Platelet rich plasma may be better than hyaluronic acid injections for knee osteoarthritis

Platelet rich plasma is a combination of growth factors that are obtained from a patient’s own blood and injected into sites of pain, such as an arthritic knee or inflamed tendon.   This has been hot area of research in orthopedics and growing in acceptance as a valid, beneficial treatment.

Hyaluronic acid injections

A recent comprehensive study compared the use of hyaluronic acid (gel injections, supartz injections, synvisc injections) with platelet rich plasma.  This paper combined the work of over 26 prior randomized trials into one paper.  The paper showed that while improvement took longer to get started, up to a month or more, the benefit lasted much longer, up to 12 months.  This was a statistically significant benefit.    While Hyaluronic acid injections are commonly used for osteoarthritis, this research gives some evidence that the regenerative medicine approach of platelet rich plasma may have an important role in the treatment of knee osteoarthritis.

We commonly perform platelet rich plasma injections in our office.  If interested we would love to see you and discuss your options with you in detail.  Every patient is different, and your treatment must be tailored to your specific needs.  Find out more today.  Contact us here.



Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Meta-analysis of 26 Randomized Controlled Trials.  Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 37, No 1 (January), 2021: pp 309-325

Hops to Help Arthritis

You may know Dr. Benjamin DuBois as our resident shoulder expert. He has been with our group since 2004 and is specialized in managing shoulder arthritis. He has performed over 1,500 shoulder replacements in San Diego. What you may not know is he is also an expert in the world of beer. Dr. DuBois opened up Bay City Brewing Company in 2015. He has always loved craft beer and wanted to contribute to the burgeoning scene here in San Diego. Located in Point Loma, Bay City has been serving up delicious brews to locals for years. Over 200,000 pints poured and counting!  He recently opened up a second location in the heart of downtown San Diego, just a few blocks from Petco Park. Come down to either location for a great time and try his San Diego International Beer Festival Gold Medal Winning Bay City IPA!

How Has He Combined His Passion For Beer and Orthopedics?

Not only has he been running a successful brewery for the last six years, but he has also made a commitment to fundraising. He has worked with many organizations over the past several years but his true passion is working with the Arthritis Foundation. He has been involved with the charitable organization for many years and even served on the local board.  According to their Senior Executive Director, Teresa Dinh Watanabe,  The Arthritis Foundation’s mission is “to educate, advocate, and find better treatments for a cure for arthritis and related diseases.”

Events At Bay City Brewing Company

Both locations have fantastic event space. The new location in East Village has an expansive rooftop deck and a full kitchen great for hosting fundraisers and private events. He hosted a kick off event for this years Jingle Bell Run at the downtown location last month. At this event teams, sponsors, and honorees gathered together to get prepared for the annual event while sipping on some delicious Bay City brews. The Jingle Bell run is the Arthritis Foundation’s annual nationwide event that raises awareness and funds to help fight arthritis.  If you’d like to participate in this year’s 5k on December 11th, sign up here. 100% of the registration fee and any fundraising goes towards the cause. This year’s 5k has already raised over $24,000!

Dr. DuBois in the News

Dr. DuBois has recently been featured on the Sharp Website. Read more about his interview discussing his passion for beer and medicine here

Nonsurgical Treatment for Knee Pain: Hyaluronic Acid

Patients with osteoarthritis of the knee usually do not need to jump right to surgery. There are many conservative treatment options a patient can try first. Today, we will discuss Hyaluronic Acid injections. You may have heard of these referred to as “rooster comb” shots or as viscosupplementation. What exactly are these injections and how do they work?

What is Hyaluronic Acid?

Hyaluronic acid is a natural substance found in the body. It is found in highest concentrations in the skin, eyes, and joints. It is a polymer that has high viscoelastic properties and moisture retention (Sze et al. 2016). Studies have shown that patients with osteoarthritis of the knee have lower levels of hyaluronic acid in the synovial fluid. These injections act to help supplement this loss. Hyaluronic acid comes in many different forms. There are oral supplements, topical serums, and injectables. It also has many different indications including treatment for osteoarthritis of the knee, use in ophthalmic surgery, and even cosmetic procedures.  Hyaluronic acid has been shown to be most effective when injected directly at the source. In our case injected into an arthritic knee.

Where does it come from and How Does it Work?

It was first isolated by Scientists Karl Meyer and John Palmer in the 1930’s from the eye of a cow. It’s was first used clinically in intraocular lens implants. You can read more about the history of hyaluronic acid here.  Today there are two common production methods: extraction from animal tissues (typically the combs of roosters) or produced by bacterial fermentation in a laboratory. Patients with allergy to birds, feathers, or eggs are encouraged to proceed with a non-avian sourced injectable product. Hyaluronic acid helps to lubricate the joint and give it a cushioning sensation. There are several different brands of hyaluronic acid with a varying number of injections. Typically, these injections are done once a week for 3-5 weeks.

What Should I Expect After the Injection?

This is a very routine and quick procedure done right in the office. Our providers utilize ultrasound technology to increase accuracy and decrease pain of the injection. We can directly visualize our target and guide the medication to the appropriate spot without exposing you to unnecessary radiation. The material that is injected is quite viscous, so some patients may experience some short-term soreness of the joint following the injection. We typically advise patients to rest and avoid vigorous exercise for 1-2 days following the procedure.

How long does the relief last?

The effects of these injections can last anywhere from 6 months to a year. There is a wide spectrum of pain relief depending on the patient. These injections are covered by most insurance carriers and can be repeated every 6 months. In some patients, a trial of these injections may help to delay the need for total knee replacement.

Is there data to support its effectiveness?

Hyaluronic Acid is an FDA approved drug supported for it’s use as an injectable treatment for osteoarthritis of the knee. There have been many studies done to support its safety and efficacy.

  • A prospective study done in Japan in 2006 found that patients with osteoarthritis of the knee who received serial hyaluronic acid injections noted significant improvement in physical function, pain, and balance.
  •  In a double blind randomized control trial done in Australia found that scores for pain and stiffness were significantly lower in the Hyaluronic Acid treatment group versus placebo.
  • A review done by Louisiana State University shows strong evidence for hyaluronic acid injections when injected into arthritic knees causing reduction in pain and improved physical function for up to 6 months. The review also suggests a very low side effect profile and high toleration rate by patients.

Am I a Candidate for These Injections?

Most patients with knee arthritis can benefit from this type of procedure. Visit one of our skilled San Diego orthopedic providers for an evaluation today to see if you are a candidate for hyaluronic acid injections.

Patient Spotlight: Freedom of Movement without Pain After Bilateral Knee Replacements

Meet Jana, a patient of Dr. Peter Hanson’s who had bilateral knee replacements performed 3 months apart this year. When we met Jana she was having severe pain in both knees and was having trouble with all of her daily activities. She was reliant on a cane and a knee brace to get around. Now, a mere 5 months after both knees were replaced she is able to enjoy long walks with her husband again, something she missed dearly. Read more here about her experience with Dr. Peter Hanson and our Grossmont Orthopaedic Medical Group team.

What Has Your Life Been like since Having Your Joint Replacement Surgeries?

My life has been completely turned around since having both knees replaced. Prior to my surgeries, I was in a brace and used a cane. My quality of life was significantly reduced due to extreme discomfort when sitting, standing, and walking. Now, I can walk long distances, ride my bike, go up and down stairs, etc. . . . all pain free! I receive frequent comments like, “Your legs are so straight!” and “Wow, you’re moving so quickly!” I smile and tell people I’m a new woman, thanks to Dr. Hanson!

What Was Your Experience Like with Dr. Hanson/The Office?

I had nothing but positive experiences in Dr. Hanson’s office. I was always treated with professionalism and respect by all staff. Dr. Hanson is extremely knowledgeable, caring, and considerate, as are his PAs, Ashley and Kalie. Every concern and question I had regarding my surgeries and recovery were answered with a thorough explanation of what to expect. I never felt that I was being rushed through an appointment.

Have You Been Able to Get Back to the Things You Wanted to Do after Joint Replacement Surgery?

My ‘life after surgery’ is more than I expected! I can’t begin to explain how exhilarating it feels to have freedom of movement without pain, and a new lease on life.

What Have You Been Able to Do Physically That Has Surprised You?

I am most pleased with being able to walk again, especially long distances. My husband and I have always enjoyed walking along the river and strolling through our neighborhood. We hadn’t been able to do so for almost two years because of my knees.

What Was the Initial Recovery Period Like?

The initial recovery period for each knee was quite different. Fortunately, I had a nerve block prior to each surgery so that alleviated the initial pain for about 24 hours. My first knee replacement seemed to go more smoothly, in my opinion, than the second. The discomfort seemed less the first time around, but then I did a better job staying on top of the pain. I highly recommend taking pain medication around the clock for the first 48-72 hours following surgery, moving as much as possible, and icing/elevation frequently. And, most importantly, don’t hesitate to ask for help!

Have You Had Any Significant Restrictions since Joint Replacement Surgeries?

I haven’t been given any restrictions since completing physical therapy. I happily move through my day and frequently don’t think about my knees at all! That’s quite a switch since my knee pain previously weighed heavily on my entire life.

What Is the Best Advice You Have for a Patient Thinking About Joint Replacement Surgery?

If you’re hesitant to have knee replacement surgery, I highly recommend that you seek out Dr. Hanson and his team to explain the procedure and how total knee replacement will change your life for the better. Dr. Hanson and his PAs don’t automatically encourage surgery, but offer options to try first. I had had two years of cortisone shots prior and a round of hyaluronic injections before realizing that surgery was imminent. I almost waited too long, though. My hip and leg muscles were significantly weakened by my inability to move for almost two years. I’m still working on strengthening my muscles, but now know that I can because I finally move without pain!!

Are Outpatient Total Joint Replacements the Way of the Future?

If you had a joint replacement about 10 or so years ago, you may remember a long extended stay in the hospital following the procedure. It was not uncommon for patients to stay up to a week in a hospital setting. Many patients then also went to a nursing home following their hospital stay. We have learned a lot about post operative recovery from joint replacement surgery in the last decade. Our techniques have advanced so much that it is entirely possible to go home the very same day of your surgery.

The orthopedic community was moving towards the idea of outpatient total joint replacements in the last several years, but the Covid-19 pandemic really kicked this into high gear. When the pandemic hit elective surgeries shut down for several months. Once these orthopedic surgeries resumed, total joint replacement surgeries were only allowed to be performed on low risk patients who would be able to go home the same day of surgery. This thought process was based on the limited availability of hospital beds and high volume of Covid patients. We realized after switching solely to outpatient surgeries that patients did quite well.  We were able to come to the conclusion that the majority of our patients don’t actually require a Hospital stay following joint replacement surgery.

Advantages to Outpatient Joint Replacement Surgery

Faster Recovery

Early mobilization has been found to be key in speeding up recovery and reducing risk of complications like blood clots. At home you are able to move around as much as you like without setting off a hospital bed alarm. (For safety purposes make sure someone is with you while ambulatory initially).

One of the modalities that has helped patients recover at home has been the addition of a long acting nerve block. This is typically performed the morning of the surgery by a skilled anesthesiologist. They will inject a long acting medication that can numb the area for a few days. This can help greatly decrease the amount of pain medication needed and help you advance in physical therapy quicker.

Less Risk of Infection

Let’s face it. Hospitals are where sick people are. There are many precautions we take as healthcare professionals to limit the spread of disease, however, some germs can be unavoidable. A brand new joint can be especially susceptible to infection. We can decrease this risk by removing you from an environment where dangerous germs are far more prevalent. This is especially true in skilled nursing facilities.


There’s no place like home! You can recover from the comfort of your own bed in your own pajamas. It is not necessary to sleep in a hard uncomfortable hospital bed in a freezing cold room. You will be able to sleep peacefully instead of being awoken several times throughout the night by the nursing and ancillary staff. Also, there will be no need to wait for the nurses to bring you your medications or help you to the restroom. Nurses are very busy caring for multiple patients at the same time and sometimes it can take quite a while to assist you with your needs. At home you are able to take your medication and go to the restroom right when you need to.


An outpatient total joint replacement may even incur a lower cost to you as the patient. This may depend on insurance plan and location of the surgery.

Recommendations for a Successful Outpatient Surgery

Dedicate a Support Person

We recommend having a support person stay with you for at least the first week to help you. It is also important to arrange transportation so you can safely get to your physical therapy appointments which are an extremely important part of your recovery.

Ensure the Home is Safe

Clear all tripping hazards out of the way (i.e loose rugs, furniture, etc.). You may want consider setting up a space on the first floor if you have stairs in the house.

Participating in “Prehab”

Whether it be going to formal physical therapy or doing a focused home exercise program. The stronger you are going into this surgery the better. We recommend focusing on strengthening the quadriceps, gluts, and the hip abductors. These will help support your weight and aid with balance. All very important in speeding up recovery.

Preparation, Preparation, Preparation

Preparation in this case is key! The more you can prepare ahead of time the better. Make sure to fill all post- operative medications prior to surgery. Set up your physical therapy appointments as soon as possible so that you are able to get in a few days following the procedure. Also, purchase any medical equipment needed (i.e shower chair, toilet seat riser, etc.). Prepare meals ahead of time and store them in the freezer prior to surgery if possible.

Are You a Candidate for an Outpatient Total Joint Replacement?

Now, not every patient is a candidate for an outpatient total joint replacement. Patients with multiple medical issues that need close monitoring will likely need to stay in the hospital one or two nights for observation. Patients who are good candidates for this type of procedure are generally healthy, independent, active and with few medical conditions.

In addition to these considerations, another important factor is that you are deemed safe to go home by the medical staff and by the physical therapists. A physical therapist will see you in the post op recovery room and get you up walking on the walker shortly after your procedure. They will typically see you a couple more times. If your surgical procedure is later in the afternoon, there is a possibility of needing a one night stay to work more with physical therapy.

Interested in Learning More About an Outpatient Total Joint Replacement Surgery?

Please call our office or visit our website to schedule an appointment with one of our highly skilled San Diego outpatient joint replacement specialists today. Outpatient total joint replacement procedures can be performed both at a qualified surgery center and at the hospital. Our surgeons operate at Sharp Grossmont Hospital, Sharp Coronado Hospital, and University Ambulatory Surgery Center.

Can Losing Weight Help Me Avoid a Joint Replacement?

The answer is, yes it’s certainly possible. It is a known fact that weight loss can significantly improve pain specifically related to joints. Why is this you ask? Well, the answer is simple. The more load you put on a joint the more wear and tear occurs over time. This can lead to a faster degradation of cartilage, lending you to the possible need for joint replacement.

Is there research to prove this concept?

There are numerous studies looking at body weight and it’s relationship to our weightbearing joints. This fact alone points to how important this topic really is.

One study conducted in Australia looked at a group of 23,916 participants 45 years or older and evaluated the association between weight change and the need for knee or hip replacement over a period of 5 years. They categorized the population into four groups: >7.5% weight loss, > 5-7.5% weight loss, stable weight, and > 5% weight gain. The study found that those that lost >7.5% body weight were associated with a reduced risk of needing a total knee replacement. The study also found that weight gain increased the risk of total hip replacement. More information of this study can be found here.

In addition to extra weight increasing the need for joint replacement, studies have also shown that weight loss can significantly improve joint pain. It has been discovered that for every 1 pound of weight loss there is a 4 fold reduction in stress on the joints, mainly knees and hips. Meaning, for every 1 pound of excess weight there are 4 pounds of extra stress on the joint. It is pretty simple to see that the more stress there is on a joint the more pain you will likely be in. The increased load can lead to more inflammation which in turn causes pain. Read more about this study here.

What else can contribute to Arthritis?

Unfortunately in some cases, weight loss alone does not prevent the progression of arthritis and the need for Joint Replacement Surgery. The cause of arthritis is multi-factorial in nature. Body mass certainly plays a big role but there are also important components to consider. Some other factors include:

  • Age
  • Genetics
  • Activity level
  • History of trauma
  • Previous surgery of the involved joint

But, if you were able to modify one of these contributing factors, wouldn’t you like to try?

I Am in Need of a Joint Replacement, Can weight loss still help me?

Absolutely! In the short term, weight loss can help wound healing and speed up recovery time. Think about it… the less tissue that needs to be repaired the quicker the healing time. In addition to increased healing time, weight loss can lower your risk of blood clots, infection, and the need for reoperation. These are all very serious complications of a total joint replacement, some of which can be life threatening.

You may be thinking…. How can I loose weight if I can’t exercise? It’s true, joint pain can affect your ability to do certain exercises, however, it absolutely does not prevent you from the ability to loose weight. Request an appointment here with one of our experienced San Diego care providers to discuss an achievable weight loss plan today!