Nstride Autologous Protein Solution Therapy

nSTRIDE autologous protein solution (APS) is a novel treatment for joint pain and osteoarthritis (OA) which has been approved by Health Canada and the FDA for treatment of knee OA.

The treatment involves a single injection of a protein liquid derived from your own blood. It’s drawn from an arm vein prior to the injection and centrifuged to remove unwanted blood components and then spun again to obtain the protein liquid. APS has proven to be a safe and effective treatment, which has been shown to reduce pain and protect cartilage by reducing further destruction. As a result, there is a decrease in pain and an improvement in joint function, often within a few weeks of the injection. In clinical studies, patients reported little or no pain in 85% of cases after the procedure and about 70% symptom improvement even 24 months after the treatment.

This treatment has been evaluated most extensively in the knee and is most effective in treatment of mild-moderate OA. For best results, we recommend a single injection. There is a fee for this treatment.

HOW DO I PREPARE FOR MY PROCEDURE?

• Please avoid anti-inflammatory medication (ibuprofen, etc.) for two weeks before and two weeks after your injection.
• Do NOT stop taking low-dose aspirin if prescribed by your doctor.
• Please inform our booking coordinators of any blood thinners you may be taking, so that they can discuss further instructions with you.
• If you take insulin to manage your diabetes, please let your booking coordinator know. You may have some juice and a small snack after taking your insulin.
• If you are currently taking antibiotics, you will need to wait two days after your last dose to be able to have your injection done.
• Take all prescribed medications as directed.
• You are encouraged to have a small snack one hour before your exam.
• Please arrive 30 minutes before your appointment to allow enough time to fill out a consent form.
• Bring photo identification and your provincial health card.
• Wear comfortable clothes.
• Please do not bring children who require supervision.

WHAT HAPPENS DURING MY PROCEDURE?

• A team member will go over your consent form, explain the procedure, and answer any questions you may have.
• We will take a small volume of blood from your arm to prepare the injection.
• The blood sample is placed in a centrifuge and then prepared in a sterile manner. You can rest in a waiting room during this process; it takes 20 minutes.
• A technologist will bring you into the treatment room and position you on the table. A radiologist will evaluate the area, clean the skin, and inject a local anesthetic.
• Once frozen, using image guidance, the radiologist will inject the APS preparation into the affected joint using a sterile needle.
• You will be assessed post-injection by our team and, if there are no concerns, you will be free to leave.

POST-PROCEDURE INSTRUCTIONS

• First 24 hours: Keep the treatment area clean. Leave the Band-Aid on. Do not shower. Please rest the injected area for the rest of the day after your injection.
• First 48 hours: Avoid bathtubs, hot tubs, and pools. Avoid strenuous activity and lifting.
• After one week: Avoid strenuous activity or physiotherapy for at least five days following your injection with a gradual return to activity. Be mindful of your pain and stop if it hurts too much, or other symptoms worsen. You may resume physiotherapy, but notify your physiotherapist that you have had this injection so they can modify your exercises if necessary.
• If possible, please avoid anti-inflammatory medication for two weeks (such as ibuprofen – Advil). It may interfere with the effectiveness of your injection.
• Watch for infection: If you develop worsening pain, skin redness at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.
• If you have pain or other symptoms beyond 48 hours after your injection, this is a normal reaction. You may apply heat and ice to the treatment area. If you have any questions, please email us at paintherapy@radiology.ca during business hours.

WHEN WILL I SEE RESULTS?

• Results from early healing are not typically appreciated until one month after the procedure, although healing and repair continue over 12 months. 
• Some patients get complete, permanent relief from their symptoms, while others may notice limited benefit. If an injection does not help relieve your symptoms after two months, then you may need further evaluation by your referring doctor. 
• Please consult with your doctor regarding your results and any follow up exams or questions.

HOW MUCH WILL IT COST?

We advise a single APS treatment for $1,250. This price includes a preparation kit, the cost of which is set by the manufacturer (Zimmer Biomet). This procedure is only available in Alberta.