PRP injections involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Why is PRP an option? Because selected research suggests it can help people with Greater trochanteric pain syndrome. To be fair the research is limited. This is pointed out in a study published in June 2021. (1)  The study author’s wrote: “Evidence supporting the use of platelet-rich plasma (PRP) injections in the treatment of Greater trochanteric pain syndrome is limited. In a systematic review of five articles and four published abstracts comprising 209 patients treated with PRP injections concluded that PRP represents a potentially viable treatment, although current evidence is based on small sample, low-quality studies.” Outlined below are some of these studies.

In January 2020, a study published in the medical journal Cureus, (2) offered the following on the comparison of PRP treatments to cortisone:

  • 24 patients with greater trochanteric pain syndrome were enrolled and randomized into two study groups
  • In Group A patients received ultrasound-guided PRP injection treatment, while group B patients received ultrasound-guided cortisone injections. Clinical outcomes in both groups were evaluated and compared using various patient reported scoring systems.
  • Both groups showed improved scores compared to the pre-injection period, but patients in the PRP group had a statistically significant decrease in pain and increase in functionality at the last follow-up (24 weeks post-injection). No complications were reported.
  • In conclusion, “patients with greater trochanteric pain syndrome present better and longer-lasting clinical results when treated with ultrasound-guided PRP injections compared to those with cortisone.

Greater trochanteric pain syndrome (trochanteric bursitis) – PRP Injections

A recent study in the Journal of hip preservation (3) made these observations on the use of Platelet Rich Plasma injections for greater trochanteric pain syndrome.

  • Greater trochanteric pain syndrome, (trochanteric bursitis), commonly affects middle-aged women.
  • It is characterized by pain over the outer side of the hip. Recently the understanding of Greater trochanteric pain syndrome has evolved. Gluteal tendinopathy is believed to be the main contributory factor rather than bursal inflammation. There are numerous studies reporting little evidence of bursal inflammation in Greater trochanteric pain syndrome but found gluteal tendon tendinopathy more commonly associated with Greater trochanteric pain syndrome.
  • Greater trochanteric pain syndrome has also been associated with low back pain, knee osteoarthritis and iliotibial band syndrome.
  • Greater trochanteric pain syndrome can be resolved with conservative treatments such as relative rest and anti-inflammatory medication in the majority of patients. If conservative measures fail then progressively more invasive treatment options including shockwave therapy, corticosteroid injections, PRP and surgery may be required.
  • Lately PRP has become very popular among the orthopedic community as a minimally invasive way of enhancing tissue healing. It is thought that PRP promotes soft tissue healing by delivering a higher than normal concentration of platelets and therefore increased concentration of platelet derived growth factors to the diseased area. This has been shown in various studies.
  • The use of PRP in treating Greater trochanteric pain syndrome has become more prevalent in recent times.
  • There is a lack of studies providing high-quality evidence as to what is causing the pain in Greater trochanteric pain syndrome. Quite often the pathology may be in the gluteus medius and minimus tendon and not exclusively the bursa, therefore the site of injection (treatment) needs to be considered.
  • In most improvements were observed during the first 3 months after PRP injection . Significant improvements were reported when patients were followed up to 12 months post treatment. There are, however, conflicting results between the randomized studies as to whether PRP is superior to corticosteroid. Considering these factors, PRP seems a viable alternative treatment with the current evidence in patients with Greater trochanteric pain syndrome not responding to conservative measures. Further large-sample and high-quality randomized clinical trials in the future should be conducted to present evidence of the efficacy for PRP as a treatment in Greater trochanteric pain syndrome.

A December 2019 study (4) questions whether PRP is an effective treatment for Greater trochanteric pain syndrome. In this study, patients with chronic lateral hip pain were randomised to either a PRP injection (intervention group) or a saline injection (control group) and both groups were prescribed identical eccentric exercise. The researchers found that there were no differences in any outcomes between the two groups at any follow-up point. They concluded a single injection of PRP resulted in no significant improvement for Greater trochanteric pain syndrome compared with a placebo injection.

  • A single injection is typically not as effective as “poking” the hip a few times within the single treatment. Patients will usually benefit from two or three PRP treatments. This would need to be confirmed before treatment begins.

This was a recent study published in the Journal of pain research.(5) It hits upon some good points that describe how PRP works and when PRP may not work.

  • Variability in treatment can lead to failure: “Despite great variability in pain outcomes, the application of autologous platelet-rich plasma (PRP) has become increasingly popular in attempts to reduce chronic pain. The variability in PRP efficacy raises the question of whether PRP actually has an analgesic capacity, and if so, can that capacity be made consistent and maximized. The best explanation for the variability in PRP analgesic efficacy is the failure during PRP preparation and application to take into account variables that can increase or eliminate its analgesic capabilities. This suggests that if the variables are reduced and controlled, a PRP preparation and application protocol can be developed leading to PRP inducing reliable, complete, and long-term pain relief.” To summarize that, you need to see a doctor or clinician that has developed effective protocols for the PRP treatment you are seeking. We have been doing regenerative medicine for over 25 years.

A May 2023 study (6) suggested “PRP injection therapy has demonstrated superior outcomes for (patient reported pain relief) and has the highest ranking probability as the best treatment for greater trochanteric pain syndrome. ESWT was effective in reducing pain compared with physiotherapy alone. Considering the long-term injury of tendon structure and few greater trochanteric pain syndrome-patients having clinical manifestation of bursitis, (it is suggested) that corticosteroid or anti-inflammatory drug treatment by high-dose or long-term should be avoided. When the initial conservative management including home training, physiotherapy, corticosteroid or anti-inflammatory drug treatment has failed in patients with refractory greater trochanteric pain syndrome, PRP injection and ESWT can serve as viable alternative therapies with safety and efficacy. . . ”

A May 2024 study (7) suggested a corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain, it is important to investigate other treatment options that will relieve pain in the hip caused by suspected greater trochanteric pain syndrome. In this study PRP is compared to enthesis needling (dry needling) for greater trochanteric pain syndrome.

  • A total of 92 patients (90% women; average age, 55 years old; mean body mass index, 25.3 just considered overweight) were randomly divided into a PRP injection group and an enthesis needling group. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment.

The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the sports-specific (HOS-SS) compared with the needling group. At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of more than 20%, After PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension. Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the sports-specific (HOS-SS) subscales was greater in the PRP group.

References

1 Begkas D, Chatzopoulos ST, Touzopoulos P, Balanika A, Pastroudis A. Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study. Cureus. 2020 Jan;12(1).
2 Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. J Hip Preserv Surg. 2018 Aug 30;5(3):209-219. doi: 10.1093/jhps/hny027. PMID: 30393547; PMCID: PMC6206702.
3 Thompson G, Pearson JF. No attributable effects of PRP on greater trochanteric pain syndrome. N Z Med J. 2019 Dec 13;132(1507):22-32. PubMed PMID: 31830014.
4 Kuffler DP. Variables affecting the potential efficacy of PRP in providing chronic pain relief. J Pain Res. 2018;12:109-116. Published 2018 Dec 21. doi:10.2147/JPR.S190065 —
5 He Y, Lin Y, He X, Li C, Lu Q, He J. The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis. BMC Musculoskeletal Disorders. 2023 May 26;24(1):423.
6 Atilano L, Martin N, Ignacio Martin J, Iglesias G, Mendiola J, Bully P, Aiyegbusi A, Manuel Rodriguez-Palomo J, Andia I. Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2024 May;12(5):23259671241249123.
7 Disantis A, Andrade AJ, Baillou A, Bonin N, Byrd T, Campbell A, Domb B, Doyle H, Enseki K, Getz B, Gosling L. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. 2023 Jan 1;10(1):48-56.