New Technologies: Platelet Gel

Platelet Gel and Uses in Orthopaedic Surgery

As part of my nature, and commitment to excellence for my patients, I enjoy both staying abreast of new technology, and occasionally helping to invent new procedures. This is my pledge to you, to try and deliver excellence and innovation in orthopaedics. To that end, I would like to share with you an exciting new technology available to my patients with hip and knee arthritis.

For the past 18 months I have used a technique on our patients that I am proud to report I have helped pioneer in orthopaedics. This is the use of autologous platelet rich plasma combined with thrombin to create a Platelet Gel (PG). This PG is then sprayed into the knee recesses and soft tissues at the end of the case. The PG forms a sticky, glue like substance which conveys some amazing properties to the tissues. As detailed below, it helps to decrease bleeding, decrease pain and enhance wound healing, among other things. As a matter of fact, the results are so dramatic that we have almost eliminated the need for transfusions after surgery in most knee patients receiving this modality. In a recent retrospective review of 80 patients, we have shown an amazing reduction in the need for bank and autologous blood when using PG during surgery. Specifically, 40 patients prior to the current regimen and having Total Knee Surgery without PG needed 21 units of bank blood and 26 units of autologous blood. The 40 patients having Total Knee Surgery with PG used only 1 unit of autologous blood. This means that 39 out of 40 patients did not need any blood products. This is an amazing statistic, and one of the most significant breakthroughs in this type of surgery in recent memory. (According to studies, the average blood loss for a Total Knee replacement is around 1800 cc-about 2 and one half units of blood.) As a matter of fact, when comparing our PG patients to non-PG patients, we have had a reduction in their length of stay by 1.4 days. This is due to the decreased blood loss, and improved wound healing. We have had similar results, though not quite as dramatic, in our Total Hip patients.

These results prompted me to learn more about this amazing by product of the patient's own blood. I have extrapolated this knowledge into another use for this product in the field of arthroscopy. In patients with full thickness cartilage loss of the knee and hip, we combine PG with a technique of marrow stimulation to produce dramatic results. In this technique, we "pick" the subchondral bone with a device that looks like an ice pick. This pick is gently driven into the bone until we see marrow elements coming from the hole it forms. This is then combined with PG, which is delivered into the area at the end of the case. Patients having had this technique performed exhibit truly remarkable results. From experience, I can tell you that without this technique, patients such as these do very poorly. These are the patients most disappointed with the results of arthroscopic surgery. Soon I will have one year follow up on 50 patients using this technique, and to date we are approaching around 75 patients. 75% of those patients have significantly improved after our technique of marrow stimulation and PG in those arthritic knees. Not only that, but the results are holding up. The uses for this product continue to expand, and recently we have used it for rotator cuff repairs, various tendon repairs and as stated, hip arthroscopy and hip replacement.