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[backdoc]

Had PRP in my knee, not a pleasant experience, but it definitely helped.

An interesting treatment in search of a target

Totally off topic, and my apologies to one and all.

22 years ago I started an RCT using PRP as bone graft augmentation, with patients as their own controls, blinded. In those days a cardiac lab tech had to spin down the sample, and the trial stopped after 10 cases as they were too unreliable i.e. they DNA'd a few times.
Anyway, at 6 months a CT scan showed no effect on fusion - i.e. those with and without PRP were identical.*

Then one of our Radiologists was sacked [very unusual in medicine]. He was spinning down the PRP samples in his kitchen, and offering the treatment to pro sportsmen under Ultrasound. This was of course swept under the carpet, and he went back to the Antipodes,  but he published quite a bit on the subject [usually in journals where he was on the editorial committee] and gave the treatment some momentum.

* [As a consequence of this, I developed a research interest in Bone Graft Substitutes [Actifuse, Inductigraft], Bone Morphogenic Protein, and eventually graft-free fusions. The latter has no licence yet, and I have retired anyway, but the materials work we did on 3D printed Titanium cages [K2M Stryker] show that you don't need bone graft to obtain an interbody fusion. ]

[Neils]

Backdoc - sorry this is an uneducated query from someone with little medical knowledge! Are the the processes you describe similar to those that Noel Fitzpatrick uses on dogs - he seems to be a step or two ahead of what we hear on humans. Sorry.

[backdoc]

Fitzpatrick uses techniques that are 'under evaluation' in humans, but the regulatory framework for treatment on animals is much looser. I dont think he comes up with anything himself. I haven't seen him do any treatment that I wasn't aware of already in humans.

So the post-amputation work he does was derived from the RNOH Stanmore which has a 75 year history of working on limb preservation for bone tumours. Animals tolerate having a Titanium 'limb' screwed into a bone end. Humans tend to get infections with the same treatment.

The head of Biomedical sciences for a number of years at RNOH was a vet by training, and there are links to the Royal Vetinary College.

Fitzpatrick works on the edge IMO. The money involved is enormous.
I have dogs. Anything serious - put them down. Yet we now have to persuade the vets. When my 13 year old German WHP had a stroke, I don't want him to have a scan, an iv line etc etc.

[Neils]

Thanks - I have often wondered about his processes.
Also kind of went seriously off him speaking to a fellow venturer to Noth Cyprus in May who outlined exactly what he required of a pet owner before he even considered a consultation. Plus the costs involved almost had me off my seat.
Thanks for the response.

[Vespula Vulgaris]

An interesting treatment in search of a target

That is pretty much what my surgeon said. I had a persistent knee effusion post ORIF. He said there was very little reliable evidence either way, some people say it helps, worst case was that it wouldn't help, so probably worth a try. I think it did in the short term but could easily be placebo.

22 years ago I started an RCT using PRP as bone graft augmentation, with patients as their own controls, blinded. In those days a cardiac lab tech had to spin down the sample, and the trial stopped after 10 cases as they were too unreliable i.e. they DNA'd a few times.
Anyway, at 6 months a CT scan showed no effect on fusion - i.e. those with and without PRP were identical.*

Then one of our Radiologists was sacked [very unusual in medicine]. He was spinning down the PRP samples in his kitchen, and offering the treatment to pro sportsmen under Ultrasound. This was of course swept under the carpet, and he went back to the Antipodes,  but he published quite a bit on the subject [usually in journals where he was on the editorial committee] and gave the treatment some momentum.

That's interesting, do you think the current increase in usage is down in particular to him? And do you think his findings have much validity?

[As a consequence of this, I developed a research interest in Bone Graft Substitutes [Actifuse, Inductigraft], Bone Morphogenic Protein, and eventually graft-free fusions. The latter has no licence yet, and I have retired anyway, but the materials work we did on 3D printed Titanium cages [K2M Stryker] show that you don't need bone graft to obtain an interbody fusion. ]

An old surgeon I worked with when I was newly qualified always said Bones heal in spite of us, not because of us. But I do love the stuff people are doing with fillers and Substitutes, I worked for Acumed briefly in a sales role and it always surprised me they weren't more popular.

[Rossm]

Pre-season Week 5.

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