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The PRP Paradox: Popular Treatment, Limited Data

  • Writer: Derick Davis, MD
    Derick Davis, MD
  • Jun 19
  • 3 min read

Glenohumeral osteoarthritis (GHOA) is second only to rotator cuff arthropathy for atraumatic shoulder pain (rotator cuff arthropathy)1. GHOA ranks third behind knees and hips as the large joint most affected by osteoarthritis (OA)2. Additionally, radiographs reveal a prevalence of 16-20% in middle to elderly-adults.  These facts set the stage for why its symptomatic management and treatment are paramount. Treatment typically includes physical therapy, NSAIDs, and corticosteroid injections, the likes of which fail to maintain relief or do not have a sufficient burden of evidence to prove their perdurability1. Platelet rich plasma (PRP) is a hopeful alternative.

PRP, a term coined within the field of hematology in the 1970s3, has become a mainstay treatment in both spine and sports medicine. Defined as a platelet concentration above baseline within a patient’s blood plasma fraction, it promotes healing and reduction of inflammation. Due to the inherent nature of interpatient cellular variability, a lack of standardization poses the greatest obstacle to consistency of PRP preparation4. Despite its popularity as a therapeutic modality, data for PRP and GHOA remains sparse5,2.

A systematic review published by Migliorini et al. in 2025 examines 13 studies (for a total of 1,126 shoulders) where GHOA was treated with intra-articular injectable preparations6. Of these 13 studies, only one, Kirschner et al. published in 2022, directly compares PRP (leukocyte-poor) against hyaluronic acid (HA)7. This study examined 69 patients over a 12-month period and assessed multiple metrics (e.g. ASES & SPADI) including function and pain. Most patients in the study qualified as having severe OA. Despite its known anti-inflammatory and immunomodulatory properties, PRP failed to outperform HA in pain reduction or function improvement. Of note, however, both groups signification benefited from these injections. Perhaps most importantly, 22.9% of the participants went on to have total shoulder replacements following the interventions.


Rossi et al. published in 2020 is a narrative review that furthers the point about the relative paucity of high-quality evidence for PRP and GHOA2.  They note a case report (Freitag and Barnard8) wherein a 62-year-old female receives a series of 3 PRP injections 1 week apart for GHOA and is followed for 42 weeks. Her VAS goes from a 6 to a 1 for the duration of this follow up period and her DASH (Disabilities of the Arm, Shoulder and Hand) goes from a 65 to a 5 at week 42.  The last study mentioned is by Lo et al. in 2016 where PRP is used in conjunction with human dermal matrix allograft for biologic resurfacing plus hemiarthroplasty. While meaningful results were obtained, this study falls outside of the scope of using PRP as the sole intervention in the treatment of GHOA9.

At this time, confidence behind PRP for GHOA appears to be more so derived from its meaningful benefit seen in rotator cuff pathology and knee OA6. Despite this, we lack multiple high-quality studies to definitively say much about PRP’s role in GHOA.

1.             Davies MR, Musahl V, Forsythe B, Calcei JG, Ma CB. Glenohumeral Osteoarthritis: Disease Burden, Current Understanding, and Gaps in Knowledge and Treatment. Orthop J Sports Med. 2025;13(5):23259671251339428. doi:10.1177/23259671251339428

2.             Rossi LA, Piuzzi NS, Shapiro SA. Glenohumeral Osteoarthritis: The Role for Orthobiologic Therapies: Platelet-Rich Plasma and Cell Therapies. JBJS Reviews. 2020;8(2):e0075. doi:10.2106/JBJS.RVW.19.00075

3.             Alves R, Grimalt R. A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification. Skin Appendage Disord. 2017;4(1):18-24. doi:10.1159/000477353

4.             Cai L, Chen J, Yuan Q, et al. Recent advances in platelet-rich plasma therapy for osteoarthritis: mechanisms and clinical efficacy. J Mater Chem B. 2025;13(30):9001-9022. doi:10.1039/d5tb00394f

5.             Gupta A, Migliorini F, Maffulli N. Management of rotator cuff injuries using allogenic platelet-rich plasma. J Orthop Surg Res. 2024;19(1):165. doi:10.1186/s13018-024-04657-4

6.             Migliorini F, Schäfer L, Masoni V, Rivera F, Pipino G, Maffulli N. Intra-articular injections for shoulder arthritis in adults: a systematic review. Eur J Med Res. 2025;30(1):1080. doi:10.1186/s40001-025-03423-4

7.             Hospital for Special Surgery, New York. The Efficacy of Ultrasound Guided Glenohumeral Joint Injections of Platelet Rich Plasma (PRP) Versus Hyaluronic Acid (HA) in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Control Trial. clinicaltrials.gov; 2022. Accessed May 31, 2026. https://clinicaltrials.gov/study/NCT02984228

8.             Freitag JB, Barnard A. To evaluate the effect of combining photo-activation therapy with platelet-rich plasma injections for the novel treatment of osteoarthritis. BMJ Case Rep. 2013;2013:bcr2012007463. doi:10.1136/bcr-2012-007463

9.             Lo EY, Flanagin BA, Burkhead WZ. Biologic resurfacing arthroplasty with acellular human dermal allograft and platelet-rich plasma (PRP) in young patients with glenohumeral arthritis-average of 60 months of at mid-term follow-up. J Shoulder Elbow Surg. 2016;25(7):e199-207. doi:10.1016/j.jse.2015.11.063

 
 
 

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