The answer to this question is simple: Yes, No and Maybe. Platelet-Rich Plasma injections have taken the orthopedic world by storm. Why is this? They are safe. They are natural. They can be done in the office in a short period of time. They may prevent surgery in some cases. They can be disease-altering, not just symptom-reducing. Most importantly, in many cases of tendon, ligament and joint problems, they are EFFECTIVE.
PRP injections involve drawing blood from a patient’s vein, typically in the arm. Then, the blood is centrifuged (spun) to separate out the red and white blood cells, while simultaneously concentrating your own platelets. Our platelets are known to have numerous growth factors that serve many beneficial roles in our musculoskeletal tissues. This concentrated solution is then injected under ultrasound-guidance back into an area of damage, such as a partially torn tendon, the plantar fascia or an arthritic joint. We believe that these platelets help to modulate unhealthy inflammation that resides in damaged tissues. This helps over the long-term to reduce pain and subsequently, improve function. In some cases, damaged soft tissue can heal in the presence of these concentrated platelets. In other cases, the deterioration often seen in cases of osteoarthritis can be slowed or halted. Thus, there are some preventative benefits of PRP.
Cortisone injections, known medically as steroids, have been around for decades. They simply are very strong anti-inflammatories. They can reduce pain and swelling within hours to days of an injection. However, they are known to have catabolic, or “breakdown” effects, meaning, numerous exposures to steroids can worsen the structure and strength of a soft tissue or joint. They also can produce short-term systemic side effects, including fluid retention, headache, insomnia, changes in emotions, skin flushing/redness and increases in blood sugar, particularly in diabetics. Cortisone injections are still used quite frequently to treat tendonitis, arthritis and disc problems in the spine.
Now, back to the question in the title. In our practice, we still use both types of injections. However, the percentage of PRP injections is increasing, while the percentage of cortisone is dropping. Why? We want our patients to have “game-changing” treatments whenever possible. We want conditions to improve over the long-term. We want to stop that deterioration process and to promote healing when possible. Also, we know that in the case of cortisone injections, some patients feel so good, so quickly, that they are prone to re-injure themselves. Thus, short-term improvement, but long-term worsening with some cortisone injections.
Thus, how do we choose what type of injection to recommend to a patient? Here are some examples:
-A 60-year-old woman will be traveling on a bucket-list trip to Italy in one week. Her arthritic knee is painful and swollen, and she needs some quick relief to really enjoy this trip. We choose a CORTISONE injection to provide that relief. She will likely feel better within a few days of the injection and will probably see a benefit for 1-3 months.
-A 35-year-old runner tore his ACL at age 20 and had successful surgery. Now, he has mild osteoarthritis of the knee that is stiff in the morning, aches after long runs and occasionally swells. He is a great candidate for PRP. PRP should help his keep inflammation down, reduce his aches and preserve his cartilage in his knee for years to come.
-A 65-year old woman has had 2 weeks of lateral hip pain after a trip to the beach with frequent walking. She can’t sleep on the side of her painful hip and going up stairs is difficult. We diagnose her with trochanteric bursitis and gluteal tendonitis. A CORTISONE injection here may do the trick. She has an acute inflammatory response and needs some relief to simply sleep better at night and handle her activities of daily living with less pain.
-A 24-year-old recreational basketball player has patellar tendonopathy and pain every time he jumps and lands. Symptoms have been present for 6 months and despite physical therapy, a brace and NSAIDS, he is only 50% better. We offer him 1-2 PRP injections. We need to promote healing of that tendon. We want long-term reduction in symptoms and tissue improvement, so that he can continue to play basketball and with reduced risk of tearing the tendon. Plus, we never inject cortisone in or around certain tendons, including the patellar and Achilles tendons, due to the risk of tendon rupture.
-A 70-year-old has mild to moderate hip and knee osteoarthritis. He can play golf a couple days a week, but relies on frequent doses of ibuprofen after his golf games and on days he plays with his grandchildren. His hoping to avoid joint replacement in his lifetime and knows that long-term use of NSAIDs is not good for his blood pressure, stomach or kidneys. We offer him PRP as a great option, with an injection into the knee and hip joints on the same day. He then will return a month later for his 2nd set of injections. After that, we hope and expect that he will have less pain and better function for 6 to 24 months, while also lowering his chances of joint replacement in the intermediate future. These PRP injections can be safely repeated months to years later, if necessary.
These are everyday examples of how we customize our treatments for patients based on their symptoms, diagnosis and goals. Age of the patient can play a role, but one is never “too old” to have a PRP injection. When head-to-head studies compare PRP to steroid injections, PRP is declared the “winner” the large majority of the time. Thus, we know that for long-term benefits of many joint and tendon problems, PRP is the better choice.
In conclusion, cortisone/steroid injections are not going away any time soon. They still play a role in helping patients in select situations. However, the world of orthobiologic injections such as PRP will only continue to expand as we strive to find more natural and less-invasive ways to treat a variety of orthopedic conditions.