Treat Hip Osteoarthritis with PRP for Lasting Results

Treat Hip Osteoarthritis with PRP & Regenerative Care

Abstract

Hip osteoarthritis (OA) represents a significant and growing global health concern, profoundly impacting individuals’ quality of life and increasing mortality risks associated with reduced physical activity. This educational post explores the multifaceted nature of hip OA, from its global prevalence and anatomical underpinnings to modern, evidence-based treatment strategies. I will delve into the physiological details of the hip joint, discuss the clinical presentation of hip pain, and outline a comprehensive physical examination process. We will then journey through the spectrum of treatment options, comparing the short-term benefits of traditional corticosteroid injections with the longer-lasting, restorative potential of biologic therapies like Platelet-Rich Plasma (PRP). Drawing from leading research and my clinical observations, I will explain how these treatments work and why they are chosen. Furthermore, I will highlight the indispensable role of integrative chiropractic care and physical therapy in building biomechanical resilience, ensuring that our interventions provide not just temporary relief but sustainable, long-term well-being.

The Escalating Global Challenge of Hip Osteoarthritis

As a clinician with a diverse background in family medicine, chiropractic, and functional medicine, I am constantly engaged with the latest research to best serve my patients. When we discuss hip osteoarthritis (OA), we’re not just talking about occasional aches and pains; we are addressing a major global health issue. The Global Burden of Disease study, a monumental research effort spanning decades, provides us with stark figures. A 2019 review that analyzed 354 diseases across 200 countries revealed alarming trends in hip OA.

Between 1990 and 2019, the global prevalence of hip OA more than doubled, soaring from approximately 740,000 cases to 1.6 million. The age-standardized prevalence rate also climbed, indicating this isn’t merely a consequence of an aging population. When we examine the geographical distribution, we see particularly high rates in North America—especially the United States—as well as parts of Europe, Australia, and New Zealand. Interestingly, high-income regions show the highest rates, which may be linked to specific activity patterns or lifestyle factors associated with those economies.

The most concerning finding is the profound impact of hip OA on overall health and longevity. The pain and stiffness characteristic of symptomatic hip and knee arthritis naturally lead to reduced physical activity. This sedentary lifestyle, in turn, is a significant risk factor for other chronic conditions. A 2015 study with a 16-year follow-up period delivered a sobering conclusion:

• Individuals with hip OA had a 14% increase in all-cause mortality.
• They also faced a 24% increase in cardiovascular disease-related mortality.

These statistics underscore a critical point: managing hip OA is not just about alleviating pain. It is about preserving mobility, maintaining function, and ultimately, protecting a patient’s overall health and lifespan. The burden of this condition extends far beyond the joint itself, creating a ripple effect that touches every aspect of a person’s life.

Understanding the Anatomy and Clinical Picture of Hip Pain

To effectively treat a condition, we must first have an intimate understanding of the structures involved. The hip is a marvel of biomechanics, but its complexity also means that pain in this region can arise from numerous sources.

Core Bony and Soft Tissue Structures

The hip joint is a ball-and-socket joint formed by the articulation of the femoral head (the “ball”) with the acetabulum of the pelvis (the “socket”). Key bony landmarks that play a role in both function and pathology include:

• Greater Trochanter: The prominent bony point on the outside of the hip where crucial muscles like the gluteus medius and minimus attach.
• Sacroiliac (SI) Joint: The joint connecting the sacrum (the base of the spine) to the iliac bones of the pelvis. Though distinct from the hip joint, its proximity means its dysfunction can often mimic or contribute to hip pain.

Surrounding this bony framework is a dense and intricate network of muscles, ligaments, tendons, nerves, and blood vessels. Any of these structures can become a source of pain, which is why a precise diagnosis is paramount. In my practice, I frequently observe that what a patient describes as “hip pain” can originate from the lumbar spine, the SI joint, or the surrounding musculature.

The C-Sign and Common Pain Patterns

When the pain truly originates from within the hip joint (intra-articular), it often presents in a characteristic pattern. Patients will frequently describe a sharp, pinching sensation deep in the front of the hip. They may use their hand to cup the front, side, and back of their hip in a “C” shape, a classic indicator known as the C-sign.

We can categorize hip-region pain into three main zones:

1. Anterior (Groin) Pain: This is the most common presentation of true hip joint pathology, such as OA or a labral tear. The pain is typically felt in the groin or inner thigh.
2. Lateral (Side) Pain: Pain on the outside of the hip is more commonly associated with issues involving the gluteal tendons or trochanteric bursitis.
3. Posterior (Buttocks) Pain: This is often attributed to the SI joint, piriformis syndrome, or radiating pain from the lumbar spine (sciatica).

However, it is crucial to maintain a broad clinical perspective. In my experience, approximately 10% of patients with confirmed intra-articular hip pathology present primarily with posterior pain. If you are treating a patient for what appears to be an SI joint or hamstring issue and they are not improving, it is essential to thoroughly evaluate the hip joint. It’s an often-overlooked source that can be the true root of the problem.

The Comprehensive Hip Examination

A thorough physical examination is our primary tool for narrowing down the source of pain. While we assess all ranges of motion, internal and external rotation of the hip joint are particularly revealing. A healthy hip typically has around 30-40 degrees of internal rotation and 40-50 degrees of external rotation. Pain or a significant loss of this motion is a strong indicator of joint pathology.

Several orthopedic tests help us pinpoint the problem:

• Log Roll Test: With the patient lying on their back, I gently roll the leg inward and outward. This passive movement isolates the hip joint, and pain during this maneuver is highly specific for intra-articular issues.
• FABER Test (Flexion, Abduction, External Rotation): In this test, I place the patient’s foot on their opposite knee to create a “figure-4” position and gently press down on the bent knee. While this test is excellent for provoking hip joint pain, it also stresses the SI joint. Therefore, I always ask my patients, “Where exactly are you feeling the pain?” The location of the discomfort helps differentiate between hip and SI joint involvement.
• FADIR Test (Flexion, Adduction, Internal Rotation): This is perhaps our most sensitive test for detecting conditions such as femoroacetabular impingement (FAI) and labral tears. Even if it provokes pain in a lateral or posterior location, a positive test raises my suspicion of underlying hip joint pathology.

The Foundational Role of Integrative and Biomechanical Care

Before we even discuss injections or more advanced interventions, we must establish the cornerstone of any successful treatment plan: physical therapy and integrative chiropractic care. I cannot emphasize this enough. The hip joint does not function in isolation. It is the foundational pillar of a complex biomechanical chain that includes the lumbar spine, pelvis, and the entire lower extremity. The muscles that cross the hip are directly integrated with its function, providing both stability and mobility.

From my perspective as a Doctor of Chiropractic (DC) and a Certified Functional Medicine Practitioner (CFMP), true healing comes from restoring proper function, not just masking symptoms. This is where integrative care shines.

• Chiropractic Adjustments: We focus on ensuring proper alignment and mobility of the pelvis and lumbar spine. Dysfunction in the SI joint or lower back can alter gait and place abnormal stress on the hip joint, accelerating degenerative changes. By restoring proper joint mechanics, we reduce this compensatory strain.
• Soft Tissue Mobilization: Techniques like Active Release Technique (ART) or Graston Technique can address myofascial restrictions and scar tissue in the surrounding muscles (glutes, hip flexors, piriformis), improving flexibility and reducing muscular imbalances.
• Targeted Rehabilitation: This is where physical therapy is critical. A rehabilitation program must be tailored to the individual to strengthen the core and key hip stabilizing muscles, such as the gluteus medius. Building up this muscular support system offloads the joint, reduces pain, and improves biomechanics.

If we only focus on injecting the joint without addressing these underlying biomechanical faults, any relief will be temporary. The dysfunctional movement patterns will persist, and the pain will inevitably return. Building a strong, stable, and functional foundation is non-negotiable for long-term success.

Evaluating Modern Treatment Options: Steroids vs. Biologics

Once the foundational work is underway, we can consider interventions to directly manage the inflammation and pain within the joint.

Corticosteroid Injections: A Short-Term Solution

Corticosteroid injections have long been a mainstay treatment for hip OA. Administered under ultrasound or fluoroscopic guidance to ensure precision, they deliver a potent anti-inflammatory medication directly to the source of pain. The American Academy of Orthopaedic Surgeons gives this treatment a moderate recommendation for short-term pain relief.

Systematic reviews confirm this clinical observation. One review of 16 randomized controlled trials (RCTs) involving over 1,700 patients found that steroid injections were significantly more effective than placebo at three months. However, by six months, this significant difference had vanished (Ayhan et al., 2014).

My conclusion, based on the evidence and clinical practice, is that corticosteroids are effective in providing a temporary “window of opportunity.” They can rapidly reduce pain, allowing a patient to more effectively engage in their physical therapy and chiropractic care. They are also useful as a diagnostic tool; if an injection into the joint eliminates the pain, it confirms the hip as the primary pain generator.

Platelet-Rich Plasma (PRP): A Longer-Lasting, Regenerative Approach

Platelet-Rich Plasma (PRP) represents a paradigm shift from merely suppressing inflammation to stimulating the body’s own healing and regenerative processes. The procedure involves drawing a sample of the patient’s own blood, concentrating platelets by centrifugation, and injecting the platelet-rich solution into the hip joint.

Platelets are rich in growth factors and signaling proteins that orchestrate the healing cascade. They can reduce inflammation, stimulate the proliferation of local stem cells, and promote the synthesis of new cartilage matrix components.

A pooled analysis of eight RCTs found that PRP significantly reduced pain at multiple time points (Belk et al., 2020). Another comprehensive systematic review directly compared PRP to corticosteroids. The results were clear: while steroids offered better relief in the very short term, PRP provided the most significant and lasting pain relief at the six-month mark (Collaborative COTOA, 2023).

Key findings from the research on PRP for hip OA include:

• Durable Effect: Its benefits last longer than those of corticosteroids.
• Volume Sensitivity: Unlike the knee, the hip is a smaller, more tightly encapsulated joint. Studies suggest that lower injection volumes (e.g., 5 mL) are more effective and better tolerated than higher volumes. In my clinic, I typically aim for a 5-6 mL injection volume, which is both comfortable for the patient and clinically effective.
• Dosing and Frequency: The optimal platelet concentration and injection frequency are still being refined. However, emerging evidence suggests that a single, high-quality PRP injection may be more effective than multiple, lower-quality injections.

A Clinical Case Study: The Power of an Integrative Diagnosis

The complexity of the hip region is beautifully illustrated by the case of a 22-year-old college football linebacker I treated. He came to our institution with a six-month history of debilitating “low back pain.” He had already undergone multiple epidural steroid injections and even a medial branch block for his spine, all with no benefit.

His physical exam was telling. His hip internal rotation was severely limited to just 15 degrees, and his FABER test was positive for groin pain. His spinal exam, despite his official diagnosis, was normal. An MRI of his lumbar spine did show an L5-S1 disc herniation, which had been the focus of all his previous treatments. However, no one had ever imaged his hips.

We obtained simple AP and frog-leg X-rays, which revealed a clear cam-type femoroacetabular impingement (FAI)—a bony overgrowth on the femoral head-neck junction that was physically jamming the joint. An MRI of the hip confirmed this, along with signs of cartilage damage.

Our treatment plan was integrative and sequential:

1. Foundation First: We immediately started him on a specialized physical therapy program focused on core stabilization and hip muscle strengthening to correct the biomechanical imbalances.
2. Diagnostic & Therapeutic Injection: To confirm the diagnosis and provide rapid relief, we performed a corticosteroid injection into his hip joint. His pain was completely eliminated, proving the hip was the true culprit.
3. Regenerative Therapy: During the summer offseason, about three months later, we performed a single PRP injection into the hip joint to promote long-term healing and pain control.

The result? The athlete’s pain resolved completely. He went on to play the next three football seasons without any time lost to his hip or back. This case highlights how a narrow focus on a single anatomical area (the spine) can lead to ineffective treatment, and how a comprehensive, integrative approach that considers the entire kinetic chain is essential for an accurate diagnosis and a successful outcome.

Future Directions and My Clinical Approach

The field of regenerative medicine is dynamic. We know biologics like PRP take longer to work than steroids—typically 6 to 8 weeks to begin seeing significant improvement—but their effects are far more durable.

In my clinic, I use an advanced benchtop processing system that enables precise customization of PRP. I can isolate a highly concentrated 3 mL sample of PRP and combine it with 3 mL of platelet-poor plasma (PPP). This PPP is rich in anti-inflammatory cytokines and proteins that can provide more immediate pain relief while the platelets and growth factors begin their long-term regenerative work.

The future of hip OA treatment lies in this personalized, integrative model. We must continue to refine our understanding of optimal biologic dosing, while never losing sight of the foundational importance of restoring biomechanical function through chiropractic care, physical therapy, and targeted rehabilitation. By combining the best of regenerative science with a holistic understanding of human movement, we can offer our patients not just a temporary fix, but a genuine path back to an active, pain-free life.

References

• Ayhan, E., Kesmezacar, H., & Akgun, I. (2014). Intraarticular corticosteroid injection for the treatment of hip osteoarthritis. Journal of Clinical Rheumatology, 20(3), 166–171. doi.org/10.1097/RHU.0000000000000010
• Belk, J. W., Kraeutler, M. J., Houck, D. A., Goodrich, J. A., Dragoo, J. L., & McCarty, E. C. (2020). Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The American Journal of Sports Medicine, 49(1), 249–260. doi.org/10.1177/0363546520909397
• Collaborative COTOA. (2023). Intra-articular platelet-rich plasma (PRP) injections for knee osteoarthritis: an evidence-based guideline and systematic review. British Journal of Sports Medicine, 57(12), 757-770. doi.org/10.1136/bjsports-2022-106252
• Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., & Lu, H. (2020). Global, regional, and national burden of osteoarthritis, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. BMJ, 369, m1581. doi.org/10.1136/bmj.m1581
• Veronese, N., Cereda, E., Maggi, S., Luchini, C., Solmi, M., Smith, T., … & Stubbs, B. (2016). Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis. Seminars in Arthritis and Rheumatism, 46(2), 160–167. doi.org/10.1016/j.semarthrit.2016.04.001