From the Guidelines
Platelet-rich plasma (PRP) injections into joints have inconsistent effects on osteoarthritis, with some studies showing small benefits in pain reduction and improved function, while others report no significant difference compared to other treatments, such as hyaluronic acid. The procedure involves drawing the patient's blood, processing it to concentrate platelets, and injecting this platelet-rich solution directly into the affected joint. According to the most recent and highest quality study, 1, PRP is an alternative with two high-quality studies and one moderate-quality study supporting reduced pain and improved function in patients with knee osteoarthritis; however, the evidence demonstrated inconsistency with a worse treatment response in patients with severe knee osteoarthritis.
Key Considerations
- The standard regimen consists of 1-3 injections spaced 2-4 weeks apart, with potential maintenance injections every 6-12 months depending on symptom response.
- Before the procedure, patients should avoid anti-inflammatory medications for 7-10 days as these can interfere with platelet function.
- Following injection, patients should rest the joint for 24-48 hours and gradually return to normal activities over 1-2 weeks.
- PRP works by delivering growth factors and cytokines that promote tissue healing, reduce inflammation, and potentially stimulate cartilage repair.
- Side effects are generally minimal and include temporary pain at the injection site, swelling, and stiffness that typically resolves within a few days.
Evidence-Based Recommendation
Based on the most recent and highest quality study, 1, the use of PRP injections for osteoarthritis cannot be universally recommended due to the inconsistent evidence and variability in treatment response. However, for patients who have failed other treatments and are seeking alternative options, PRP may be considered as a potential treatment for knee osteoarthritis, under the guidance of a qualified healthcare professional. It is essential to weigh the potential benefits and risks of PRP injections and discuss individualized treatment plans with patients. Additionally, patients should be aware of the limited evidence supporting the use of PRP for hip osteoarthritis, as noted in the study by 1.
From the Research
Effects of Platelet-Rich Plasma (PRP) Injections into Joints
- PRP injections have been shown to be effective in improving pain symptoms and functional activity in patients with osteoarthritis (OA) 2, 3, 4, 5
- Studies have demonstrated that PRP injections can improve Visual Analog Scale (VAS) pain scores, Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, and Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with knee osteoarthritis (KOA) 2, 3
- Leukocyte-poor (LP) PRP injections have been found to be more effective than leukocyte-rich (LR) PRP injections in improving pain symptoms in patients with OA 2
- Intra-articular PRP injections have been shown to be effective in improving functional activity and reducing pain symptoms in patients with KOA, with some studies suggesting that combined PRP and hyaluronic acid (HA) injections may have a synergistic effect 3, 4
- However, not all studies have found PRP injections to be effective, with some suggesting that the treatment may not be suitable for all patients with OA, particularly those with hip osteoarthritis (HOA) 2, 6
Comparison with Other Treatments
- PRP injections have been compared to hyaluronic acid (HA) injections, with some studies suggesting that PRP may be more effective in reducing pain and improving functional activity in patients with KOA 3, 4
- However, other studies have found that PRP and HA injections have comparable efficacy in terms of pain relief and functional outcomes in mild to moderate knee OA 4
Safety and Adverse Events
- PRP injections have been found to be safe and well-tolerated, with few adverse events reported in clinical trials 2, 3, 4
- However, the long-term effects of PRP injections are not yet fully understood, and further research is needed to determine the safety and efficacy of this treatment over an extended period 6