Protein Solution Injection
This is presently the gold standard, non-surgical treatment for Osteoarthritis. With just one injection, you can have 70% improvement from joint pain and stiffness for up to 2-3 years.1,2 Not only this, but you can also improve joint function and possibly slow the destruction of cartilage.3,4
The process is similar to a PRP injection, as a sample of blood is first taken from the arm, and the processed. It’s different in the sense that the sample is then process a second time, specifically to isolate and increase the number of anti-inflammatory proteins. Compared to normal blood, the solution at the end may have up to 1000 times the normal concentration of good proteins to decrease pain and protect cartilage.
Presently, this technique is approved by Health Canada to treat Knee Osteoarthritis. Research is ongoing for other joints. It does not work for everybody. Please speak with your physician if this is the right treatment for you.
Some more science: In a normal knee, there is a balance between inflammatory and anti-inflammatory cytokines. In an osteoarthritic knee, this balance is offset, where the inflammatory cytokines IL-1 and TNFa are able to destroy cartilage. There is no cure for Osteoarthritis, but by concentrating “good”, anti-inflammatory cytokines (IL-1ra, sIL-1R, sTNF-RI, and sTNF-RII) in an overwhelming solution, cartilage degeneration can be slowed. What’s more, through further processing of the blood, the white blood cells release anabolic growth factors IFG-1 and TGF-ß1 which are beneficial for cartilage health.5,6 For ever more information, see Scientific Narrative.
What are the benefits?
Pain relief, joint protection, and tissue repair/regeneration. As mentioned above, the research is still evolving in this field, but many see it as a way of postponing eventual surgery. The injectate is taken directly from the person’s own blood, so the risk of allergy is virtually non-existent.
How long will my pain be reduced?
Pain relief occurs within 1-2 weeks. The overall length of relief is variable, from at least 1 year, up to 2-3 years.
How often can I have this done?
Repeat injections can be performed indefinitely.
Who can’t have this done?
Any patient who may appear to have:
Infection within the body, near the site of administration, or the actual joint itself
What should I do in advance of my injection?
If possible, and safe:
Avoid corticosteroid medications 2-3 weeks prior to the procedure
Avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil), 2 weeks before and after injection
Drink plenty of fluids on the day of the procedure, so that it’s easier to draw a blood sample
What are the side effects?
Common, but not severe
Pain after injection: A post-injection flare occurs in approximately 10% of patients. Like other injections, it usually settles within 2 days. Application of ice and Tylenol can help, if desired. Please avoid any anti-inflammatories, such as Advil (Ibuprofen) afterwards, as this can reduce how well the procedure works.
Pain during the procedure: The skin is the most sensitive part when it comes to any injection. We minimize this by using local anesthetic and/or a vapocoolant spray on the skin. With the injectate itself, this layer is usually quite acidic, and we add sodium bicarbonate to reduce the acidity so that there is a feeling of less burning. Pain associated with the injection is usually brief and well-tolerated.
Not common, but potentially severe
Infection: When a needle is passed through the skin into the body, there is a very small chance of introducing a joint infection. The chance of this occurring is extremely low, less than 0.002%, or equivalent to being struck by a car as a pedestrian and experiencing a catastrophic event. To minimize this risk, we not only follow the WHO minimum best practice standards for injections, but use sterile gloves, sterile ultrasound probe covers, and sterile ultrasound gel.
Bleeding: This is a greater risk if you have a known bleeding disorder or are taking blood thinners. By using ultrasound guidance, there is less “poking” around to get to the target tissue of interest, and thus less theoretical risk of bleeding. Pressure is maintained over the skin afterwards to reduce bleeding.
Systemic Side Effects
No specific reactions have been described.
Can I drive afterwards?
We recommend bringing a driver with you if you’re scheduled for an ankle or foot injection. Otherwise, most people can drive afterwards. Nonetheless, we ask all patients to remain in the clinic waiting room for a minimum of 15 minutes afterwards to observe for any adverse reactions to the medication.
Can I play sports afterwards?
This depends on the type of sport and intensity, but we generally recommend taking it easy for 2 days as post-injection flares may occur. Overall, please be mindful with anything you do and listen to your body.
How much does this cost?
Kon E. et al. (2018): Two-year clinical outcomes of an Autologous Protein Solution injection for knee osteoarthritis. ICRS 14th World Congress.
A Multicenter, Double-Blind, Randomized, Placebo [Saline]-Controlled Pilot Study of a Single, Intra-Articular Injection of Autologous Protein Solution in Patients with Osteoarthritis of the Knee. Clinical Investigation Report – 36 Month, APSS-33-00, Version 1.0. 14. January 2019.† † As measured by WOMAC pain scores reported by patients continuing follow-up through 3 years (n = 19). 19 out of the original cohort of 31.
Matuska A, O’Shaughnessey K, King, W., Woodell-May J. (2013): Autologous solution protects bovine cartilage explants from IL-1. and TNF.-induced cartilage degradation. Journal of Orthopaedic Research. 31(12):1929-35.
King W, van der Weegen W, Van Drumpt R, Soons H, Toler K, Woodell-May J. (2016): White blood cell concentration correlates with increased concentration of IL-1ra and improvement in WOMAC pain scores in an open-label safety study of autologous protein solution. Journal of Experimental Orthopaedics. 3:9.
O’Shaughnessey K, Matuska A, Hoeppner J, et al. Autologous protein solution prepared from the blood of osteoarthritic patients contains an enhanced profile of anti-inflammatory cytokines and anabolic growth factors. J Orthop Res 2014 Oct;32(10):1349-55
Goldring SR, Goldring MB. The role of cytokines in cartilage matrix degeneration in osteoarthritis. Clin Orthop Relat Res 2004 Oct;(427 Suppl):S27-S36.