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.
- 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.
- 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 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
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 the 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 as 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 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 for 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
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.”
PRP does work for many people
A 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:
- Corticosteroid injections are recommended as the most efficient in hip osteoarthritis patients in the short term. PRP is reported to have the highest rank for pain relief for up to 6 months. PRP is better in the long-run.
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 into the hip is focused on how to make wound healing better after invasive 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.(7)
- 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.(8)
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.(9) 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.(10)
- Researchers from the Rizzoli Orthopedic Institute in Italy published their findings in the American Journal of Sports Medicine which showed intra-articular PRP injections offered a significant clinical improvement in patients with hip osteoarthritis without relevant side effects.(11)
Our experience with PRP and hip osteoarthritis.
The video below is from 2010. We have been offering PRP treatments for even longer than that. Over the years we have found how to give these treatments in ways that will provide the patient the best chance for successful healing and the avoidance of hip replacement surgery. As pointed out above, PRP therapy does not work for everyone, sometimes a hip will be too far gone.
Dr. Hauser explains the treatment
We are starting the video at the treatment point at 4:15.
Video summary points
- The initial injections anesthetize the back of the hip and around the hip. This makes the procedure a lot more comfortable for the patient
- (At 4:35) The “red” injections is the Platelet Rich Plasma injection. You can see this is not a “one shot, treatment. The injections is moved around.
- PRP is comprised of the portion of the blood that has the healing growth factors including platelet-derived growth factor, fibroblast growth factors, and healing factors that initiate the healing cascade.
- We have found PRP injections to be effective for hip labral tears and for articular cartilage degeneration (the developing bone on bone situation)
- (at 5:10) Prolotherapy inections follow up the PRP injections. Here I am injecting the greater trochanter area and then I also do around the hip and here we’re going to inject structures such as the iliofemoral ligament, the ischiofemoral ligament, as well as the muscle attachments into and around the hip.
- The reason to do both PRP and Prolotherapy is because when someone has chronic hip pain, it is not only the the joint itself that is damaged, the cartilage and the bone on bone, but it is also the supporting structures around the hip that can be damaged. If you don’t treat the structures around the hips, such as the muscle attachments, the tendon attachments, and the ligament attachments, the pain, for many people, will not resolve completely with only PRP.
- As you can see from this video the procedure is very well tolerated it only takes a couple minutes and it works very well for labral tears and various tendinopathies as well.
There are more articles on our website surrounding the avoidance of hip replacement.
- You can read about The evidence for alternatives to hip replacement
- Research on Platelet Rich Plasma Prolotherapy stimulating bone growth and repair
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, (1) 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
1 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]
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]
4 Le AD, Enweze L, DeBaun MR, Dragoo JL. Current clinical recommendations for use of platelet-rich plasma. Current reviews in musculoskeletal medicine. 2018 Dec 1;11(4):624-34. [Google Scholar]
5 Medina-Porqueres I, Ortega-Castillo M, Muriel-Garcia A. Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: a systematic review and meta-analysis [published online ahead of print, 2020 Jun 30]. Clin Rheumatol. 2020;10.1007/s10067-020-05241-x. doi:10.1007/s10067-020-05241-x [Google Scholar]
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. 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]
10. 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]
11. 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]