PRP, cortisone, and knee gel are different shots

prp vs cortisone often comes down to timing

Cortisone may ease some joint soreness sooner. The relief can fade, so talk with your doctor before another shot. Whether a repeat makes sense depends on your exam, past care, and how the first shot went.

You'll often wait longer before judging PRP. Some knee and elbow studies favor it later, yet a large knee test found it worked about the same as salt water. One good result can't promise what will happen for you.

Knee gel has shown only a small average benefit

Knee gel isn't swallowed; a shot places it inside the sore knee. Large reviews found only a small gain over a comparison shot containing salt water and no medicine. Some people still choose gel after asking about cost and coverage.

Here is what matters. Before you pay, ask when relief may begin, how much it may help, when it may fade, what your total bill covers, and why another visit would be needed. Your doctor should base each answer on your knee and exam, not a sales claim.

Clinics don't prepare every PRP shot the same way

A machine divides the blood into parts. Clinics may keep different amounts of the parts that help clotting and repair. Those differences matter because the studies aren't always testing the same shot.

Before paying, ask how the clinic makes its PRP and what each planned visit costs. QC Kinetix uses biologic therapies for blood-based care made on site, with trained medical providers handling both your exam and treatment.

Sources

1. A meta-analysis of eight studies (648 patients, mean age 59) judged at low risk of bias found PRP significantly better than intra-articular corticosteroid for knee OA symptoms at 3, 6 and 9 months (P<0.01), with the largest effects at 6 months (SMD -0.78; 95% CI -1.34 to -0.23) and 9 months (SMD -1.63; 95% CI -2.14 to -1.12). This is the strongest available case for PRP as a longer-acting alternative to a steroid shot.

   McLarnon M, Heron N — Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis. BMC Musculoskeletal Disorders, 2021. DOI: 10.1186/s12891-021-04308-3.

2. A network meta-analysis of 79 randomized trials with 8761 patients compared 11 injectable options for knee osteoarthritis. At 4-6 weeks and 3 months the highest-ranked treatment for WOMAC was high-molecular-weight hyaluronic acid plus corticosteroid; at 6 months the highest-ranked treatment for WOMAC was PRP. Stromal vascular fraction ranked highest for VAS at all time points, on a much thinner evidence base.

   Anil U, Markus DH, Hurley ET, et al. — The efficacy of intra-articular injections in the treatment of knee osteoarthritis: A network meta-analysis of randomized controlled trials. The Knee, 2021. DOI: 10.1016/j.knee.2021.08.008.

3. In a 2-year double-blind randomized trial, intra-articular triamcinolone every 12 weeks produced significantly greater cartilage volume loss than saline (mean change in index compartment cartilage thickness -0.21 mm versus -0.10 mm; between-group difference -0.11 mm; 95% CI -0.20 to -0.03) and no significant difference in knee pain (-1.2 versus -1.9). The authors concluded the findings do not support this treatment for symptomatic knee osteoarthritis - which is the honest reason a patient may want an alternative to repeat steroid shots.

   McAlindon TE, LaValley MP, Harvey WF, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

4. A systematic review and meta-analysis in the BMJ concluded that strong conclusive evidence indicates viscosupplementation (hyaluronic acid) leads to only a small reduction in knee osteoarthritis pain compared with placebo - less than the minimal clinically important between-group difference - and that based on 15 large placebo-controlled trials in 6462 participants it is associated with a statistically significant higher risk of serious adverse events (relative risk 1.49; 95% CI 1.12-1.98). The findings do not support broad use of viscosupplementation.

   Pereira TV, Juni P, Saadat P, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

5. In the RESTORE trial - the largest placebo-controlled PRP trial in knee osteoarthritis - 288 adults aged 50+ with symptomatic Kellgren-Lawrence grade 2-3 medial knee OA received three weekly intra-articular injections of leukocyte-poor PRP from a commercial system or saline placebo. At 12 months the mean change in knee pain was -2.1 points with PRP versus -1.8 with saline (difference -0.4; 95% CI -0.9 to 0.2; P=.17) against a minimum clinically important difference of 1.8, and the change in medial tibial cartilage volume was -1.4% versus -1.2% (difference -0.2%; 95% CI -1.9% to 1.5%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings do not support use of PRP for knee OA.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

6. A systematic review of 105 clinical PRP studies in orthopaedics published 2006-2016 found that only 11 (10%) described the preparation protocol clearly enough for another investigator to repeat it, and only 17 (16%) reported any quantitative metric of the final PRP composition. The authors concluded that the current reporting of PRP preparation and composition does not allow the PRP products actually delivered to patients to be compared between studies.

   Chahla J, Cinque ME, Piuzzi NS, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. Journal of Bone and Joint Surgery (American), 2017. DOI: 10.2106/JBJS.16.01374.

7. The devices used to spin PRP at the point of care are cleared by FDA as clinical centrifuges, product code JQC, a Class I device under 21 CFR 862.2050 - for example the Biomet GPS Platelet Separation Kit (K030555, cleared 2003) and the Harvest SmartPrep2 / SmartPrep Platelet Concentration System (K103340, cleared 2010). That clearance covers the equipment that separates blood. It is not an FDA approval of platelet-rich plasma as a treatment for osteoarthritis, tendinopathy or any other orthopedic condition, and copy must never blur the two.

   U.S. Food and Drug Administration (Center for Devices and Radiological Health) — 510(k) Premarket Notification database and Product Classification: JQC, Centrifuges (Micro, Ultra, Refrigerated) For Clinical Use, 21 CFR 862.2050. FDA accessdata (CDRH device databases), 2003.