Interventional Treatments

Platelet Rich Plasma (PRP)

Platelet rich plasma, known commonly as PRP, describes plasma that has a higher platelet concentration that baseline. Blood is collected and centrifuged to produce the collected volume. PRP contains several growth factors including but not limited to PDGF, TFG-ᵦ VEGF, FGF and EGF. These growth factors. These ‘concentrated growth factors’ stimulate natural processes involved in the healing process.

PRP can be used in various conditions including but not limited to:

• Osteoarthritis
• Tendinopathy
• Tendon tears
• Ligament injuries
• Muscle strains and tears
• Plantar fasciitis

Though PRP is increasingly accessible, not all PRP is the same. Platelet concentration is highly variable and dependent on the collection method and processing techniques. Platelet concentration is likely to have a significant impact on the efficacy of the treatment. This is demonstrated in earlier studies in which there was significant variation in the harvesting process and final concentration leading to mixed efficacy from the treatment. Today, there is better understanding of PRP and strong evidence to support the use of PRP for various musculoskeletal issues. See below for a collection of studies supporting the use of PRP.

Dr Karmakar performs PRP in the rooms. He collects blood and processes the PRP using different techniques depending on the injection to be performed. Following the injection patients may experience an increase in pain typically for 24-48 hours. Depending on the site of injection a series of injections may be recommended. Exercise rehabilitation is recommended as an adjunct in most cases to improve the effectiveness of the treatment. PRP can also be used in combination with other treatments such as hyaluronic acid in arthritis or shockwave in tendon injections.

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Cortisone

Cortisone injections have been used extensively for various injuries. Cortisone is a corticosteroid hormone that operates as an anti-inflammatory. When injected directly to the site of inflammation they can act directly to reduce inflammation. Though cortisone continues to be used for conditions including bursitis, tendinopathy and arthritis, its role in all these sites is becoming more and more limited. This is due to several factors such as risk of infection, degradation of soft tissue structures including tendons and cartilage and availability of better agents including PRP. Despite this, cortisone is used widely in the community mainly due to its easy availability.

Dr Karmakar performs cortisone injections in his rooms. He will discuss with you the specific indications for the procedure and alternative options. Following the injection, it may be advisable to modify some activities to reduce the risks of soft issue irritation.

Hyaluronic Acid (HA)

Hyaluronic acid is a non-sulfated glycosaminoglycan that is naturally produced by the body. It is typically found in soft connective tissues. In osteoarthritis there appears to be less concentration of HA. Synthetic versions of the molecule have been developed. When injected in the joint these can help restore the viscoelastic properties of HA and thrn act as a lubricant and shock absorber. Additionally, it may help prevent further degradation of cartilage and limit pro-inflammatory mediators. HA is considered a safe option and appears to be most effective for mild and moderate OA of the knee.

Dr Karmakar performs HA injections in the rooms. He will discuss indications and alternatives of the procedure. Most patients can remain active soon after the injection

Other procedures

He is happy to discuss efficacy and treatments of various novel treatment agents.

Various other regenerative medicine techniques are being used in Australia and globally. Many of these techniques will be increasingly adopted as evidence improves. Dr Karmakar stays up to date with new treatments. He is happy to discuss current efficacy and treatments of various novel treatment agents.