Knee osteoarthritis with more inflammation
PRP + Protein-Rich Plasma.
PRP made from your own blood, combined with a second part of your plasma that is concentrated for two proteins, alpha-2-macroglobulin (A2M) and fibrinogen. We consider it for mild-to-moderate knee osteoarthritis when the knee shows signs of more inflammation.
PRP + PROTEIN
What is PRP + Protein?
Standard PRP carries concentrated platelets and growth factors. The second part, protein-rich plasma, is made by concentrating the platelet-poor plasma left over from your blood draw. This raises the levels of alpha-2-macroglobulin (A2M), fibrinogen, and other plasma proteins.
The idea is to work on two sides of osteoarthritis. PRP supplies signaling. The protein part carries A2M, which in laboratory studies blocks some of the enzymes (proteases) that break down cartilage. We consider it mainly when a person's arthritis looks more inflammatory than mechanical.
Autologous PRP
From your blood · two-spin · Lp-PRP
Leukocyte-poor PRP, prepared in our on-site lab. Its concentrated platelets release growth factors and signaling proteins that can start the body's own repair processes and adjust local inflammation.
Protein-Rich Plasma fraction
From your PPP · ultrafiltration · A2M-concentrated
Platelet-poor plasma is passed through a fine filter (ultrafiltration) that holds back large proteins and concentrates them. The main one is alpha-2-macroglobulin, a protein that blocks a wide range of enzymes involved in cartilage breakdown.
Regulatory Disclosure
PRP and plasma-derived protein concentrates are autologous blood products. These products are not approved by the U.S. Food and Drug Administration (FDA) as drugs or biologics for the treatment of osteoarthritis. Clinical use is based on physician judgment, current evidence, and individualized patient evaluation. No outcomes can be guaranteed.
The procedure
What to expect during a visit.
Both fractions are prepared from the same venous draw. The procedure takes about 2 hours, mostly lab processing time.
Intake & screening
We review your history and labs together, including checks for other types of inflammatory arthritis, and confirm this is the right approach for your knee.
Blood collection
Single venous draw into anticoagulated tubes; volume sized for both PRP and protein fractions.
PRP preparation
Two-spin centrifugation produces Lp-PRP from the cellular fraction.
Protein concentration
Platelet-poor plasma undergoes ultrafiltration to concentrate A2M-rich protein fraction.
Image-guided delivery
Combined PRP + protein fraction delivered intra-articularly under ultrasound guidance.
About alpha-2-macroglobulin
What alpha-2-macroglobulin does in the joint.
In osteoarthritis, enzymes called matrix metalloproteinases (MMPs) and ADAMTS proteases break down cartilage. Inflammation in the joint switches these enzymes on. Over time the breakdown outpaces the cartilage cells' ability to rebuild, and the joint surface wears thin.
Alpha-2-macroglobulin (A2M) is a large protein in blood plasma. It traps many of these enzymes, including ADAMTS-4 and ADAMTS-5, and switches them off. Concentrating A2M from your own plasma may tip the balance in the joint away from breakdown, especially when the arthritis is more inflammatory.
In a 2014 study in rats, Wang and colleagues found that A2M protected cartilage from breakdown in a model of osteoarthritis (Wang S, Wei X, Zhou J, et al. Arthritis Rheumatol. 2014;66(7):1843–1853). Studies in people are still at an early stage.
Talking it through
When PRP + Protein is the right protocol.
This combination is one of several options for knee osteoarthritis. At your consultation we check together for other inflammatory types of arthritis, such as rheumatoid arthritis, psoriatic arthritis, and gout, because they need different care. We're more likely to suggest this approach when your osteoarthritis looks more inflammatory than mechanical.
What we look at together
- Mild-to-moderate knee osteoarthritis (grade 2 to 3 on the Kellgren-Lawrence X-ray scale) with signs of inflammation
- Joint-lining inflammation (synovitis) on MRI or exam
- Symptoms that continue despite physical therapy and activity changes
- Labs and an exam to check for rheumatoid arthritis, psoriatic arthritis, and gout
- Expecting change to build over 3 to 4 months
Frequently asked
Questions about PRP + protein-rich plasma.
How is this different from PRP alone or PRP + HA? +
Standard PRP supplies biological signaling. PRP + HA adds hyaluronic acid for lubrication. PRP + protein-rich plasma adds concentrated A2M, which blocks enzymes involved in cartilage breakdown. Each suits a different type of knee osteoarthritis, and we help you sort out which fits yours.
Why check for other types of arthritis first? +
Rheumatoid arthritis, psoriatic arthritis, and gout are not osteoarthritis. They have different causes and need different treatment, and mistaking one for osteoarthritis can delay the medicines that control it. We check for them with labs and an exam before choosing this treatment.
What does α2-macroglobulin actually do? +
A2M is a large protein in blood plasma that blocks a wide range of protein-cutting enzymes, including the MMP and ADAMTS enzymes that break down cartilage in osteoarthritis. By concentrating it from your own plasma and injecting it into the knee, we aim to shift the balance in the joint toward less cartilage breakdown.
How long until I know if it's working? +
Plan for a 3–4 month assessment window. Symptoms typically improve gradually; we follow-up functionally at 6 and 12 weeks and do a comprehensive reassessment at 3–4 months. Response is variable and depends on phenotype, severity, and adherence to post-procedure guidance.
Does insurance cover this? +
No. Most insurers don't cover either part, so it's an out-of-pocket cost. We discuss the cost with you when you book your service and supply documentation for HSA/FSA reimbursement where applicable.
Related therapies
Other paths for knee OA.
Schedule a call
Find out if this combination fits your knee.
Dr. Glowney reviews your imaging, labs, and OA phenotype, and recommends the protocol most likely to help. Sometimes that's this combination; sometimes it's plain PRP, BMAC, or a different path entirely.
720-550-6175