PRP vs Cortisone Injections: Which Is Better?

PRP vs cortisone vs hyaluronic acid at a glance

Hyaluronic acid is included because it is the other injection most often offered for knee arthritis.

	PRP	Cortisone	Hyaluronic acid
What it is	A concentrate of your own platelets	A synthetic corticosteroid	A gel-like fluid similar to natural joint fluid
Common uses	Knee osteoarthritis, chronic tendon problems, some ligament and muscle injuries	Arthritis, tendinitis, bursitis, tennis elbow, trigger finger	Knee osteoarthritis
How it works	Delivers growth factors involved in tissue repair	Suppresses inflammation	Adds lubrication and shock absorption
When relief starts	Gradually, often over 3 to 6 weeks	Within days, up to about a week	Over several weeks
How long relief lasts	Often six months to a year or longer when it helps	A few weeks to a few months	Several months for some patients
Repeat injections	Sometimes given as a series	Usually no more than three a year	1 to 5 shots per course, often repeated about every 6 months
Effect on tissue	Cartilage change similar to placebo in a 12-month knee trial	More cartilage loss than saline in a 2-year knee trial	Not shown to regrow cartilage

How cortisone injections work

Cortisone is a corticosteroid, a strong anti-inflammatory. Injected into a joint, bursa or the sheath around a tendon, it quiets inflammation and the pain that comes with it. Cleveland Clinic says it can take up to a week to take effect and usually lasts between a few weeks and a few months. It eases symptoms while the underlying problem, such as worn cartilage or a degenerated tendon, remains.

Because of side effects with repeated use, Cleveland Clinic advises most people to have no more than three cortisone shots a year, with at least three months between rounds. Blood sugar can rise for a few days afterward, which matters for people with diabetes.

How PRP injections work

PRP is made from your own blood. A small sample is spun in a centrifuge to concentrate the platelets, which carry growth factors involved in healing, and the concentrate is injected into the injured tissue. Its goal is to support the tissue's own repair process, which is why it works on a slower clock: Cedars-Sinai describes inflammation easing over three to six weeks, and Cleveland Clinic reports that the effect may last six months to a year or longer when it helps. For the full background, read What is a PRP injection?

Where hyaluronic acid fits

Hyaluronic acid injections, also called viscosupplementation, add a gel-like fluid to the knee to restore some of the lubrication and shock absorption that osteoarthritis wears down. The course is 1 to 5 shots depending on the product, relief takes several weeks to appear, and for patients who respond it can last several months. The AAOS notes that the most recent research has not found hyaluronic acid to meaningfully reduce pain or improve function, and that it has never been shown to regrow cartilage.

In head-to-head trials, PRP has generally come out ahead. A 2020 meta-analysis of 20 randomized trials found PRP relieved knee pain more effectively than hyaluronic acid at 6 and 12 months, without more side effects. Hospital for Special Surgery reports emerging data that combining PRP with hyaluronic acid may work better than either alone.

What the research shows

Knee osteoarthritis

A 2021 systematic review and meta-analysis of eight studies and 648 patients compared PRP with cortisone injections directly. PRP reduced pain and stiffness and improved function more than cortisone at 3, 6 and 9 months, with the largest differences at 6 and 9 months. Three PRP injections spaced about a week apart beat a single injection over 12 months.

The case against routine cortisone in knee arthritis comes from a two-year JAMA trial. Patients who received a corticosteroid injection every three months lost significantly more cartilage than those given saline, and their pain was no better. PRP has its own skeptics: the RESTORE trial found three PRP injections were no better than saline for pain or cartilage volume at 12 months, which is a useful reminder that results vary by preparation and patient.

Tennis elbow and other tendon problems

A systematic review of five randomized trials in 250 patients with tennis elbow found cortisone gave rapid relief that peaked around six to eight weeks, after which symptoms tended to come back. PRP improved more slowly but kept improving for up to two years. On ultrasound, cortisone was associated with thinner tendons and more bone erosion, while PRP was associated with thicker tendons and fewer tendon tears. The AAOS considers PRP effective for chronic tennis elbow, and promising, though less proven, for Achilles and patellar tendon problems.

Side effects and long-term risks

Cortisone: pain and swelling at the site, bruising, skin lightening or discoloration, a temporary rise in blood sugar and, rarely, infection. Repeated injections have been linked to cartilage loss in the knee and, with many rounds, a higher osteoporosis risk.
PRP: soreness at the injection site that can last a few days to a week or two. Because it comes from your own blood, the risk of an allergic reaction is very low, and the AAOS reports that infection and nerve injury appear no more likely than with cortisone.
Hyaluronic acid: brief pain, warmth and swelling after the shot. Rarely, the knee fills with fluid and becomes red and painful, which needs prompt attention.

When each one makes sense

Cortisone can make sense for fast relief: an acute flare of bursitis or arthritis, pain that is blocking sleep or rehab, or an inflammatory condition where speed matters most.
PRP can make sense for chronic tendon problems such as tennis elbow, for mild to moderate knee osteoarthritis, or when you have already had several steroid shots and want relief that lasts.
Hyaluronic acid is a knee-only option some patients try for osteoarthritis, though the evidence for it is weaker than for PRP.

Whichever injection you choose, it works best alongside the exercise and rehab that address why the joint or tendon became painful in the first place.

Cost and insurance

Cost often decides the question in practice. Cortisone is a standard, inexpensive treatment that insurance plans commonly cover. PRP is usually paid out of pocket: the AAOS notes that few plans provide even partial reimbursement, and a survey of 179 U.S. centers found an average price of $714 for a single knee injection. Ask for a written quote, and weigh the cost of one longer-lasting treatment against repeated short-term ones.

Choosing between PRP and cortisone in Miami

In my Miami practice, I use both. I start with a diagnosis, using an in-clinic musculoskeletal ultrasound when it helps, because the right injection depends on whether the problem is inflammation, a degenerated tendon or worn cartilage. Sometimes a single cortisone shot is the right call. For chronic tendon pain or knee arthritis in someone who wants to stay active, I often talk through PRP, guided by ultrasound and paired with a rehab plan.

Read What is a PRP injection?, learn about PRP injections in Miami, or book a consultation.

Frequently asked questions

Is PRP better than cortisone?

For lasting relief, the research favors PRP in knee osteoarthritis and tennis elbow. A 2021 meta-analysis found PRP outperformed cortisone for knee arthritis symptoms at 3, 6 and 9 months, and a review of tennis elbow trials found cortisone worked faster but PRP held up longer. For fast relief from an acute flare, cortisone usually wins.

Which works faster, PRP or cortisone?

Cortisone. Cedars-Sinai notes cortisone usually reduces pain in two to seven days, while PRP reduces inflammation over three to six weeks. That speed is the main reason cortisone is still widely used.

How long does a cortisone shot last compared with PRP?

Cleveland Clinic says cortisone injections usually last between a few weeks and a few months. When PRP helps, its effect may last six months to a year or longer, and some knee osteoarthritis results have lasted up to two years.

How many cortisone shots can you get in a year?

Cleveland Clinic advises that most people should not have more than three cortisone shots a year and should usually wait at least three months between rounds. Your physician sets the exact timing based on the joint and your health.

Does cortisone damage cartilage?

Repeated injections may. In a two-year trial, knees injected with a corticosteroid every three months lost significantly more cartilage than knees injected with saline, without better pain relief. That trial tested regular injections every three months, so it says less about an occasional single shot.

Is PRP or hyaluronic acid better for knee arthritis?

A 2020 meta-analysis of 20 randomized trials found PRP relieved pain better than hyaluronic acid at 6 and 12 months, with no difference in side effects. The AAOS notes that recent research has not found hyaluronic acid to meaningfully reduce pain or improve function for most patients.

Does insurance cover PRP like it covers cortisone?

Usually not. The AAOS notes that few insurance plans provide even partial reimbursement for PRP, so most patients pay out of pocket. Cortisone injections are a standard treatment that plans commonly cover, which makes cost a real part of the decision.