PRP injection vs Steroid Injection for Knee Pain (2022)

By Dr. Frank Yap, MD -

While steroid injections can often be a “quick fix” for pain, they often accelerate the progression of the disease the patient is suffering from.

Still, thousands of medical practitioners and physicians around the globe continue to give their patients steroid injections because they say it makes them feel good, at least for the time being anyway. However, a momentary state of euphoria is not justification enough to put the patient through the multiple risk factors associated with steroids. Healthcare physicians and patients alike need to consider the risks and ramifications of steroid injections, especially when it comes to short-term pain management. What follows is an attempt to bring awareness to the medical community, both on the doctor’s and patient’s side, about the potential dangers of steroid injections.

prp for knee osteoarthritis


Risks of Steroid Injections

The most common form of steroid injection for pain comes in the form of corticosteroids, which are most commonly injected right into the patient’s joints. One of the biggest problems with these injections is that the body is not used to such a high dose of hormones at one go and so the joints along with many of the cells get affected and react accordingly by deteriorating and dying off. In essence, the disease which caused the pain in the first place gets worse.

Some of the other common health ramifications of steroid injections include:

  • Killing cartilage cells
  • Destroying stem cells
  • Increasing the risk of fractures in senior citizens
  • Increasing the risk of osteonecrosis (bone disease)
  • Disturbing the stress-management system of the body
  • Damaging tendons
  • Damaging cartilage

Steroid Shots to Treat Pain are Really Bad for Patients

Doctors use steroids in medical treatment like priests use holy water. While there are clinical situations where they can be life-saving, their use to treat pain has grown increasingly controversial as our understanding of the nasty side effects has mounted:

  • 3 days of oral steroid use results in an 80% increase in GI bleeds and a doubling of the heart failure and sepsis risk (R).
  • More than 30 days of oral use results in a 5X risk for sepsis, 3X increase in the risk of blood clots, and 20X for fractures (R).
  • These drugs both injure stem cells and cartilage cells, including documented loss of cartilage in the knee joint (JAMA 2017).
  • There is an increased risk of infection in a knee or hip replacement or meniscectomy surgery when steroids are injected into that joint before the procedure (R).
  • Inhaled steroid use in asthma is now associated with brain atrophy (BMJ 2022).
  • Steroid injections in tendons reduce blood supply, injure tendon cells, and increase rotator cuff repair failure rates (R).
  • Injections of steroids for pain worsen osteoporosis, cortisol levels, and blood sugar (R).

The Case For Steroid Injections

Although the above risks are well-known to almost all physicians supporting steroid injections, they still consider the short-term pain reduction and energy boost to be the decisive factor in its use.

As a patient, however, one must weigh the scales when it comes to short-term relief and long-term health disabilities. Is it really worth it to feel good today only to suffer from more ailments tomorrow?

As for the doctors, they should try to think outside of the box a little and not just go for those treatments, like steroid injections, that are covered by insurance and instead look for more dynamic and regenerative medical breakthroughs, which are continuously being discovered almost on a daily basis.

In the end, the doctor should do what is in the best interest of the patient and the patient should agree to the treatment that is the best interest of their health, even when that goes against the grain of traditional medicine.

If Steroids Is A Must, Then Use The Right Dose

If both the doctor and patient ultimately agree that steroids are the best treatment for pain management at the moment then knowing and using the correct dosage is a must.

Just what is the correct dosage? Studies have shown that steroids can influence pain receptors in the tens to hundreds of nanogram range, yet most of the steroid injections given today for pain management are almost a million times more than this. The worst part is that these high-dose ranges kill off cells, making the disease progressively worse as time goes on.

PRP – An Alternative To Steroid Injections


Patient Rich Plasma Therapy (PRP) uses platelets, the body’s way of regenerating and repairing damaged tissue, to accelerate the healing process.

Through PRP Therapy, doctors are able to separate platelets from the red blood cells and so increase growth factors and stimulation of stem cells at a higher level than what the body is normally capable of. In doing so, the affected area undergoes a rapid repair process that is often accompanied by a quick dose of pain relief.

The entire process takes only 30 minutes and the effects are long-lasting. The best thing of all, there are no long-term health risks of using this form of therapy as there are with steroid injections.

PRP vs Steroid Injections

There are 5 PRP studies that show superiority over steroid injections:
  1. Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up (J Orthop Surg Res. 2020)
  2. Comparative Effect between Infiltration of Platelet-rich Plasma and the Use of Corticosteroids in the Treatment of Knee Osteoarthritis: A Prospective and Randomized Clinical Trial (Rev Bras Ortop (Sao Paulo). 2020)
  3. Platelet-Rich Plasma Injections for Advanced Knee Osteoarthritis: A Prospective, Randomized, Double-Blinded Clinical Trial (Orthop J Sports Med. 2017)
  4. Comparison of Efficiency Between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients With Knee Osteoarthritis (Arch Rheumatol. 2017)
  5. Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: A pilot study (J Back Musculoskelet Rehabil. 2018)

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