What Are My Injection Options? Cortisone, Gel & PRP Compared

Three injections do most of the work in my office: cortisone, hyaluronic acid — the one most people call gel — and PRP. Patients often arrive thinking of them as three versions of the same thing, cheapest to most expensive. They are not. They work by different mechanisms, they take different lengths of time to do it, and they suit different people.

Here is how I actually choose between them, what each one honestly delivers, and what it costs.

The three, at a glance

The short version, before the detail. If you have the printed sheet from my office in front of you, this is the same comparison with room to breathe.

Cortisone

Cortisone is a potent anti-inflammatory placed directly where the problem is. It does not repair anything — it quiets the inflammation that is making the joint, tendon or bursa hurt. That is a real and useful thing to do, and it is the fastest relief of the three.

What it is good at. Getting you through a bad stretch. A hot, swollen knee that will not settle. A flare before a wedding, a holiday, a move. Bursitis that has taken over your sleep. When the problem is inflammation and the clock matters, cortisone is the right tool and I use it without hesitation.

What it is not. A strategy. Relief is temporary, typically three to six months, and I use it selectively rather than on a schedule. Repeated steroid into the same joint is not harmless over years. If you find yourself asking for another one every few months, that is information — it usually means the underlying problem has moved past what an injection can manage. More on how I use cortisone.

Hyaluronic acid (gel)

Hyaluronic acid occurs naturally in your joint fluid, where it does the lubricating and shock-absorbing. In an arthritic joint there is less of it and what remains works less well. Gel injections supplement it.

Knees only, and I mean that. Gel is FDA-approved for the knee, and the knee is the only place I use it. You will find practices offering it for hips off-label; I don't, because the evidence there doesn't support it. If you are here about a hip, gel is not your answer — PRP or cortisone is the conversation we should be having instead.

What to expect. Relief builds over a few weeks rather than arriving immediately, and in patients who respond it can hold for months. Some products are a single injection, others a series. It does not work for everyone — that is true of all three of these — and I would rather set that expectation now. More on gel injections.

PRP (platelet-rich plasma)

PRP is made from your own blood. We draw a small sample, spin it to concentrate the platelets — the cells carrying the growth factors your body already uses to manage inflammation and repair — and inject that concentrate where it is needed. About an hour in the office, start to finish. No donor product, no steroid.

What to expect. Improvement is gradual. Most people notice change over weeks, not days, which makes PRP a poor choice if you need relief by Friday and a good one if you are playing a longer game. In patients who respond, the benefit tends to outlast what cortisone gives them. My full guide to PRP for arthritis.

Does PRP actually work?

This is the question I get most, and it deserves a straight answer rather than a brochure one.

For the right patient, yes — and I say that as someone who sends plenty of people away from it. Across the published trials in knee arthritis, PRP has generally outperformed both placebo and gel at six and twelve months. That is the weight of the evidence, and it is why I offer it.

The honest complication. Not every trial agrees. At least one well-run study found PRP no better than a saline injection, and you should know that before you spend money rather than hear it from someone else afterwards. The likeliest explanation is that “PRP” is not one thing. How the blood is spun, how concentrated the platelets end up, and whether white cells are included all vary enormously between practices — and those differences change the product being injected. Two trials can both study “PRP” and be studying meaningfully different preparations.

Which is the real argument for caring who does it. A consistent preparation, placed accurately, in a patient selected because they were likely to respond, is not the same treatment as the version sold by volume down the road.

PRP vs cortisone

The most common comparison, and the one where the answer genuinely depends on you rather than on the science.

The pattern worth noticing is the fourth one. Cortisone buying you less time than it used to is one of the more reliable signals that it is worth having a different conversation.

PRP vs gel: how long each lasts

If you have already been offered gel — and most patients who reach this question have — this is the comparison that actually matters to you.

Duration is the main difference. Gel tends to give meaningful relief for around six months in patients who respond, after which it fades and the conversation starts again. PRP, in responders, more often holds through six months and into the region of a year. In head-to-head knee trials, PRP has generally come out ahead of gel at both the six and twelve month marks.

Where gel still wins. It is usually covered by insurance, and PRP is not. For a knee patient where cost is the binding constraint, gel is a perfectly reasonable place to start — and having had it does not rule out PRP later.

Where PRP wins. Hips, where gel is not an option at all. Tendon and bursa problems, where gel has no role either. And the patient who has been round the gel cycle once or twice already and wants something that lasts longer than the gap between injections.

What PRP costs

PRP is $800 per injection. I recommend a course of two injections, two weeks apart.

PRP is not covered by insurance — no regenerative injection currently is — so this is an out-of-pocket decision, and I would rather you have the number before you come in than discover it at the desk. Cortisone and gel are generally covered, which is a legitimate part of the comparison rather than a footnote to it.

It is not only hips and knees

Hips and knees are the bulk of my practice, but these injections are not restricted to joints. Cortisone and PRP are both used in tendons, muscle and bursa — rotator cuff, tennis and golfer's elbow, IT band, Achilles, trochanteric bursitis at the side of the hip. Gel is the exception: it supplements joint fluid, so it belongs in a joint — and in my practice, only in a knee.

If your problem is a tendon rather than a joint, that genuinely changes which injection I reach for — so it is worth saying at the start of the visit rather than halfway through.

Stem cells, amniotic products and the rest

You will see other injections advertised — stem cells, amniotic or placental fluid, fat-derived and exosome products, dextrose prolotherapy — often at considerably higher prices than PRP. Patients ask me about them regularly, so here is my position.

I do not offer them, and the reason is the evidence. For hip and knee arthritis specifically, none of them has published support approaching what PRP has, and several are sold in ways that outrun their data considerably. Amniotic and placental products in particular are marketed with claims about living cells that the products themselves often do not support.

I am not telling you these are worthless or that the research will never get there — some of it is genuinely interesting. I am telling you that today, if you are spending your own money on an injection for an arthritic hip or knee, PRP is where the evidence is, and that a clinic charging you three or four times as much for something with less behind it is not doing you a favour. What the trials actually found for each.

Timing, surgery and blood thinners

Two timing rules that catch people out, both worth knowing before you book anything.

Blood thinners and aspirin. Tell me what you take — do not stop anything on your own. For PRP, aspirin is generally held for about a week beforehand, because it blunts the platelet function the treatment depends on. Other blood thinners are handled case by case, with the doctor who prescribed them.

How I choose

In the room, it comes down to three questions, roughly in this order.

You do not need to have decided before you come in. Bring the question and any imaging you have, and we will work out which of these fits — including the possibility that the right answer is none of them. Being seen does not commit you to an injection or an operation.

Request a consultation at either my Washington, D.C. or Germantown, Maryland office.