Platelet-rich plasma, also known as regenerative injection therapy, treats common musculoskeletal conditions, including knee arthritis. We produce PRP from whole blood taken from your arm. The blood is spun, separating the heavier red and white cells from the lighter platelets and plasma. This plasma, containing a higher concentration of platelets and growth factors, is injected into the joint. Recent evidence suggests that PRP may improve pain and function in patients with knee arthritis. However, usually more than one injection is required.
Additionally, the effects typically last only 6-12 months and rarely persist beyond a year. Recently, a new type of regenerative injection therapy called Nstride claims to give longer-lasting pain relief of up to 3 years with only one injection. Could Nstride be the new regenerative injection therapy?
How Does Nstride Differ from Traditional PRP?
Like normal PRP, Nstride PRP is taken from whole blood and spun in a centrifuge. First, we separate the plasma containing platelets and white cells from the heavier red cells. The plasma is then transferred again into a separate, unique tube. This second spin super-concentrates the growth factors (or beneficial proteins) and removes the ‘bad’ proteins. This dual-spin tips the balance toward a more significant and longer-lasting effect on pain and swelling.
Although Nstride is just one injection, the cost is considerably higher than that of a normal PRP. Generally, the price of one Nstride injection is £2000 compared to a normal PRP of £500.
How Much Blood is Needed for a Nstride Treatment?
We collect approximately 55 ml of whole blood. This allows us to concentrate the platelets to 8 times normal and the white blood cells to 4 times normal. In comparison, normal PRP has concentrations 2- 3 times normal.
Are There Side Effects?
Generally, people tolerate a PRP injection well. However, you may experience a short-term increase in pain and swelling for about two weeks after the injection. We advise people not to exercise if they develop a flare. Other side effects include a slightly increased risk of infection, although the risk is lower than with any additional injection.
What Are the Advantages of Nstride PRP?
A supposed advantage of Nstride over PRP systems is that the concentration of platelets and white cells is much higher. Given the higher concentration, some practitioners claim that the effect is significantly more pronounced, meaning that only one injection is needed and lasts up to 3 years.
If we only need one injection, this significantly differs from the current PRP treatments, which typically require three injections. Also, the claims that Nstride provides three years of pain relief are much better than current PRP systems, which offer only 6-12 months of relief.
What is the Evidence for Nstride? Is What We Read All True?
Unfortunately, the evidence remains somewhat underwhelming.
A recent higher-level study compared the injection of Nstride PRP with a placebo. One half of the group received the trustworthy PRP, and the other group received sterile water. The doctors and subjects were unaware of the substance being injected, a process known as blinding. Surprisingly, there was no difference between the two groups until 12 months had passed. There was a difference in some pain scores but no difference in overall functional scores.
More recently, doctors followed subjects with knee arthritis and had a Nstride injection. At the end of the study, 75% of subjects had pain relief three years after only one injection.
Although three years of pain relief after just one injection is exciting news, we need to see more evidence that N Stride is better and more cost-effective than normal PRP.
So, should you consider Nstride PRP?
Based on what we currently know, we do not recommend paying extra for Nstride.. However, a higher concentration of platelets and white blood cells doesn’t necessarily mean that Nstride is better or lasts longer.
In the meantime, standard PRP is a viable option for treating knee arthritis when used in conjunction with exercise and other treatments. You can review the evidence for PRP here.
Additionally, high-molecular-weight hyaluronic acid, such as Durolane, shows a significant response with a single injection.
Second-generation PRP is Now Available: Arthrex ACP Max.
An alternative to Nstride and standard PRP preparations is now available. Arthrex ACP Max is a novel, second-generation PRP system that utilises a dual syringe to deliver a higher concentration and dose of platelets. It is our preferred one-shot PRP, containing 7-10 billion platelets per injection. ACP Max PRP is now available in Dr Masci’s clinic.
Final Word from Sportdoctorlondon About Nstride PRP
To date, the evidence suggests that Nstride PRP is no more effective than standard PRP for knee arthritis. Does the evidence justify the extra cost? Probably not until more evidence becomes available.
We look forward to seeing a randomised controlled trial on the use of Nstride in knee arthritis, which we believe will be published shortly. Stay tuned.
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