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Knee osteoarthritis (OA) is a common degenerative joint disease affecting millions of people worldwide. It is characterised by the breakdown of cartilage in the knee joint, leading to pain, stiffness, and reduced mobility. Traditional treatments for knee OA, such as pain medications and physical therapy, aim to manage symptoms. However, emerging research suggests that autologous protein solution (APS) injection may provide a novel and effective approach for treating knee osteoarthritis. In this blog post, we will explore the concept of APS, its potential benefits, and its role in revolutionising knee OA management.

What is Autologous Protein Solution (APS) Injection?

Autologous protein solution (APS) injection is a cutting-edge regenerative medicine technique that harnesses the healing power of a patient’s own blood to treat knee osteoarthritis. The procedure involves extracting a small amount of the patient’s blood, processing it to concentrate growth factors and anti-inflammatory proteins, and then injecting the concentrated solution back into the affected knee joint.

How Does APS Injection Work?

The APS injection process can be divided into the following steps:

Blood Extraction: A small sample of the patient’s blood (usually around 60 millilitres) is drawn from a vein, typically in the arm.

Centrifugation: The blood sample is placed in a centrifuge machine, which spins the blood at high speeds. This process separates the whole blood into its components: red blood cells, platelet-poor plasma, and platelet-rich plasma (PRP).

Concentration: The platelet-rich plasma (PRP) is collected and subjected to further centrifugation with beads to break the cells to release the intracellular proteins to obtain a highly concentrated solution of growth factors and other healing proteins.

Injection: The concentrated APS solution is then injected directly into the knee joint, targeting the damaged areas.

Benefits of APS Injection for Knee Osteoarthritis 

Reduced Inflammation: The growth factors and anti-inflammatory proteins present in APS help to suppress inflammation in the joint, providing relief from pain and stiffness.

Cartilage Regeneration: APS promotes the regeneration of damaged cartilage by stimulating the production of chondrocytes, the cells responsible for maintaining healthy cartilage.

Pain Relief: By reducing inflammation and promoting tissue repair, APS injections have shown to significantly alleviate pain associated with knee osteoarthritis.

Minimal Side Effects: Since APS is derived from the patient’s own blood, the risk of allergic reactions or adverse effects is minimal. Occasionally the injected knee may swell and cause some stiffness. 

Clinical Evidence and Effectiveness

Several clinical studies have demonstrated the potential effectiveness of APS injection for knee osteoarthritis. While more research is needed to establish its long-term benefits fully, early results show promising outcomes, particularly in terms of pain reduction and improved knee function.

Here are some key findings from studies supporting the use of APS injections for knee osteoarthritis:

Pain Reduction: Numerous clinical trials have demonstrated that APS injections can lead to a significant reduction in knee pain associated with osteoarthritis. The growth factors and anti-inflammatory proteins present in APS are believed to help mitigate pain and discomfort.

Improved Function: APS injections have been associated with improved knee function and increased mobility in patients with knee osteoarthritis. This improvement may be related to the regenerative effects of the growth factors on damaged cartilage and tissues.

Cartilage Regeneration: Some studies suggest that APS injections may stimulate the regeneration of damaged cartilage. The growth factors in APS have the potential to promote the production of chondrocytes, which are essential for maintaining healthy cartilage.

Safety Profile: APS injections are considered safe, as they use the patient’s own blood, reducing the risk of allergic reactions or transmission of infections.

Comparative Studies: Several studies have compared APS injections with other treatments, such as corticosteroid injections or hyaluronic acid injections. In some cases, APS injections have shown comparable or superior results in pain relief and functional improvement.

How long does it take for the effects to start kicking in after an injection of APS?

The time it takes for the effects of an autologous protein solution (APS) injection, also known as a platelet-rich plasma (PRP) injection, to kick in can vary from person to person and depends on several factors. These factors may include the severity of knee osteoarthritis, individual response to the treatment, the specific treatment protocol used, and the overall health of the patient. Generally, patients may experience some changes within a few weeks, but the full effects may take several weeks to a few months to become noticeable.

In most patients, they only start to feel some improvement in symptoms from 4 to 6 weeks after the injection.

Here is a general timeline of what to expect after an APS injection:

Immediate Post-Injection Period: After the APS injection, some patients may experience mild soreness, swelling, or discomfort at the injection site. These side effects are usually temporary and should subside within a few days.

Short-Term Response (First Few Weeks): In the first few weeks following the injection, patients may start to notice some improvement in knee pain and inflammation. Some individuals experience an initial reduction in pain and improved joint function during this period.

Intermediate Period (Several Weeks to a Few Months): As the growth factors and healing properties in APS start to work, further improvements in knee pain, function, and mobility may become evident. Patients may notice increased comfort during daily activities and improved range of motion in the affected knee.

Long-Term Response: The full regenerative effects of APS may continue to develop over several months. Cartilage repair and tissue regeneration processes take time, and patients may experience continued improvements in knee osteoarthritis symptoms over an extended period.

It’s important to note that individual responses to APS injections can vary significantly. Some patients may experience more rapid and substantial improvements, while others may require additional injections or alternative treatments for better results.

Patients should closely follow their healthcare provider’s post-injection instructions, which may include rest, physical therapy exercises, and activity modifications to support the healing process.

As with any medical procedure, it is essential for patients to have realistic expectations and to communicate regularly with their healthcare provider about their progress and any concerns they may have. If the desired effects are not achieved after a reasonable period, the healthcare provider may suggest adjustments to the treatment plan or consider other treatment options based on the individual’s specific needs.

How Long Can the Effects of APS Injection Lasts?

The duration of pain relief from a single autologous protein solution (APS) injection, also known as a platelet-rich plasma (PRP) injection, can vary from person to person. While some individuals may experience significant and prolonged pain relief, others may find that the effects diminish over time. 

Kon et al found that the beneficial effects of APS injection can last up to 3 years.

Background: Blood derivative injections have been recently proposed to address osteoarthritis (OA) with overall positive results, although long-term data on their efficacy are lacking. A novel blood derivative has been developed to concentrate growth factors and antagonists of inflammatory cytokines and shown promising early findings.

Purpose: To investigate if the positive effects of a single intra-articular injection of autologous protein solution (APS) in patients affected by knee OA-previously documented at 1 year in a multicenter double-blind randomised saline-controlled trial-last up to 3 years.

Study design: Case series; Level of evidence, 4.

Methods: A total of 46 patients with Kellgren-Lawrence 2 or 3 knee OA were randomised into 2 groups: 1 ultrasound-guided APS injection (n = 31) or 1 saline injection (n = 15). At 1 year, the saline group was allowed to cross over. Patients were re-evaluated at 24 and 36 months through the visual analog scale for pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index Likert 3.1 (WOMAC LK 3.1), Knee injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey (SF-36), and Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder rate. Magnetic resonance imaging evaluation was performed with the MRI Osteoarthritis Knee Score (MOAKS) before and at 24 months after treatment, and radiographs were assessed per Kellgren-Lawrence before and annually after treatment.

Results: In the APS cohort, WOMAC pain improved from 11.5 ± 2.4 (mean ± SD) to 4.3 ± 4.0 at 1 year and to 5.7 ± 5.0 at 3 years (P < .0001 vs baseline). The APS cohort also showed a statistically significant improvement in its KOOS pain score from 39.4 ± 13.1 to 70.6 ± 21.5 at 1 year and to 64.1 ± 24.6 at 3 years (P < .0001 vs baseline) and VAS pain scores from 5.5 ± 2.2 to 2.6 ± 2.5 at 1 year and to 3.4 ± 2.9 at 3 years (P = .0184 vs baseline). VAS pain score significantly worsened from 12 to 36 months (P = .0411). All patients in the saline group decided to cross over to APS, and their final scores were better than baseline, although not significantly better than at the crossover point. Overall, 7 of 26 (26.9%) APS cases and 4 of 14 (28.6%) crossover cases were considered failures as patients underwent further injective treatments or surgical procedures between the 12- and 36-month follow-up. MOAKS findings showed no statistically significant differences. Patients with better cartilage had greater WOMAC pain improvement when their baseline scores were worse, whereas the trend was reversed for patients with cartilage loss at baseline.

Conclusion: Intra-articular use of APS for mild to moderate knee OA was safe, and significant pain improvement was documented 3 years after a single injection. Patients with better cartilage status seem to respond better than patients with more cartilage loss, with more clinical improvement even when starting from more painful conditions.

Reference: Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G. Autologous Protein Solution Injections for the Treatment of Knee Osteoarthritis: 3-Year Results. Am J Sports Med. 2020 Sep;48(11):2703-2710.


Autologous protein solution (APS) injection is a groundbreaking treatment option that holds great promise for individuals suffering from knee osteoarthritis. By tapping into the body’s natural healing abilities, APS offers a minimally invasive and potentially transformative approach to managing the symptoms and promoting cartilage regeneration. Although further research is warranted, APS injection has the potential to revolutionise knee osteoarthritis management, offering hope for improved quality of life for millions of patients worldwide. If you or a loved one are considering APS treatment, consult with a qualified healthcare professional to determine its suitability and potential benefits for your specific condition.

How Much Does Autologous Protein Solution Injection for Knee Osteoarthritis Cost?

Autologous Protein Solution Injection for Knee Osteoarthritis cost $2000 before GST per knee. Book an appointment today to consult further. 

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