Non-Operative Treatments

Blood from the body is often called ‘plasma’ and is full of many different types of cells, from red cells, white cell, and platelets to name a few. Platelets are full of growth factors that are important in the healing of injuries, so we get a higher concentration of these healing plasma cells from the blood, creating this ‘platelet rich plasma’ or PRP.

The way we obtain the PRP is by taking a blood sample, centrifuging it in a machine, taking away the top layer of PRP, then using that as the injection fluid. The injection can be given in the clinic, and you should do light duties on the day of the injection, with most benefit felt at after 1-2 weeks.

There are 2 main ways the PRP can be delivered. The first is a lower concentration of platelets which should be given 3 times over a few weeks, with the other being a higher concentration of platelets given just once. We would expect pain relief in the majority of patients for 6-9 months.

There are very few complications as it is your own blood being injected. Whilst cortisone can thin the cartilage or cause weakening of tendons, this is not the case with PRP, and in a few studies has been shown to stabilise or even slightly increase the cartilage layer.

Hyaluronic Acid is a natural fluid in joints, and helps lubricate and cushion the joint. When arthritis sets in, the volume or quality of the hyaluronic acid can be affected, so the aim is to supplement this with new hyaluronic acid fluid – a bit like an oil change.

The fluid is made in different ways, and the fluid we use is grown in a laboratory and has a small amount of steroid, so has the lowest chance of getting a localised reaction to the fluid. After the injection you should do light duties that day, and the peak effect is felt 2-3 weeks after the injection

The evidence suggests that hyaluronic acid injections work in most but not all patients, and gives pain relief for around 6 months. There is a small chance of having a local reaction to the injected fluid. We reserve this injection for those in whom it has worked well before, or in those who have early or moderate joint arthritis, and in those who haven’t responded well to PRP injections and don’t want radiofrequency ablation.

Radiofrequency ablation (RFA) is a long established technique where the nerves causing pain are treated in order to stop the pain signals from being transmitted. It has been used in a more innovative way for joint pain in recent years, and can be used to treat hip pain, knee pain and shoulder pain.

The procedure is done in theatre with a general anaesthesia or sedation, and we use Xray in theatre to guide the needle probes into position. The small radiofrequency needle is inserted at various points around the joint, the nerves are treated, and afterwards you just have 5 or 6 tiny needle puncture marks. Patients go home the same day.

The procedure has been shown to be very safe and have a quick recovery. It reduces pain in the majority of patients for about a year on average. The length of treatment success is determined by how long it takes for the nerves to regenerate.

RFA is a great option for many different conditions: