Platelet Rich Plasma Therapy Hip Osteoarthritis Treatments

Ross Hauser, MD. Danielle R. Steilen-Matias, MMS, PA-C

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.

PRP can help you avoid a hip replacement

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.

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 the 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.

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 (1). 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.

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, (2) 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 (3) 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 (4) 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.”

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.

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, has contributed to the bone on bone situation.

PRP does work for many people

June 2020 in the journal Clinical Rheumatology (5) while suggesting that the effectiveness of PRP injections for osteoarthritis is still controversial, they found that “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.”

Comparing PRP and Cortisone

A January 2020 study in the medical journal Arthroscopy (6) compared 4 intra-articular injections (platelet-rich plasma [PRP], hyaluronic acid, corticosteroid, and hyaluronic acid plus PRP) for hip osteoarthritis.

The researchers made these recommendations:

We have a separate article, Hyaluronic acid or platelet-rich plasma in the treatment of hip osteoarthritis? That further compares these two treatments.

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.

PRP after Core Decompression

Can PRP help avoid surgery?

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, (13) 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:

In this video for athletes and active patients, a demonstration of the type of Comprehensive Prolotherapy offered at Caring Medical is shown.

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

1 Singh JR, Haffey P, Valimahomed A, Gellhorn AC. The effectiveness of autologous platelet-rich plasma for osteoarthritis of the hip: a retrospective analysis. Pain Medicine. 2019 Aug 1;20(8):1611-8. [Google Scholar]
2 Jones IA, Togashi RC, Vangsness CT. The economics and regulation of PRP in the evolving field of orthopedic biologics. Current reviews in musculoskeletal medicine. 2018 Dec 1;11(4):558-65. [Google Scholar]
3 Cengiz IF, Pereira H, Espregueira-Mendes J, Reis RL, Oliveira JM. The Clinical Use of Biologics in the Knee Lesions: Does the Patient Benefit?. Current reviews in musculoskeletal medicine. 2019 Sep 15;12(3):406-14. [Google Scholar]
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6 Zhao Z, Ma JX, Ma XL. Different Intra-articular Injections as Therapy for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Jan 7. [Google Scholar]
7 Wang X, Ma J, Wang Z, Xiao L. The clinical efficacy of using autologous platelet-rich plasma in total hip arthroplasty: A retrospective comparative study. Medicine. 2018 Oct 1;97(40):e12451. [Google Scholar]
8 Aavikko A, Puhakka J, Haapala J, Kukkonen J, Mäkelä K, Kosola J. Perioperative platelet rich plasma (PRP) in total hip arthroplasty through the Hardinge approach: protocol to study the effectiveness for gluteus medius healing. Journal of Experimental Orthopaedics. 2018 Dec 1;5(1):23. [Google Scholar]
9 Aggarwal AK, Poornalingam K, Jain A, Prakash M. Combining platelet-rich plasma instillation with core decompression improves functional outcome and delays progression in early-stage avascular necrosis of femoral head: a 4.5-to 6-year prospective randomized comparative study. The Journal of Arthroplasty. 2021 Jan 1;36(1):54-61.
10 Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PM R. 2012 Dec;4(12):1015-9. doi: 10.1016/j.pmrj.2012.07.009.  [Google Scholar]
11 Civinini R, Nistri L, Martini C, Redl B, Ristori G, Innocenti M. Growth factors in the treatment of early osteoarthritis. Clinical Cases in Mineral and Bone Metabolism. 2013;10(1):26-29. doi:10.11138/ccmbm/2013.10.1.026. [Google Scholar]
12 Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, Tschon M, Giavaresi G. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. The American journal of sports medicine. 2016 Mar;44(3):664-71. [Google Scholar]
13 Hauser RA, Hauser MA. A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Hip Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2009;2:76-88. [Google Scholar]

This page was updated February 22, 2021

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Fort Myers, FL 33908
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