What is a PRP injection?
Platelet-rich plasma, or PRP, is a natural substance obtained from the person’s own blood. It has a high concentration of different growth factors that can help the healing process when injected into a joint or tendon. Plasma is one of the normal blood constituents and can be extracted by spinning the blood in a special machine at high speed (centrifuge) to separate its different components. The plasma naturally has a high concentration of platelets, which are rich in growth factors. Research shows that these factors can assist in healing when injected into joints or tendons.
Are there different types of PRP preparations?
Yes, there are different types of PRP preparations. For example, some can concentrate platelets 8x their normal level, while others only double the platelets concentration. Generally, PRPs are divided into either “leukocyte-rich “ or “leukocyte-poor” preparations, according to the concentration of the white blood cells (leukocytes).
Determining which PRP injection to use to manage hip joint pain depends on the disease process affecting the joint. For example, in hip joint osteoarthritis, evidence shows good effects for “leukocytes-poor” preparations. However, “leukocyte-rich“ preparations are preferred for conditions like greater trochanteric pain syndrome, proximal hamstring and adductor tendinosis.
What hip conditions would benefit from PRP injections?
Hip osteoarthritis is a degenerative condition that results from progressive wear and tear of the articular cartilage (the protective layer that covers the bones at the joint). It is the most common type of hip arthritis. To find out more, read our article about hip osteoarthritis. The available injection treatment options for osteoarthritis include corticosteroid injections, hyaluronic acid injections and Platelets-rich plasma (PRP) injections. PRP injections are being increasingly used in the management of osteoarthritis.
Gluteal tendinosis is a common condition seen in up to 25% of the population. It results from inflammation of the gluteal tendons at their attachment to the greater trochanter. Often, there is associated inflammation of the overlying trochanteric bursa, a condition referred to as trochanteric bursitis". When injected into the inflamed tendon, PRP injections can induce a natural healing process. Some research shows a good response from PRP injections in patients with partial gluteal tendon tears, but we prefer to preserve PRP injections only for the management of tendinosis. Using ultrasound guidance is essential to ensure accuracy. Please see our article about greater trochanteric pain syndrome to learn more about gluteal tendinosis.
Proximal hamstring and adductor tendinosis
Do PRP injections reverse hip joint damage?
Although the injected plasma is rich in growth factors and can promote healing, there is no convincing evidence that PRP injections can reverse damage to the articular cartilage. Further studies are needed to establish whether PRP injections have a regenerative effect when injected into joints and tendons.
What shall I do before a PRP injection?
Make sure you are well-hydrated before attending your appointment. Also, it is important to avoid anti-platelet medications (like aspirin and ibuprofen) as these reduce the efficiency of platelets and interfere with their function. Therefore, you should avoid such medicines for 10-14 days before the procedure. Similarly, you should avoid these medicines for a few weeks following the procedure.
How many PRP injections do I need?
The evidence suggests that a course of treatment is more effective than a single injection for managing arthritis and tendinosis. Still, more research is needed to strengthen this. The current results show that a course of 2 or 3 injections provides a longer response, lasting up to 24 months after the injection, compared to a single injection.
Is ultrasound needed to perform platelet-rich plasma injections for the hip?
Yes. Hip injections must be done under ultrasound guidance. The hip joint is a deep structure; ultrasound is required to ensure an accurate and safe procedure.
What are the possible side effects of a hip PRP injection?
As with other injections, there is a minimal risk of infection (approx. 1:10000 to 1:100000).
A pain flare for a few weeks following the injections is possible. You can use simple painkillers like paracetamol and codeine but avoid using medicines like Ibuprofen and Voltarol, as these can interfere with the platelets' function.
The possibility of tendon injury/rupture is very rare and only applicable to PRP injections performed into tendons (like the gluteal and hamstring tendons).
Rarely, in about 1-2% of cases, the symptoms can worsen after the injection.
I will discuss the treatment and the potential risks before the procedure.
What do I need to do after the procedure?
You will be advised to rest and avoid strenuous activities to the body area injected for at least one week after the injection. The advised rest period may vary depending on the area treated. Also, monitor the area for any redness, swelling, pain or warmth. These are potential signs of infection that are extremely rare (1:10000-1:100000) but require urgent medical attention.
How soon will I notice improvement after a PRP injection?
The PRP injection is a long-term therapy, meaning it usually takes a few weeks after the procedure for the patient to start noticing the benefits.
Could both PRP and hyaluronic acid be combined in one injection?
Hyaluronic acid is a naturally occurring substance found in joints, tendons and connective tissues. Please read our article about Hyaluronic acid injection to learn more about this treatment option. A study looking into combining PRP and hyaluronic acid injections has shown less pain in the combined treatment group at 3 and 12 months compared to PRP injection only. However, research is still scarce, and more is needed to help us build more robust conclusions. Generally, we advise separating these treatment options.
Is PRP injection for the hip better than corticosteroid?
A recent systematic review and meta-analysis showed that PRP treatment has superior results compared to cortisone for managing moderate knee joint osteoarthritis. The positive results from the PRP injections were double those observed from the corticosteroid treatment. Furthermore, the effect lasted longer, as significant results secondary to the PRP treatment were observed 6-9 months after the treatment. PRP therapy is not found to cause harm, unlike corticosteroids, as some research has shown potential adverse effects on the articular cartilage, especially with repeated injections.
Can I have a PRP injection if I am on blood thinners like Warfarin?
Yes. Warfarin does not affect PRP treatment. However, there is a small risk of increased bleeding following the procedure if you are on warfarin or other blood-thinning medicines. I will discuss this before the procedure.
Hip conditions and treatments