s experience and skill
- Patient selection; the patient’s overall health, confirmed diagnosis, appropriateness of the procedure(s)
- Abiding by strict sterile techniques throughout the entire procedure(s)
The physician discusses the potential risks and complications with the patient in advance of the procedure. An informed consent document contains this information, which is accepted by the patient by their signature. This is routine in regenerative medicine.
It is reasonable that the patient understands there may be appropriate alternative treatment(s) as well. Patients are given ample opportunity to research their diagnosis and the recommended treatment (eg, procedure, technique).
Are stem cell and platelet-rich plasma (PRP) injections typically covered by Medicare and other health insurance plans?
LMK: Unfortunately, stem cell and/or PRP procedures are not currently covered under Medicare or most commercial health plans at the time of this writing. It is hoped that as research advances, results improve, techniques become more widely known, and patient demand for coverage grows, the US government will compel insurance plans to make coverage for regenerative medical procedures available.
What do stem cell and PRP procedures typically cost?
LMK: Costs are determined by the treating physician and the patient, and vary by treatment center or facility. Recently, an impartial volunteer queried two centers; one in Arizona and another in New Jersey: procedural costs ranged from $4,900 to $7,000. Regenerative medicine procedures are physician/clinician-intensive and equipment-intensive—costs of the clinic or treatment facility.
- Many clinics provide extended payment plans and/or related financing to patients who request the courtesy.
- Patients may seek advice from their tax specialist and/or financial planner about medical expenses not reimbursed by their health insurance plan. Possibly, the medical expenses can be deducted from their federal tax filing.
Off-label Statement: The US Food and Drug Administration (FDA) has not approved stem cell-based products, except for blood forming stem cells used to treat certain types of cancers.2 When certain products (eg, platelet rich plasma) are used by a medical professional, it’s use is termed “off-label”.3
To learn about Dr. Kamhi’s practice, click here.