J Knee Surg 2019; 32(09): 879-885
DOI: 10.1055/s-0038-1669953
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

What Is the Price and Claimed Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis in the United States?

Nicolas S. Piuzzi
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
2   Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Mitchell Ng
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Ariel Kantor
3   Department of Biomedical Engineering, Duke University Hospital, Durham, North Carolina
Kenneth Ng
4   Downstate Medical Center, College of Medicine, State University of New York, Albany, New York
Stephanie Kha
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Michael A. Mont
5   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
George F. Muschler
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

07 April 2018

27 July 2018

Publication Date:
06 September 2018 (online)


Platelet-rich plasma (PRP) injections are often used for the treatment of knee osteoarthritis (OA), despite clinical value and cost-effectiveness not being definitely established. PRP injections are considered as a potential means of reducing pain and improving function in patients with knee OA, in the hope of delaying or avoiding the need for surgical intervention. Centers that offer PRP injections usually charge patients out of pocket and directly market services. Therefore, the purpose of this study was to quantify the current (1) prices and (2) marketed clinical efficacy of autologous PRP injections for knee OA. A prospective cross-sectional study was performed based on 286 centers identified in the United States offering PRP injections for knee OA. A total of 179 (73.4%) centers were successfully contacted via e-mail or phone, using a simulated 52-year-old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the current marketed prices and clinical efficacy, either reported as “good results” or “symptomatic improvement,” claimed by each treating center. The mean price for a single unilateral knee same-day PRP injection was $714 with a standard deviation of $144 (95% confidence interval [CI]: $691–737, n = 153). The mean claim of clinical efficacy was 76% with a standard deviation of 11% (95% CI: 73.5–78.3%, n = 84). Out of the 84 clinics, 10 claimed “90 to 100% efficacy,” 27 claimed “80 to 90%,” 29 claimed “70 to 80%,” 9 claimed “60 to 70%,” 8 claimed “50 to 60%,” and 1 claimed “40 to 60%.” These findings provide a unique perspective on the PRP market for the treatment of knee OA that is valuable to physicians and health care providers in providing better education to patients on the associated costs and purported clinical benefits of PRP injections.

Supplementary Material

  • References

  • 1 Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26 (03) 355-369
  • 2 Felson DT, Lawrence RC, Dieppe PA. , et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 2000; 133 (08) 635-646
  • 3 Deshpande BR, Katz JN, Solomon DH. , et al. Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken) 2016; 68 (12) 1743-1750
  • 4 Losina E, Paltiel AD, Weinstein AM. , et al. Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty. Arthritis Care Res (Hoboken) 2015; 67 (02) 203-215
  • 5 Leigh JP, Seavey W, Leistikow B. Estimating the costs of job related arthritis. J Rheumatol 2001; 28 (07) 1647-1654
  • 6 Bitton R. The economic burden of osteoarthritis. Am J Manag Care 2009; 15 (8, Suppl): S230-S235
  • 7 Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee osteoarthritis: a primer. Perm J 2017; 21: 16-183
  • 8 Piuzzi NS, Chughtai M, Khlopas A. , et al. Platelet-rich plasma for the treatment of knee osteoarthritis: a review. J Knee Surg 2017; 30 (07) 627-633
  • 9 Campbell KA, Saltzman BM, Mascarenhas R. , et al. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 2015; 31 (11) 2213-2221
  • 10 Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 2016; 32 (03) 495-505
  • 11 Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 2015; 49 (10) 657-672
  • 12 Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med 2016; 44 (03) 792-800
  • 13 Sadabad HN, Behzadifar M, Arasteh F, Behzadifar M, Dehghan HR. Efficacy of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: a systematic review and meta-analysis. Electron Physician 2016; 8 (03) 2115-2122
  • 14 Lai LP, Stitik TP, Foye PM, Georgy JS, Patibanda V, Chen B. Use of platelet-rich plasma in intra-articular knee injections for osteoarthritis: a systematic review. PM R 2015; 7 (06) 637-648
  • 15 Chahla J, Cinque ME, Piuzzi NS. , et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopaedic literature. J Bone Joint Surg Am 2017; 99 (20) 1769-1779
  • 16 Murray IR, Geeslin AG, Goudie EB, Petrigliano FA, LaPrade RF. Minimum information for studies evaluating biologics in orthopaedics (MIBO): platelet-rich plasma and mesenchymal stem cells. J Bone Joint Surg Am 2017; 99 (10) 809-819
  • 17 Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy - future or trend?. Arthritis Res Ther 2012; 14 (04) 219
  • 18 Grand view research. Platelet rich plasma (PRP) market analysis by product (pure, leukocyte-rich, leukocyte-rich fibrin), by application (orthopedics, cosmetic surgery, ophthalmic surgery, neurosurgery), and segment forecasts, 2018–2025
  • 19 Bashir J, Panero AJ, Sherman AL. The emerging use of platelet-rich plasma in musculoskeletal medicine. J Am Osteopath Assoc 2015; 115 (01) 24-31
  • 20 Vavken P, Sadoghi P, Palmer M. , et al. Platelet-rich plasma reduces retear rates after arthroscopic repair of small- and medium-sized rotator cuff tears but is not cost-effective. Am J Sports Med 2015; 43 (12) 3071-3076
  • 21 Hsu WK, Mishra A, Rodeo SR. , et al. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg 2013; 21 (12) 739-748
  • 22 Metcalf KB, Mandelbaum BR, McIlwraith CW. Application of platelet-rich plasma to disorders of the knee joint. Cartilage 2013; 4 (04) 295-312
  • 23 Zhang JY, Fabricant PD, Ishmael CR, Wang JC, Petrigliano FA, Jones KJ. Utilization of platelet-rich plasma for musculoskeletal injuries: an analysis of current treatment trends in the United States. Orthop J Sports Med 2016; 4 (12) 2325967116676241
  • 24 Samuelson EM, Odum SM, Fleischli JE. The cost-effectiveness of using platelet-rich plasma during rotator cuff repair: a Markov model analysis. Arthroscopy 2016; 32 (07) 1237-1244
  • 25 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22 (04) 233-236
  • 26 Vallier HA, Patterson BM, Meehan CJ, Lombardo T. Orthopaedic traumatology: the hospital side of the ledger, defining the financial relationship between physicians and hospitals. J Orthop Trauma 2008; 22 (04) 221-226
  • 27 Dhillon MS, Patel S, John R. PRP in OA knee - update, current confusions and future options. SICOT J 2017; 3: 27
  • 28 Gobbi A, Lad D, Karnatzikos G. The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (08) 2170-2177
  • 29 Hart R, Safi A, Komzák M, Jajtner P, Puskeiler M, Hartová P. Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg 2013; 133 (09) 1295-1301
  • 30 US Census Bureau. Income, Poverty and Health Insurance Coverage in the U.S.: 2016. US Census Bureau; 2017. . Available at: https://www.census.gov/newsroom/press-releases/2017/income-povery.html . Accessed August 29, 2018
  • 31 Medicare Program - General Information. Available at: https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html . Accessed August 29, 2018
  • 32 Medicare Coverage Document (MCD) for Guidance for the Public, Industry, and CMS Staff: Coverage with Evidence Development
  • 33 Autologous Platelet-rich Plasma. 2015
  • 34 Decision Memo for Autologous Blood-Derived Products for Chronic Non-Healing Wounds (CAG-00190R3)
  • 35 Fiorentino S, Roffi A, Filardo G, Marcacci M, Kon E. European definitions, current use, and EMA stance of platelet-rich plasma in sports medicine. J Knee Surg 2015; 28 (01) 51-54
  • 36 Guidance Documents FDA. “Off-Label” and Investigational Use Of Marketed Drugs, Biologics, and Medical Devices - Information Sheet Search for FDA Guidance Documents. Available at: https://www.fda.gov/RegulatoryInformation/Guidances/ucm126486.htm . Accessed June 5, 2018
  • 37 Milants C, Bruyère O, Kaux J-F. Responders to platelet-rich plasma in osteoarthritis: a technical analysis. BioMed Res Int 2017; 2017: 7538604
  • 38 Scanzello CR, Loeser RF. Editorial: inflammatory activity in symptomatic knee osteoarthritis: not all inflammation is local. Arthritis Rheumatol 2015; 67 (11) 2797-2800
  • 39 Lee CA. Editorial commentary: PRP: platelet-rich plasma or promising but rarely proven?. Arthroscopy 2016; 32 (07) 1245-1246
  • 40 Piuzzi N, Ng M, Chughtai M. , et al. The stem-cell market for the treatment of knee osteoarthritis: a patient perspective. J Knee Surg 2018; 31 (06) 551-556