How Does Platelet-Rich Plasma (PRP) Therapy Compare to Other Non-Surgical Arthritis Treatments?

What is Osteoarthritis?

Osteoarthritis (OA)1 – the “wear and tear” type of arthritis – is the leading type of arthritis worldwide. As patients age, their risk of OA increases. Other risk factors include previous injury to the joint, obesity, genetics, and a myriad of other factors.1 OA occurs due to a combination of these risk factors, mechanical stress on the joint, and abnormal biomechanics of the joint and surrounding muscles.1 This results in joint space degradation, which can lead to symptoms such as stiffness, pain, and restricted range of motion. OA can affect any joint in the body but most commonly targets the knees, hips, and shoulders.

How is Osteoarthritis Treated?

After being diagnosed with osteoarthritis (often by X-Ray), patients have multiple non-surgical osteoarthritis treatment options available to them. Treatment options can include: 

Additionally, image-guided injection therapy can be used to further relieve arthritis pain when more conservative treatments are not effective. Common injection treatments include corticosteroids, Hyaluronic acid (HA) and Platelet-Rich Plasma (PRP).

How Do Injection Therapies Work?

Corticosteroids2 are medications made to mimic our body’s own anti-inflammatory molecules.  Steroid injections can be helpful in reducing joint pain, but repeated injections can worsen bone health2 and are linked with cartilage breakdown – a risk factor for worsening arthritis.3 In addition, response to steroid injections can be short lived. These shortcomings make other injection options like PRP very promising. 

Hyaluronic Acid (HA) (aka visco-supplementation) injections supplement the joint’s natural hyaluronic acid, which acts as a lubricant and shock absorber.4 These “gel” injections are synthetically made or are derived from the rooster comb. HA injections are only approved for knee arthritis and are typically administered in a series of 3-5 weekly injections. Previous studies comparing HA to PRP injections have found PRP injections to be more helpful for treating knee arthritis, especially for long-term pain relief.

Platelet-Rich Plasma (PRP) has emerged as treatment not only for the management of soft-tissue injuries, but also for treating osteoarthritis. PRP utilizes a portion of a patient’s own blood which is spun in a centrifuge to separate the platelets from the whole blood prior to injecting them into the arthritic joint. The platelets carry growth factors and proteins which stimulate the body’s natural inflammatory cascade to promote healing, reduce pain, and improve function. If you have more questions about PRP or want to know what to expect during your inital PRP injection, be sure to contact our team.

So, Does PRP Work for Knees?

Substantial evidence supports the use of PRP for knee osteoarthritis, which can help reduce pain and improve function.

A 2021 study5 compared PRP injections to corticosteroids, HA and placebo injections; PRP was superior at reducing pain scales at 3 months, 6 months and 12 months for patients with knee OA. 

One of the most cited studies supporting PRP for knee OA was published in 20166, where PRP was shown to have better outcomes, require less re-intervention, and lead to better patient pain satisfaction scores when compared to HA.

A 2021 systemic review of several studies7 comparing PRP and HA for knee OA, found that patients receiving PRP had reduced pain scores and more significant improvement at 11 months compared to HA injections.

A 2020 study in the Journal of Orthopedic Surgery and Research8 demonstrated that PRP and corticosteroids elicited similar pain relief for mild-to-moderate knee arthritis pain at one week following injection. PRP, however, had much longer lasting benefits, with lower pain scores reported at one year.  

The long lasting effect of PRP for knee OA has been confirmed9 by many other randomized controlled trials, and additionally, another study10 showed a link between repeated PRP injections and improved outcomes.

Can PRP be Used on My Arthritic Hip?

There is also evidence for the efficacy of PRP in managing hip arthritis-related pain and reduced function.

A randomized controlled trial11 compared the effects of HA vs PRP, and found that PRP alone, and a combination of PRP and HA together were superior to HA alone for patients with hip OA; it should be noted that all three treatments provided pain relief.

A 2016 study12 compared PRP vs PRP+HA vs HA alone, injected weekly for 3 weeks for patients with hip OA. The PRP group had the most pain relief, followed by PRP+HA. 

Compared to knee OA, there are fewer high-quality studies comparing PRP to corticosteroid injections for the hip. However, given the short term effect of steroids and the long-term risk of repeated steroid injections, PRP should be considered as an early alternative injection for hip OA.

What About PRP for an Arthritic Shoulder?

Non-operative treatment of shoulder arthritis has commonly used corticosteroids, however, many patients requiring these injections eventually undergo shoulder replacement 13. PRP is being studied as an alternative option for patients with shoulder OA. Case reports and small studies have supported PRP as a beneficial treatment, and research for the use of PRP for shoulder arthritis is ongoing. 

The 2022 PROBE trial 14 showed that corticosteroids provided faster relief than PRP, but PRP provided longer lasting results for shoulder OA. 

A 2022 study 15 from the Clinical Journal of Sports Medicine showed that HA injections and PRP injections both reduced shoulder pain scores in patients with shoulder arthritis.

Can My Sacroiliac (SI) Joint be Injected with PRP?

A 2021 systematic review showed 16 that while corticosteroids are an effective treatment for SI joints, those undergoing PRP interventions had similar pain relief, with better outcomes at 3 and 6 month follow ups.

There is certainly a role for PRP in treatment of SI joint OA, and further research should continue to show promising effects.

What Else Can Be Injected with PRP?

In addition to knee, hip, shoulder, and SIJ arthritis, PRP is widely being used to treat other arthritic joints throughout the body for pain relief that is more sustained and healthier for the joint in comparison to corticosteroid injections.

Want to Learn More?

Come see us at Desert Spine and Sports Physicians for a consultation. Our Board-Certified PM&R and Fellowship-trained providers are skilled in non-operative arthritis treatment and are happy to help find the best treatment for you. 

 

  1. Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482326/
  2. Hodgens A, Sharman T. Corticosteroids. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612/
  3. https://dailybulletin.rsna.org/db22/index.cfm?pg=22tue16
  4. Migliore A, Procopio S. Effectiveness and utility of hyaluronic acid in osteoarthritis. Clin Cases Miner Bone Metab. 2015 Jan-Apr;12(1):31-3. doi: 10.11138/ccmbm/2015.12.1.031. PMID: 26136793; PMCID: PMC4469223.
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