Platelet Rich Plasma Therapy Hip Osteoarthritis Treatments
Ross Hauser, MD.
The evidence for Platelet Rich Plasma therapy for treating Hip Osteoarthritis
Our offices have been offering regenerative medicine injections since 1993 as a service to people who wish to avoid hip replacement surgery. As part of our comprehensive program, we offer Platelet Rich Plasma Therapy, or as we describe it Platelet Rich Plasma Prolotherapy.
If you have come upon this page, it is likely that you have received a recommendation to Platelet Rich Plasma Injections for your hip pain and you are doing your research. We are going to try to offer help with that research, but first, we would like to take a moment to describe how we offer Platelet Rich Plasma Injections for your hip pain as opposed to how you may have been offered this treatment in other offices.
- In Platelet Rich Plasma treatment, your blood is drawn from your arm, it is spun to concentrate the blood platelets which contain concentrated healing elements. The concentrated plasma “rich in healing platelets” solution is then injected into your hip.
In another office, Platelet Rich Plasma treatment may have been explained to you as a one-time injection treatment. You may have been told this one injection will help with your problems of hip joint erosion and address the concern of irreversible hip damage.
- In another office, Platelet Rich Plasma treatment may have been explained to you as a one-time injection treatment. You may have been told this one injection will help with your problems of hip joint erosion and address the concern of irreversible hip damage.
- This “one time,” treatment explanation may offer confusion in that many patients assume PRP injections are cortisone-like in that it is one injection offered at the time of treatment. The single injection PRP causes an inflammatory response, opposite of the cortisone injections effect of causing an anti-inflammatory effect. The effects of the two injections could not be more opposite. Patients are often confused when the inflammation gets worse after PRP and they tell everyone they know that PRP does not work.
- This “one time,” treatment may also confuse patients who have or had been suggested to Hyaluronic acid. This is typically seen in patients who ask about PRP injections “How long does this last?” Hyaluronic acid injections have a finite or limited beneficial effect and patients are typically told how long these types of injections will last. Please read this article comparing Hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis
The controversy surrounding PRP injections for hip osteoarthritis. When it does not work and when it does
We use PRP injections in our office to help facilitate healing. We rarely offer them as a single injection. In our office, we combine PRP injection with Prolotherapy injections as explained and documented below. First, let’s explore the controversial findings surrounding the use of PRP in hip osteoarthritis treatments.
A January 2021 paper published in the journal Clinical Rheumatology (1) questioned the effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis. Calling the use of this treatment as one that “is still controversial.” The researchers noted that “Previous research supports the use of intra-articular PRP injections to promote a favorable environment for joint tissue healing and to delay the progression of osteoarthritis.” (Some of those studies are noted below). The purpose of this study according to the researchers was to investigate the effectiveness of PRP in the management of hip osteoarthritis by reviewing previously published patient data. A total of 4 trials (334 participants, 340 hips) were included. The findings: “PRP may be beneficial and safe for patients with hip osteoarthritis . . . however, its superiority over other procedures such as hyaluronic acid remains unclear.”
In our experience in treating thousands of patients, PRP is much less effective than a single dose treatment.
We have found PRP to be very effective as part of a comprehensive multi-dose treatment program
PRP treatments for hip pain will not help everyone. But because of the great variation in treatments researchers suggest that it is difficult to tell who the treatment can help and who the treatment will not help.
Single PRP treatment is not how we see PRP treatments. We see PRP treatments in conjunction with Prolotherapy treatments (Prolotherapy is a simple injection technique that works to strengthen the hip ligaments and provide stability to the hip. This is explained below.) In combination, we see these treatments as a means to not only delay the need for a hip replacement but to prevent the need for a hip by repairing and regenerating tissue in the hip. We see this as the best chance for success.
In our experience, when somebody has degenerative hip disease and the cartilage is wearing away and being lost, you simply cannot repair the cartilage without addressing what is causing the cartilage damage. This is the joint erosion or irreversible joint damage you are hearing so much about. It manifests itself as instability in your hip, the feeling that your hip is giving way or is loose and wobbly.
- It is important that anyone contemplating treatment with platelet-rich plasma therapy should address the instability issue by adding comprehensive Prolotherapy treatments to the PRP treatments. Please see our article The evidence that alternatives to hip replacement can work for you. This includes a more detailed discussion of the use of PRP in combination with hip osteoarthritis.
Prolotherapy utilizes hypertonic dextrose, among other simple ingredients that are individualized to each case, to initiate localized soft tissue repair. In the hip, the treatment is used to repair, tighten and strengthen the ligaments that hold the hip bones in place.
PRP does not work for everyone. Your candidacy for treatment should be carefully evaluated
An August 2019 study come to us from the Weill Cornell Medicine, Department of Rehabilitation, New York-Presbyterian Hospital. It was published in the journal Pain Medicine (2). Here are the simple learning points of that paper:
“Platelet-rich plasma (PRP) is a minimally invasive treatment option to reduce pain and promote tissue healing. At the time this study was performed, there was limited published literature analyzing outcomes for patients treated with PRP for hip osteoarthritis.
How the study worked: Thirty-six patients aged 49-85 years with chronic hip pain who were deemed good candidates for this study’s purposes, underwent image-guided intra-articular hip PRP injection. Outcomes were measured at baseline, two weeks, three months, and up to six months using standard scoring and disability scales. The number of people who had more than a 50% improvement in pain reduction and functional ability was further assessed.
- Results: At two weeks, there was a significant improvement of function in people divided into one of two Hip Disability and Osteoarthritis Outcome Score groups:
- Symptoms and Activities of Daily Living.
- Pain Symptoms
- Sixty-seven percent (24/36) of the patients reported a more than 50% improvement in pain at three months;
- 58% (21/36) reported a more than 50% improvement in pain at six months.
- Conclusions: In patients with mild/moderate hip osteoarthritis, PRP may provide pain relief and functional improvement for up to six months.
There are some doctors who warn against PRP use
There are some doctors who warn against PRP use. Doctors at the Keck School of Medicine of USC, wrote in the journal Current Reviews in Musculoskeletal Medicine, (3) December 2018, “PRP is a costly treatment not covered by insurance, and clinical trials have not demonstrated definitive efficacy, we recommend informing patients when providing PRP ‘off-label.” Like any medical treatment, PRP will not fix everything, for some patients, PRP will not work for their hip pain for various reasons, generally speaking, a condition of hip degenerative disease that is “too far gone.”
Further doctors stress that patients be evaluated for the realistic candidacy of treatment. PRP should only be offered when there is a realistic expectation that the patient is considered a good candidate for treatment success. A multinational team of researchers also writing in the journal Current Reviews in Musculoskeletal Medicine (4) June 2019 suggested: “Although PRP is safe to use and it can be easily applied in the clinics, case-specific considerations are needed to determine whether PRP could be beneficial or not. If the use of PRP is favored, then, the configuration/optimization of the preparation and administration/delivery strategy with or without a concomitant treatment may further enhance the clinical outcomes and patients’ experience.”
A third paper in the journal Current Reviews in Musculoskeletal Medicine (5) December 2018 from Stanford University suggested: “PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.”
PRP can help you avoid a hip replacement
In November 2021, doctors in Italy published a comparative study in the journal BioMed Central Musculoskeletal Disorders (6). This article is filled with comparative studies, some even in contradiction with each other. However, they did find benefits of PRP injections:
“Intra-articular hip injections can be a useful instrument to reduce pain and improve function in hip osteoarthrosis, however, structured studies of high quality about this topic are still lacking. Although this review does not allow us to provide strong recommendations, we can observe that there is a short-term efficacy of PRP for pain decrease and long-term effectiveness for the improvement of function in patients affected by hip osteoarthrosis. The association of hyaluronic acid and corticosteroid can give better results compared to hyaluronic acid alone, while the use of intra-articular ketorolac and saline solution requires more studies.”
As described above, many patients come in with preconceived notions suggested to them by their orthopedists that PRP treatment is a one-injection treatment, the effects will wear off, when the PRP effects wear off, surgery can then be discussed.
Despite evidence that PRP can help patients with hip osteoarthritis by addressing and correcting the destructive hip instability, there is a belief among many in the medical community that PRP is only a stopgap to delay hip replacement surgery. By offering the patient that one-time treatment, they will be providing the patient with significant pain relief until they are ready for hip replacement.
There are numerous studies that show a lack of effectiveness in PRP treatments. These studies surround single-dose/injection treatment. It should make sense to anyone researching the use of PRP for hip osteoarthritis that it is unlikely that you can reverse years of degenerative hip disease with a single injection of anything. A degenerative disease does not happen overnight, nor does it reverse overnight.
PRP compared to other treatments
A May 2020 (7) study published in the journal Arthroscopy compared the clinical outcomes of platelet-rich plasma, hyaluronic acid, corticosteroid, and a combined treatment of hyaluronic acid plus platelet-rich plasma for effectiveness in patients with hip osteoarthritis. What they found was: “corticosteroid injections are recommended as the most efficient agent in hip osteoarthritis patients in the short term. Moreover, PRP is reported to have the highest rank for pain relief for up to 6 months.” Again this is one injection vs one injection study. One injection of PRP is not our treatment standard.
A September 2022 study in the journal BMC Musculoskeletal Disorders(15) sought to compare the effectiveness of intraarticular injections of PRP, hyaluronic acid and a combination injection treatment of PRP and hyaluronic acid for patients with hip osteoarthritis. The researchers theorized that since hyaluronic acid injections and PRP injections work in different ways, combining the two may have a synergistic effect and work better than either application applied alone. Was this in fact the case? No.
- In this study, the researchers followed patients with grade two and grade three osteoarthritis.
- These patients were then randomly divided into three injection groups:
- PRP injection treatments
- hyaluronic acid injection treatments and
- a combination of PRP and hyaluronic acid injection treatments.
- In these groups, two injections with 2 weeks’ interval were performed into the hip joint under ultrasound guidance.
All three groups, PRP injection treatments, hyaluronic acid injection treatments and the combination of PRP and hyaluronic acid injection treatments, showed significant improvement in pain reduction and pain and disability scores at two months and six months compared with baseline. However, the researchers found: “Although all 3 interventions were associated with improvement of pain and function in patients with hip osteoarthritis, the therapeutic effects of PRP and PRP and hyaluronic acid injections lasted longer (6 months), and the effects of these two interventions on patients’ performance, disability, and activities of daily living were superior to hyaluronic acid in the long run. Moreover, the addition of hyaluronic acid to PRP was not associated with a significant increase in the therapeutic results.”
Please see these articles for further comparisons
- Hyaluronic acid or platelet-rich plasma in the treatment of hip osteoarthritis?
- The different kinds of injections for bone on bone hip
What are we seeing in this image?
In this x-ray comparison, we see a hip joint that has been subjected to numerous cortisone injections and has demonstrated accelerated and significant breakdown. The cortisone injections, as documented in research in this article, have contributed to the bone-on-bone situation.
The evidence for PRP in hip surgery wound and injury repair
It is somewhat amazing that the bulk of research surrounding the use of PRP in the hip is focused on how to make wound healing better after hip replacement surgery. It is amazing because patients seek PRP to avoid surgery.
- In October 2018, in the journal Medicine, doctors found that PRP might prevent postoperative bleeding in total hip replacement patients. Postoperative bleeding can be a problem in many patients following hip replacement. (8)
- In July 2018, in the Journal of Experimental Orthopaedics, doctors wrote of the possible extensive tendon damage following hip replacement procedures. They suggested PRP may assist in the healing of these tendons. Extensive tendon damage could be a problem for some patients getting a hip replacement and severely impact the patient’s ability to walk correctly after surgery. (9)
PRP after Core Decompression
- In January 2021, researchers writing in the medical journal Clinical Rheumatology (10) sought to investigate whether PRP could make a core decompression procedure more successful. Here is what they wrote: “Avascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression remains controversial. . . PRP use after core decompression provides significant pain relief, better midterm functional outcome, retards the progression, and enhances the survivorship free from reoperation for hip arthroplasty and femoral head collapse in early stages of avascular necrosis of hip than core decompression alone.”
Can PRP help avoid surgery?
- In one case published in PM & R: The Journal of Injury, Function, and Rehabilitation PRP was found very effective for advanced-stage degenerative AVN of the hip, with the patient demonstrating significant functional improvements and the ultimate outcome of being able to avoid surgery. (11) It should be noted that this was a single case history.
- In a study from doctors at the University of Florence, researchers found that a majority of patients receiving PRP for hip osteoarthritis had significant pain reduction at 6-7 weeks, which was sustained at 6 months, with a better range of motion. (12)
- Researchers from the Rizzoli Orthopedic Institute in Italy published their findings in the American Journal of Sports Medicine which showed intra-articular PRP injections offer a significant clinical improvement in patients with hip osteoarthritis without relevant side effects. (13)
An April 2021 paper (5) published in the World Journal of Stem Cells summarized the use of PRP this way:
“PRP therapy has advantages such as rapid preparation and technical simplicity; it is also a point-of-care procedure, and can be carried out in-office due to its minimal invasiveness, permitting intra-articular, intra-tendinous or even intra-osseous injection. As a result of its autologous origin, it exhibits a unique safety profile, lacking many drug-related side effects or interactions. In osteoarthritis), PRP can interfere in the catabolic and inflammatory cascade (work as an anti-inflammatory), in order to promote anabolic responses.
Our experience with PRP and hip osteoarthritis.
Our published research
Prolotherapy, by itself, is a very effective treatment. We may add Platelet Rich Plasma as part of the Prolotherapy treatment when damage to the hip cartilage is more substantial. We never give only PRP into the hip without Prolotherapy to the surrounding, supportive ligaments.
In our published research, only on the use of Prolotherapy, published in 2009, (14) we looked at 61 patients, 33 of them had hip pain in both hips. Twenty of these patients were told that there were no treatment options available to them, with eight being recommended to surgery as their “only hope,” for hip pain alleviation.
Of the 94 hips treated in the 61 patients:
- 89% experienced more than 50% of pain relief with Prolotherapy;
- more than 84% showed improvements in walking and exercise ability, anxiety, depression, and overall disability;
- 54% were able to completely stop taking pain medications.
In this video for athletes and active patients, a demonstration of the type of Comprehensive Prolotherapy offered at Caring Medical is shown.
- This should also be seen as a demonstration of how Prolotherapy can help get the worker back to the job, and the hip osteoarthritis patient back to mobility. In the video, the patient is comfortable in receiving these injections.
In this video, you also see that the injections are not only targeted at the center of the joint, as in PRP injections but also around the joint. What this does is address joint instability by treating the ligaments of the peri-articular or “outside” hip region.
If you have questions about PRP for your hip pain, Get help and information from our Caring Medical staff
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This page was updated December 14, 2021