I get asked this question from most of my patients. The better question to ask is Cortisone or PRP, which is the right treatment for me?
So traditionally, cortisone, or in other words a “steroid shot” has been used for the treatment of joint pain and tendinitis. Cortisone/steroids are powerful anti-inflammatory medications that actually do a very good job of taking away the pain, whether it is from an acute arthritis exacerbation, tendinitis or bursitis. They also work very fast. It usually takes 2-3 days for the effects of the steroid to set in and make you feel a lot better.
The problem is that cortisone does not help repair the site of injury. In fact, repeated cortisone shots are highly discouraged. In the joints, repeated shots can contribute to progression and development of early osteoarthritis. In the tendons, steroids will actually weaken the structure of the tendon and may cause the tendon to rupture after repeated injections.
Platelet rich plasma, on the other hand is derived from your own blood, and is injected into the effected joint or tendon. Unlike Steroids which are anti-inflammatory, PRP it actually pro-inflammatory and helps stimulate healing, growth and regeneration of the injured area. As it is derived from your own blood, it is very safe, and can be used multiple times as a regenerative treatment.
Now PRP does not work as fast as cortisone, usually the positive effects including pain relief are seen after a few weeks rather than a few days as seen with cortisone. However, in the long run, studies are showing that long term benefits of PRP outlast cortisone treatment.
So then you might ask the question, why do we even use cortisone/steroids?
Cortisone is still a very effective method for good pain control. Look at these 2 knee x rays below and I will explain why in case #1, I prefer to give a cortisone shot and why in case # 2, I prefer to give PRP.
As you seen in this picture, this patient has complete joint space loss of the medial and lateral knee compartments. This patient will need to have knee replacement surgery. This patient will have more immediate and better pain control with a cortisone shot rather than PRP treatment. There is no cartilage left, so PRP will not be able to slow down the progression osteoarthritis, as it is already advanced “bone on bone” arthritis. In this patient, we are aiming for adequate pain control, until the patient gets knee replacement surgery.
This knee, on the other hand is a very good candidate for a PRP injection. Patient had acute exacerbation of arthritis and was in a lot of pain after a few weeks of persistent exercise and lack of adequate rest. You can see that the patient has mild narrowing of both knee compartments. There is still a good amount of cartilage that we can protect and help heal. Here PRP can help take away the pain and also help slow or even stop the progression osteoarthritis. We don’t want to give cortisone in this case just to help ease the pain, as we may also contribute to deteriorating the remaining cartilage in the long run.
So the learning point is, if you can catch your arthritis early, you can treat it and slow down its progression with PRP. Advanced arthritis cases without significant cartilage will not respond well to PRP and cortisone is a faster and better treatment for pain relief.
Posted on behalf of Advanced Healing Institute
22972 El Toro Road
Lake Forest, CA, 92630
Phone: (949) 239-3206