Chiropractor Chandler AZ

PLATELET-RICH PLASMA PROLOTHERAPY FOR HIP ARTHRITIS

Arthritis is the most common condition that people develop in their middle age. In the United States, 28 million people were estimated to have arthritis in 2011. Arthritis can develop in any joint of the body, but its main victims are weight bearing joints such as the hip joint.

After the knee joint, the hip joint is the largest weight-bearing joint in the body. It is a very strong joint because of its structure and the strong muscles and ligaments attached to it. During walking, the stress on the hip is 5 times a person's body weight. Various parts of the joint help in mobility and the weight bearing ability of the hip joint. Any damage to even one component can lead to discomfort and partial or complete lack of mobility.

Hip arthritis causes pain and stiffness in the hip joint. Pain caused by hip arthritis can make it difficult for the patient to perform daily activities such as bending over to tie a shoe or standing from a chair.

ANATOMY OF THE HIP

The structure of hip is made of the thigh bone (Femur), and three bones of the pelvis (Ilium, pubis, and ischium). Two iliac bones are attached to the most posterior bone of the lower back (sacrum) with ligaments and muscles. The hip joint is a ball and socket joint which is much more stable than the shoulder joint due to its unique structure.

The muscle groups that are found in the hip are:

• Gluteals: Three gluteal muscles are the muscles in the buttocks.
• Quadriceps: The four heads of the quadriceps muscles are located at the front of the femur.
• Iliopsoas: This is the primary hip flexor muscle.
• Hamstrings: These are three muscles at the back of the thigh.

Adductor group of muscles: These muscles are attached to the pubis and run down on the medial side of the thigh.

The ligaments provide stability to the structure of hip. Three main ligaments of the hip joint are:

• Iliofemoral ligament
• Pubofemoral ligament
• Ischiofemoral ligament

The nerves that supply different muscles in the hip include:

• Femoral nerve
• Lateral femoral cutaneous nerve
• Obturator nerve
• Sciatic nerve.

The blood vessels that supply blood to the hip include:

• Internal and external iliac
• Femoral
• Obturator
• Superior and inferior gluteal arteries

CAUSES OF HIP ARTHRITIS

There is no single cause of hip arthritis, but certain factors are responsible for the development of arthritis. These factors include:

• Age above 50
• Family history of arthritis
• Previous injury to hip joint
• Obesity
• Developmental dysplasia of the hip

TYPES OF HIP ARTHRITIS

The following are types of arthritis that affect the hip joint:

Osteoarthritis: Most common type of arthritis, it is caused by wear and tear of the hip joint. That is why it is more common in people with old age. The hip joint is a ball and socket joint. The inside of this joint is lined with smooth cartilage which helps the joint to move smoothly. If this cartilage is damaged, the friction between the rough surface of the ball and socket will increase which will cause pain. Over time, the hip joint can be permanently damaged by osteoarthritis.

Rheumatoid arthritis: It is an autoimmune disease that affects all joints of the body including the hip joint. Rheumatoid arthritis causes inflammation of synovial lining which causes pain. With time, it can cause the bone and cartilage of the hip joint to deteriorate.

Ankylosing spondylitis: It is a chronic inflammation of the spine and sacroiliac joint that affects the hip joint. It affects people of all ages, including children, and affects men more than women.

Systemic Lupus Erythematosus: It is a systemic autoimmune disease that can affect any part of the body including the hip joint. It causes damage and inflammation in the hip joint. It affects women between the ages of 15-35 more than men.

Psoriatic Arthritis: It is related to a skin condition called Psoriasis. This condition develops first and then can lead to arthritis in any part of the body including the hip joint. It causes pain, swelling, and stiffness.

SYMPTOMS OF HIP ARTHRITIS

The symptoms of hip arthritis, regardless of their type, can include:

• Pain in the hip joint
• Pain worse in the morning
• Difficulty in walking and climbing
• Pain worse after rigorous exercise
• Limited range of motion of hip joint
• Fatigue
• Weakness

DIAGNOSIS OF HIP ARTHRITIS

A diagnostic evaluation of hip arthritis includes the following:

• Medical history
• Physical examination to evaluate the range of motion
• Radiograph or X-ray to see if there is any abnormality in the hip joint
• Blood test to diagnose autoimmune arthritis

TREATMENT OF HIP ARTHRITIS

NONSURGICAL TREATMENT

• Lifestyle changes such as minimizing the activity that aggravates the hip to reduce pressure on the hip joint.
• Physical therapy: Certain exercises are helpful in increasing the flexibility and range of motion in a hip joint that helps to relieve pain and stiffness caused by hip arthritis.
• Assistive devices: using a cane or walker can improve mobility and independence of arthritis patients.
• Medication: If other nonsurgical treatments fail to work, then medication is prescribed to relieve the pain and improve the situation. Acetaminophen is helpful in improving mild arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are also used to relieve pain.
• Corticosteroids are strong anti-inflammatory agents that are used to treat arthritis.

SURGICAL TREATMENT

If the pain is not relieved by nonsurgical options and is hindering movement, then surgery is recommended by doctors.

ALTERNATIVE TREATMENT

Hip arthritis is a degenerative disease. The current treatment options available only work on relieving pain, decreasing inflammation, or increasing the range of motion. None of the conventional treatments actually work on the regeneration of cartilage and other damaged parts to restore the normal structure of the hip joint. Platelet-Rich Plasma Prolotherapy (PRP) is an alternative treatment option that regenerates the damaged structure in the hip joint, restores the normal hip joint structure, and prevents hip arthritis from getting worse.

Platelet-rich plasma therapy is an alternative treatment method in which the patient's own blood is used to repair the injury by activating the body's own healing mechanism. In this method, blood composition is reversed and the healing property of platelets is manipulated. It is used to heal ligaments, tendons, muscle and bone injuries. To prepare PRP injection, the patient's own blood is drawn and centrifuged to separate the different blood components. The layer containing platelet-rich plasma is separated and the rest of the material is discarded. When this PRP is injected at the site of injury, these platelets get activated and release alpha granules that activate the patient's own growth factors which then trigger epithelial growth factors (EGF). EGF induces the cell migration and replication at the site of damage, stimulating damaged tissue to heal through the following stages:

• INFLAMMATION PHASE that lasts for 2-3 days. In this phase, growth factors are released.
• PROLIFERATION PHASE that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
• REMODELLING which lasts over a year. In this phase, collagen is matured and strengthened.

Side effects associated with this method are minimal. There is no risk of blood-borne disease transfer and allergic reaction. The only risks involved are an infection, no relief of pain, neurovascular injury, and scar tissue formation. The loss of a limb or death is rare, but possible.

Several in vitro and animal studies have proven the role of PRP Prolotherapy in promoting the growth of new bone. A research conducted on 40 patients with monolateral severe hip osteoarthritis showed a decrease in the pain score after 7 weeks and 3 PRP injections while the side effects were negligible and were limited to the sensation of heaviness at the injection site.

PRP Prolotherapy has seen to be effective in treating arthritis in other parts of the body such as the knees. A study performed in 2013 showed that PRP injections might slow the progression or worsening of osteoarthritis. The average arthritic knee can lose up to 5% of cartilage per year. The same study showed that there was no further cartilage damage in knee arthritis in more than 70% of the patients after one year of PRP injections. This shows that PRP prolotherapy can be an effective treatment for hip arthritis as well.

According to a research published in May 2015, doctors articulated concerns over the lack of standardization of PRP Prolotherapy. The research done in the past 10 years acknowledged that the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration is very promising, but some controversial results have also arisen.

One session of PRP prolotherapy for hip joint does not take longer than 2 hours which also includes recovery time. PRP prolotherapy is still under research and the FDA has categorized it as an experimental method, but it is hoped that its effectiveness will be fully established soon and it will be widely available for people suffering from hip arthritis.

CONSERVATIVE TREATMENTS TO COMBINE WITH PRP

While PRP and stem cell treatments are enhancing the tissue repair and regeneration, conservative treatments can enhance healing, strengthen the muscles, and stabilize joint movements to maximize your recovery.

COLD LASER THERAPY TREATMENTS

1. Accelerated tissue repair and cell growth

Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.

2. Faster wound healing

Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.

3. Reduced fibrous tissue formation

Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.

4. Anti-inflammation

Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.

5. Pain relief

Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.

Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reduces your perceived pain.

6. Increased blood flow

Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.

7. Increased repair and regeneration

Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.

8. Nerve function and repair

Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.

9. Increased energy production- ATP

ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have the ability to heal and repair.

SOFT TISSUE TREATMENTS

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercises and flexibility programs.

Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries are common because of weakness and poor stabilization of the leg and hip muscles. The combination of muscle weakness, poor coordination, and altered gait mechanics produce excessive strain on the soft tissues.

The lower extremities work as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments foot pain and exercises.

BIBLIOGRAPHY

Hameed, F., & Ihm, J. (2012). Injectable Medications for Osteoarthritis. PM&R, S75 - S81.

Vora, A., Borg-Stein, J., & Nguyen, R. T. (2012). Regenerative Injection Therapy for Osteoarthritis: Fundamental Concepts and Evidence-Based Review. PM&R, S104 - S109.

Jang, S. J., Kim, J. D., & Cha, S. S. (2013). Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. European Journal of Orthopaedic Surgery & Traumatology, 573–580.