PRP Joint Injections - The Alternative to Cortisone

If knee, hip, or shoulder pain is limiting your life, you have probably been offered cortisone. The cycle is familiar: a shot, a few weeks of relief, the pain creeps back, and you are offered another shot in three to six months. It is a decades-old routine. And it works by quieting inflammation, not by fixing the joint.

Short answer: PRP joint injections (platelet-rich plasma, made from your own blood) work differently than cortisone. Cortisone calms pain for a few weeks but does not repair anything, and repeated shots may speed up cartilage loss. PRP sends repair signals into the joint. For mild-to-moderate arthritis, recent studies show PRP gives better and longer-lasting pain relief than cortisone, usually over a series of 2 to 3 injections.

What cortisone does, and why repeated shots are a concern

Cortisone is a strong anti-inflammatory. Think of it like a fire extinguisher sprayed on the joint: it puts out the flame of inflammation fast, usually within a few days, and the relief lasts a few weeks to a couple of months.

The problem is what it does not do. Cortisone does not repair the joint. Arthritis is a slow wearing-down of cartilage (the smooth cushion on the ends of your bones), and quieting the pain does not slow that wear. The joint keeps breaking down while the warning signal is muted.

There is a second concern. A 2017 study in JAMA compared a cortisone shot every three months to a saltwater placebo in knee arthritis over two years. The cortisone group lost more cartilage on MRI scans and had no real pain advantage at the two-year mark. The takeaway is not “never use cortisone.” It is useful for a sudden flare. It is just not a long-term plan for saving a joint.

What PRP is, in plain words

PRP comes from your own body. The steps are simple:

1. We draw a small amount of your blood, usually 15 to 60 mL (about one to four tablespoons).
2. We spin it in a centrifuge (a machine that separates blood into layers) to concentrate the platelets, the tiny cells that start healing.
3. We inject that concentrated plasma into the sore joint, often using ultrasound to guide the needle to the right spot.

Platelets do more than help blood clot. They carry growth factors, which are the body’s repair signals. Once concentrated PRP is placed in a worn joint, those signals tell the nearby tissue to calm inflammation, support cartilage, and improve local blood supply. The effect builds over 4 to 12 weeks rather than overnight, which is why PRP is usually given as a series of 2 to 3 injections spaced a few weeks apart.

Why we offer it. PRP puts repair signals into the joint rather than only muting the pain, which is why the effect builds over weeks and then tends to hold. A 2021 systematic review and meta-analysis in BMC Musculoskeletal Disorders pooled eight trials and 648 patients and found PRP was significantly better than corticosteroid injection for pain, stiffness, and function at 3, 6, and 9 months, with the largest difference at the later time points. A 2024 review in the Journal of Clinical Orthopaedics and Trauma, covering 21 randomized trials and 2,406 participants, reached the same conclusion: PRP outperformed both placebo and corticosteroid for pain and function.

What the evidence shows

The research comparing PRP to cortisone has matured a lot in the past five years, and it now leans clearly toward PRP for lasting results in knee arthritis.

• Better pain relief at 6 months. A 2024 meta-analysis (a study that pools many trials) in Annals of Medicine and Surgery found greater pain improvement with PRP than cortisone at six months.
• Better function. Patients moved and felt better with PRP, especially those with mild-to-moderate arthritis.
• Longer-lasting. Cortisone works faster but fades in weeks. PRP builds more slowly but lasts 6 to 12 months in most people who respond.
• A specific type works best in joints. “Leukocyte-poor” PRP (a preparation with fewer white blood cells) tends to outperform the leukocyte-rich kind for joints. We use the leukocyte-poor type for joint work at Arbour.

A 2025 review pooling 30 randomized trials confirmed meaningful improvement with PRP, with the biggest benefit in mild-to-moderate disease. The honest caveat: PRP recipes vary between clinics, which makes studies harder to compare directly. That is why a standardized preparation matters.

When PRP is the right tool, and when it is not

PRP works best when there is still joint left to repair. Good candidates include people with mild-to-moderate knee, hip, or shoulder arthritis (graded I to III on the Kellgren-Lawrence scale, an x-ray rating of severity from I to IV), certain tendon injuries like tennis elbow or rotator cuff strain, and anyone hoping to delay joint replacement surgery.

PRP is not the answer for bone-on-bone, end-stage arthritis (grade IV), where there is too little structure left to rebuild. It is also not appropriate with an active joint infection, certain bleeding disorders or blood thinners (needs provider review), active cancer in the area, or a severely weakened immune system. For end-stage joints, the realistic path is pain management and a surgical opinion. PRP is best used earlier, not later.

What I see in clinic

A common pattern is an active person in their 50s or 60s with knee pain who has had two or three cortisone shots that each helped less than the one before. They are not ready for a knee replacement and do not want to keep masking the problem. For mild-to-moderate wear, a PRP series, often paired with simple weight and strength work, frequently gets them back to walking, hiking, or golf without the next round of shots. The patients who do best are the ones who start before the joint is bone-on-bone.

Add-ons that can help

Peptides. Certain peptides (small proteins) such as BPC-157 and TB-500 are used to support tissue healing alongside joint work. They are individualized and provider-supervised.

Weight support. Every pound off reduces the load on your knees with each step, so for many patients we combine joint care with medical weight loss for a more durable result. PRP for hair, skin, and joints is explained further in our PRP therapy guide for Ann Arbor.

A note on exosomes. Patients often ask whether exosomes can be added to a joint injection. They cannot. At Arbour Longevity, exosome preparations are applied topically to the skin surface only, they are never injected and are never delivered into tissue, and they are therefore not part of any intra-articular protocol and are not an add-on to PRP for a joint. Where they are used elsewhere in the clinic they are investigational, only Phase 2 research preparations are used, and they are not a cure for anything.

What a PRP joint visit looks like

First, a consultation: history, exam, and a look at any imaging. Then a quick blood draw and about 20 to 30 minutes to prepare the PRP. The injection is guided by ultrasound for accuracy and takes only a few minutes, with numbing medicine for comfort. Afterward, you avoid anti-inflammatory painkillers (NSAIDs) for 72 hours because they blunt the healing signal, and you skip high-impact activity for 5 to 7 days. Mild soreness for a couple of days is normal and is a sign the repair process has started. Most people return for the second and third injections every 4 to 6 weeks, with full effect by 8 to 12 weeks. New to the clinic? Here is what the $35 consultation covers.

Frequently Asked Questions

How is PRP different from a cortisone shot?

Cortisone quiets inflammation; PRP sends repair signals. Cortisone works in days but fades in weeks and may speed cartilage loss with repeated use. PRP builds over weeks and lasts 6 to 12 months in people who respond, while supporting the joint instead of just masking pain.

Does PRP hurt?

The injection is well-tolerated with numbing medicine. Mild soreness for 2 to 5 days afterward is normal as the repair response begins.

How many sessions do I need?

Most people have 2 to 3 injections spaced 4 to 6 weeks apart. A maintenance injection every 6 to 12 months is common for long-term joint health.

Is PRP covered by insurance, and what does it cost?

PRP for joints is usually not covered by insurance. Arbour is a self-pay practice that accepts HSA/FSA cards and Klarna/Affirm financing. Exact pricing depends on the joint and the number of sessions, and is reviewed at your visit. The new-patient consultation is $35, credited toward treatment if you proceed.

Can I exercise after PRP?

Light activity is fine within a day or two. Avoid high-impact or heavy-loading activity for 5 to 7 days so the repair response can take hold.

What is the success rate?

Results vary by joint and severity. In well-chosen patients with mild-to-moderate disease, meaningful pain and function improvement is reported in roughly 70 to 85 percent of people in the published research.

How does PRP compare to surgery?

PRP is most useful for people who are not yet candidates for, or want to delay, joint replacement. End-stage, bone-on-bone joints usually need surgery. PRP is best used earlier in the process.

The next step

If you are stuck in the cortisone cycle, the next step is a real workup with a regenerative-medicine clinician. Started early enough, PRP and its add-ons can change the direction of your joint health.

Arbour Longevity, 2217 Packard St #15, Ann Arbor, MI 48104. (734) 436-3357. arbourlongevity.com. Thursday through Monday, 10am to 7pm.

References

1. McAlindon TE, LaValley MP, Harvey WF, et al. (2017). Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA.
2. Comparative effectiveness of intra-articular therapies in knee osteoarthritis. (2024). Annals of Medicine and Surgery.
3. Belk JW, Kraeutler MJ, Houck DA, et al. (2024). Efficacy of Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Cureus.
4. Comparative efficacy of intra-articular PRP, hyaluronic acid, corticosteroids, and NSAIDs for knee OA: A retrospective cohort study. (2025). PMC. PMC12499739
5. Efficacy of intra-articular platelet-rich plasma compared with placebo in knee osteoarthritis. (2025). Joint Bone Spine. ScienceDirect S1297319X25001095
6. Bennell KL, Paterson KL, Metcalf BR, et al. (2021). Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis. JAMA.

This article is educational and does not replace individualized medical advice.