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PRP vs. Cortisone for Hip Bursitis: What’s the Difference?
When hip bursitis continues to cause pain despite activity modification, physical therapy, medications, and other conservative treatments, an injection may be considered as part of the treatment plan.
When considering PRP vs. cortisone for hip bursitis, it is important to understand that these injections work differently and may be considered for different reasons.
But these treatments aren't interchangeable. They work differently, and determining which—if either—is appropriate starts with understanding what is actually causing the pain.
Hip Bursitis Isn't Always Just Inflammation of the Bursa
Pain on the outside of the hip is commonly described as hip bursitis. While irritation of the bursa can contribute to symptoms, the surrounding gluteal tendons may also be involved.
This distinction matters when choosing treatment.
A treatment intended primarily to reduce inflammation may serve a different purpose than one being studied for chronic tendon-related conditions. That's why an accurate diagnosis should come before deciding between PRP, cortisone, or another treatment.
Key Takeaway: The question isn't simply “PRP or cortisone?” The underlying source of the patient's lateral hip pain should help guide treatment.
How Does a Cortisone Injection Work?
Corticosteroids are anti-inflammatory medications. When injected into the affected area, they are intended to reduce inflammation and pain.
For some patients, this can provide relatively rapid symptom relief. Research has demonstrated short-term improvements following corticosteroid injections for lateral hip pain, although the durability of that improvement varies.
A cortisone injection does not, however, directly repair an injured tendon. When tendon pathology is contributing substantially to the patient's symptoms, that distinction may become relevant to the treatment discussion.
How Does PRP Work?
Platelet-rich plasma (PRP) is prepared from a sample of the patient's own blood. The blood is processed to create a concentration of platelets, which contain growth factors and other biologically active proteins involved in the body's healing response.
The resulting PRP is injected into the targeted area.
Unlike corticosteroids, PRP is not primarily intended to suppress inflammation. It is being investigated as a treatment for several musculoskeletal conditions, including chronic tendon-related lateral hip pain.
The important point is that these differences do not automatically make one treatment superior to the other.
What Does the Research Say About PRP vs. Cortisone?
Research comparing PRP and corticosteroid injections for lateral hip pain has produced mixed results.
Some randomized studies have found better outcomes with PRP at later follow-up periods compared with corticosteroid injections. A 2021 systematic review and meta-analysis also reported potential longer-term advantages for PRP, while noting uncertainty surrounding which treatment is superior.
Other research has been less conclusive. A small randomized study found improvement with corticosteroid treatment but not PRP over its short follow-up period.
More recently, a double-blind randomized controlled trial involving 79 patients compared leukocyte-rich PRP with placebo for refractory lateral hip pain associated with bursitis and/or gluteal tendinopathy. The study did not demonstrate a significant advantage for PRP over placebo.
There is also considerable variation in how PRP is prepared and administered across studies, making direct comparisons difficult.
Bottom line: PRP is a treatment option being studied for chronic lateral hip pain, but current evidence does not establish that PRP is universally better than cortisone. Treatment should be individualized.
PRP vs Cortisone for Hip Bursitis: Which Injection Is Right?
When comparing PRP vs cortisone for hip bursitis, there isn't one treatment that is appropriate for every patient.
Before recommending an injection, a physician may consider factors such as:
The underlying cause of the patient's pain
Whether the bursa, gluteal tendons, or both appear to be involved
How long symptoms have been present
Previous treatments and the patient's response to them
Physical examination and imaging findings
Activity level and treatment goals
Other health considerations
In some cases, neither injection may be the appropriate next step.
Physical therapy, activity modification and other conservative measures remain important components of treatment, particularly because addressing the underlying mechanics and strength deficits may be necessary for longer-term improvement.
When Should PRP Be Considered?
PRP may be discussed for selected patients with persistent lateral hip pain, particularly when symptoms have not responded adequately to an appropriate course of conservative treatment and tendon involvement is suspected.
Whether PRP is appropriate requires an individualized evaluation. Patients should also understand that PRP protocols vary and research into its effectiveness for hip bursitis and related tendon conditions is continuing. A recent systematic review found generally favorable outcomes across much of the published literature but emphasized the need for larger, higher-quality randomized trials.
The Most Important Step Is Getting the Diagnosis Right
PRP and cortisone aren't simply two versions of the same treatment.
They work differently, and the decision to use either should start by identifying the structures responsible for the patient's pain.
For someone experiencing persistent pain on the outside of the hip, a hip preservation specialist can evaluate the hip, determine whether bursitis, tendon pathology, or another condition may be contributing to symptoms, and discuss the appropriate non-surgical treatment options.
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