Marc Darrow MD, JD 

Over the years we have seen many patients with hip pain.Many of them having a “hip bursitis.”  The areas around the hip are covered with and protected by several bursal fluid filled sacs. Each bursa produces lubricating fluid and functions to reduce pressure and friction of the muscles and ligaments as they move against the bone. These bursae can become irritated from injury, excessive pressure, and overuse. Inflammation of a bursa is called bursitis. More often this diagnosis is actually a tendonitis or tendinosis.

Nevertheless, once a diagnosis of bursitis is made, the patient will typically be given a “healing,” regiment that will include:

  • Activity modification and rest
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Physical therapy.
  • Injection of a corticosteroid

These treatments may be effective for some, non-effective for others. Once the cortisone injection or injections fail to provide any relief, the patient will usually start seeking other options. One option is Platelet Rich Plasma therapy or PRP. PRP treatments 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.

Greater trochanteric pain syndrome (trochanteric bursitis)

A 2018 study in the Journal of hip preservation (1) 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.

Method of how PRP is given can impact the effectiveness of the treatment

I want to bring attention to a December 2019 study (2) that 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.(3) 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 20 years.

Do you have questions? Ask Dr. Darrow



A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. There is controversy in the medical community about whether umbilical cord blood stem cells are alive or dead, and which type of stem cell may be appropriate.

Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References
1 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.
2 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.
3 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