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Scientific literature review: PRP (Platelet Rich Plasma) for the treatment of trochanteric bursitis and gluteal tendinitis

Both conditions cause pain in the area of the greater trochanter (the prominent bone on the side of the hip). For patients who have tried and failed the usual non-operative treatment methods like Physiotherapy and possibly steroid injections, PRP injection treatment can be an effective way of reducing pain and improving function. At the Orthobiologics Clinic we feel encouraged by the outcomes of the published clinical trials. At the same time, we feel that further research with prospective randomised trials and longer follow up is needed to demonstrate the true potential of treatment with PRP.

Platelet-Rich Plasma (PRP) More Effective than Cortisone for Severe Chronic Hip Bursitis

Monto RR, 2014

In this podium presentation to the American Society of Orthopaedic Surgeons the authors report the outcomes of 40 patients with chronic trochanteric bursitis. All patients were randomly treated with either a corticosteroid injection of PRP injection. After 3 months both treatment groups showed significant improvements in their symptoms. However, after a year following treatment, patients in the corticosteroid group returned to their pre-treatment levels of pain while patients treated with PRP maintained their initial improvements in pain and function. The authors concluded that PRP injections are significantly more effective and durable than cortisone injections for the treatment of severe chronic hip bursitis.

At the Orthobiologics Clinic we were pleased to see this well designed prospective randomised trial that demonstrates clear benefits of using PRP in patients with chronic trochanteric bursitis.

PRP in the treatment of trochanteric syndrome: A pilot study

Arthur de Goes Ribeiro, Walter Ricioli Junior, Alice Roxo Nobre Sousae Silva, Giancarlo Cavalli Polesello, Rodrigo Pereira Guimaraes, 2016

This publication from Brazil compares the short-term outcomes of patients with trochanteric bursitis treated with an injection of either corticosteroids or PRP. Patients were followed up for 60 days. The Authors concluded that there was no difference in pain and function between treatment of trochanteric pain syndrome with infiltration of PRP and corticosteroids.

At the Orthobiologics Clinic we would have liked to see the one-year results of this interesting trial. Unfortunately patients were only followed up for 60 days. This does not allow for a meaningful long-term analysis. It has been known for a long time that corticosteroid injections can provide excellent short-term symptom relief, but these initial improvements are rarely maintained in the long-term. PRP however typically results in a sustained improvement even after many months as demonstrated by other publications.

Platelet-Rich Plasma Versus Surgery for the Management of Recalcitrant Greater Trochanteric Pain Syndrome: A Systematic Review

Rafael Walker-Santiago, M.D., Natalia M. Wojnowski, B.S., Ajay C. Lall, M.D., M.S., David R. Maldonado, M.D., Stephanie M. Rabe, A.C.N.P.-B.C., and Benjamin G. Domb, M.D., 2019

The authors of this very recent publications carried out a systematic review of scientific publications regarding the treatment of chronic trochanteric pain syndrome with either PRP or surgery. 10 suitable publications were identified and analysed. The authors found that PRP treatment was safe with no reported complications, while surgical treatment had a low risk of complications. Both treatment groups showed obvious improvements in pain and function. The authors concluded that both PRP and surgical intervention for the treatment of recalcitrant GTPS showed statistically and clinically significant improvements based on patient reported outcomes. Although not covered by most medical insurance companies, PRP injections for recalcitrant GTPS provides an effective and safe alternative after failed physical therapy.

At the Orthobiologics Clinic we strongly feel that injection treatment with PRP is preferable over surgical intervention in patients who have tried and failed other non-operative treatment methods. Fortunately, more private insurers in the UK now recognise the benefits of PRP treatment and are happy to fund it.

The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review

Mohammed Ali, Eshan Oderuth, Ismael Atchia and Ajay Malviya, 2018

This is a further systematic literature review, this time focussing on published outcomes of patients treated with PRP. The authors analysed 3 randomised controlled trials, 2 case series and fours conference abstracts. The authors found significant symptom improvement after 3 and 12 months. They concluded that PRP is safe and effective and a viable treatment option in patients with treatment resistant trochanteric pain syndrome. The authors also felt that the limited methodological quality of the available trials warrant further high-quality research with larger study groups.

At the Orthobiologics clinic we had a close look at the outcomes of this publication and wholeheartedly agree with the author's conclusions.

Leucocyte-Rich Platelet-Rich Plasma treatment of Gluteus Medius and Minimus Tendinopathy. A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

Jane Fitzpatrick, Max K. Bulsara, John O'Donnell and Ming Hao Zheng, 2019

The authors have previously reported the 3-month outcomes of a prospective randomised study and have now published the final 2-year results. They enrolled 80 patients with chronic gluteal tendinopathy and randomly allocated them to treatment with either a single corticosteroid injection or a single PRP injection. The authors noticed that the improvement from a corticosteroid injection was maximal at 6 weeks and not maintained beyond 24 weeks. They also noticed that the improvement from a single PRP injection was sustained up to 2 years.

At the Orthobiologics Clinic we were delighted to see a randomised trial with a long follow-up of 2 years demonstrating the benefits of PRP injection in patients with chronic gluteal tendinitis.

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