PRP for Gluteus Medius Tendinosis

Q: Does PRP work better than a cortisone shot for hip tendon pain?

For lasting relief, the best available evidence favors PRP. In a two-year double-blind randomized trial, a single leukocyte-rich PRP injection produced greater improvement in hip function than a cortisone injection, and that advantage widened over time. Cortisone tends to help within the first few weeks, but its benefit typically fades by three to six months, while PRP works more slowly and lasts longer. That said, a separate placebo-controlled trial found PRP was no better than saline, so we describe PRP as a low-risk option that outperforms cortisone for durability, not as a certain cure.

Q: How long does PRP take to work for gluteus medius tendinosis?

PRP does not provide the quick relief a cortisone shot can. Because it works by stimulating your tendon to rebuild disorganized collagen, the benefit develops gradually. Most patients notice meaningful improvement over the first two to three months, with maximal benefit typically reached between three and six months as the tendon remodels. Setting this expectation matters, because patients who expect immediate relief can feel discouraged during the normal, slower healing timeline. A brief flare of soreness in the first few days after the injection is expected and is not a sign of a problem.

Q: Can PRP treat a partial gluteus medius tendon tear?

Yes, for partial-thickness tears PRP is a reasonable option, especially after physical therapy has not resolved the pain. A prospective study of patients with moderate-to-severe tendinosis and partial tears showed significant improvement in hip function scores sustained beyond a year, with only minor injection-site soreness reported. Full-thickness, retracted tears are different. Those generally require surgical evaluation rather than injection, because the torn tendon ends have pulled apart and need to be reattached. An MRI helps us determine which category your tear falls into and guide the right treatment.

Q: Is PRP safer than surgery for lateral hip pain?

PRP carries a much lower risk profile than surgery. In a systematic review comparing the two, PRP was associated only with temporary injection-site soreness, while surgical repair carried complication rates as high as 19 percent in one series, including blood clots, infection, retears, and fracture. Both approaches can improve symptoms in the right patients, so the decision depends on the severity of the tendon damage. For tendinosis and partial tears that have failed conservative care, PRP is a sensible next step before considering surgery, which we reserve for tears that genuinely require repair.

Q: What should I do before trying PRP?

Structured physical therapy is the foundation and should come first. The evidence for gluteal tendinopathy is clear that education and a progressive exercise program focused on hip abductor strengthening produce durable improvement, often outperforming a cortisone injection at one year. We generally recommend a dedicated course of physical therapy and activity modification before considering PRP, and our Rockville office offers physical therapy for exactly this purpose. If pain persists despite a proper rehabilitation effort, and imaging confirms tendinosis or a partial tear, PRP becomes a well-supported next option.

What is prp for gluteus medius tendinosis?

PRP for gluteus medius tendinosis is an ultrasound-guided injection of your own concentrated platelets into a degenerated hip abductor tendon. In a double-blind randomized trial, a single leukocyte-rich PRP injection produced greater and more durable improvement in hip function than a corticosteroid injection, with benefits sustained at two years.

Does PRP Work for Gluteus Medius Tendinosis?

Platelet-rich plasma (PRP) has become an evidence-supported option for chronic gluteus medius and minimus tendinosis, including partial-thickness hip abductor tears, in patients who have not improved with physical therapy and activity modification. The strongest evidence comes from a double-blind randomized controlled trial in which a single ultrasound-guided leukocyte-rich PRP injection produced significantly greater improvement in hip function than a corticosteroid injection at 12 weeks, with that advantage widening and holding through two years (Fitzpatrick et al., AJSM 2019).

The evidence is genuinely nuanced, and we believe patients deserve the full picture. A corticosteroid injection tends to help quickly but fades within a few months, whereas PRP works more slowly and lasts longer. A separate 2025 placebo-controlled trial found PRP was no better than a saline injection for this condition, which tells us that some of the improvement patients experience reflects natural healing and the effect of the needle itself (Atchia et al., JBJS 2025). We present PRP as a reasonable, low-risk option that outperforms cortisone for durable relief, not as a guaranteed cure.

At Maryland Orthopedic Specialists, our physicians provide ultrasound-guided PRP for lateral hip tendon pain at our Bethesda and Germantown offices, serving patients throughout Montgomery County and the greater Washington area. Physical therapy for this condition is also available at our Rockville location.

Understanding Gluteus Medius Tendinosis

The gluteus medius and gluteus minimus are the two main muscles that stabilize your pelvis when you stand on one leg or walk. Their tendons attach to the greater trochanter, the bony prominence on the outer side of the hip. Because these tendons stabilize the hip in much the same way the rotator cuff stabilizes the shoulder, orthopedic surgeons often call them the "rotator cuff of the hip," a term first used to describe torn hip abductor tendons (Reksoprodjo et al., 2024).

Pain from these tendons is the most common driver of what clinicians call greater trochanteric pain syndrome. It typically shows up as aching or sharp pain on the outer hip that worsens when lying on that side, climbing stairs, or standing on one leg. This condition was once labeled "trochanteric bursitis," but imaging and surgical studies have shown that tendon degeneration and tearing, not bursal inflammation, drive most cases (Radsource anatomy review).

Greater trochanteric pain syndrome accounts for an estimated 10 to 20 percent of hip pain seen in primary care. It affects women far more often than men, with most cases appearing between ages 40 and 60, and a higher body weight increases the risk (Speers and Bhogal, British Journal of General Practice).

Why It Is Tendinosis, Not Tendinitis

An important point for patients is that chronic gluteal tendon problems are degenerative rather than inflammatory. Repetitive stress sets off a self-perpetuating cycle of tissue breakdown and incomplete repair. The tendon shifts from strong Type I collagen toward weaker Type III collagen, becomes disorganized, and develops abnormal blood vessels and nerve fibers that carry pain (StatPearls, GTPS).

This explains a frustration many patients know well. Because the problem is structural degeneration rather than active inflammation, anti-inflammatory treatments like cortisone and NSAIDs tend to calm symptoms only briefly. They do not repair the disorganized collagen, and repeated cortisone injections near a tendon may weaken it further over time.

How PRP Works for Hip Abductor Tendons

PRP is prepared from a small sample of your own blood, spun in a centrifuge to concentrate the platelets. When those platelets are injected into a degenerated tendon, they release growth factors such as PDGF, TGF-beta, IGF-1, VEGF, and FGF. These signaling proteins recruit repair cells, stimulate tenocyte activity, and support the gradual replacement of disorganized collagen with stronger, more organized tissue (Frontiers in Bioengineering review).

Because tendon remodeling is slow, PRP does not provide instant relief the way a cortisone shot can. The maximal benefit typically develops over three to six months as the tendon matrix reorganizes. Understanding this timeline is essential to setting realistic expectations.

The formulation used matters. Every major randomized trial in the gluteal tendon used leukocyte-rich PRP (LR-PRP), which contains a higher concentration of white blood cells. Whether leukocyte-rich or leukocyte-poor PRP is biologically better for chronic tendinosis remains an open scientific question, so our current practice follows the formulation that carries the strongest clinical evidence in this specific tendon (Ali and Malviya, J Hip Preserv Surg 2018).

Clinical Evidence: Literature Review

The Landmark Randomized Trial (Fitzpatrick et al., 2018 and 2019)

The best evidence for PRP in gluteal tendinopathy comes from a double-blind randomized controlled trial of 80 patients with chronic gluteus medius and minimus tendinopathy, most of whom had symptoms for more than 14 months. Patients received a single ultrasound-guided injection of either leukocyte-rich PRP or corticosteroid, and hip function was measured with the modified Harris Hip Score (mHHS).

At 2 and 6 weeks, both groups improved similarly. By 12 weeks, the PRP group pulled ahead, with a mean mHHS of 74.05 versus 67.13 for corticosteroid (P = .048). The proportion of patients achieving a clinically meaningful improvement was 82 percent with PRP versus 56.7 percent with corticosteroid (P = .016) (Fitzpatrick et al., AJSM 2018).

The two-year follow-up showed the gap continued to widen. At 24 weeks the PRP group scored 77.60 versus 65.72 (P = .0003), and by 104 weeks the PRP group reached a mean mHHS of 82.59 and sustained it, while most corticosteroid patients had needed to cross over to another treatment. The authors concluded that PRP produced greater improvement in pain and function than corticosteroid, that the PRP benefit was sustained at two years, and that the corticosteroid benefit peaked at 6 weeks and was not maintained beyond 24 weeks (Fitzpatrick et al., AJSM 2019).

The Conflicting Placebo-Controlled Trial (Atchia et al., 2025)

Scientific honesty requires presenting the counterevidence. A 2025 double-blind trial published in the Journal of Bone and Joint Surgery randomized 79 patients with refractory greater trochanteric pain syndrome to leukocyte-rich PRP or a saline placebo injection. It found no significant difference between PRP and placebo on any outcome measure at 3, 6, or 12 months, and the authors did not recommend routine use of PRP for this condition (Atchia et al., JBJS 2025).

The most likely explanation for the difference is the comparison used. The Fitzpatrick trials compared PRP against cortisone, whose benefit is known to fade, while the 2025 trial compared PRP against inert saline, and the saline group also improved. Taken together, the evidence supports PRP as superior to cortisone for lasting relief, while leaving genuine uncertainty about how much it adds beyond natural healing.

PRP for Partial-Thickness Tears (Lee and Vargas et al., 2016)

A prospective study of 21 patients with moderate-to-severe gluteus medius tendinosis and partial-thickness tears, all of whom had failed physical therapy, used ultrasound-guided PRP with a needle tenotomy technique. At an average follow-up of nearly 20 months, the modified Harris Hip Score rose from 56.73 to 74.17, and the iHOT-33 score rose from 34.06 to 66.33, with all measures improving significantly (P < .001). The authors concluded PRP was a safe and effective option for tendinosis and partial tears, with only self-limited injection-site soreness reported (Lee et al., Orthop J Sports Med 2016).

PRP Compared With Surgery

A systematic review comparing PRP against surgical repair for recalcitrant greater trochanteric pain syndrome found both approaches produced significant clinical improvement in appropriately selected patients. The safety difference was substantial. PRP was associated only with minor, self-limited soreness, while one surgical series reported a complication rate as high as 19 percent, including blood clots, infection, retears, and fracture. The authors positioned PRP as an effective, safe alternative after failed physical therapy, reserving surgery for cases that genuinely require repair (Walker-Santiago et al., American Hip Institute).

Why Cortisone Fades

A three-arm randomized trial of 204 patients (the LEAP trial) compared education plus exercise, a single corticosteroid injection, and a wait-and-see approach. Corticosteroid helped at 8 weeks, but by 52 weeks it was no longer better than doing nothing (P = .46), while structured exercise maintained its advantage. This pattern, strong early relief followed by decline, is one of the clearest illustrations of why cortisone is a short-term tool rather than a durable solution for gluteal tendinopathy (Mellor et al., BMJ 2018).

Who Is a Candidate?

Good candidates for PRP generally share these features:

Lateral hip pain present for more than three months that has not responded to a proper course of physical therapy and activity modification
MRI or high-resolution ultrasound confirming gluteus medius or minimus tendinosis, a partial-thickness tear, or both
Hip abductor weakness or dysfunction on clinical examination
An inadequate or short-lived response to a prior corticosteroid injection, which does not reduce the likelihood of responding to PRP

PRP is generally not appropriate in these situations:

A full-thickness, retracted tendon tear, which typically requires surgical evaluation rather than injection
Current use of anticoagulant or antiplatelet medication, including aspirin, because PRP depends on platelet activity
A corticosteroid injection within the prior three months, which may blunt the healing response
Active infection at or near the injection site
Significant fatty atrophy or denervation of the gluteal muscles, reflecting advanced and likely irreversible muscle-tendon failure
Severe hip arthritis or active lumbar nerve compression that better explains the pain

Treatment Protocol at Maryland Orthopedic Specialists

The Injection

We draw a small volume of your blood and concentrate the platelets into leukocyte-rich PRP. With you positioned on your side or stomach, we use real-time ultrasound to visualize the greater trochanter and the gluteus medius and minimus tendons. A spinal needle is guided directly into the degenerated, hypoechoic regions of the tendon, and several needle passes are made through the damaged tissue before the PRP is delivered into the tendon substance. Ultrasound guidance ensures the growth factors reach the exact area of tendon damage while avoiding nearby nerves and vessels.

After the Injection

Recovery follows a structured, criterion-based progression rather than a fixed calendar. The tendon needs a protected window while the biology takes hold.

Weeks 0 to 2 (protection): Relative rest, avoiding lying on the treated hip, stair climbing, squatting, lunging, and resisted abduction. A temporary increase in soreness for a few days is expected and reflects the healing stimulus the injection is designed to create.
NSAID avoidance: Anti-inflammatory medications are avoided for roughly six weeks, because they can blunt the platelet-driven healing response.
Weeks 2 to 6 (rehabilitation): Structured physical therapy begins, emphasizing core stability, eccentric hip abductor strengthening, and balance training. This exercise component is essential, and the evidence shows structured rehabilitation is a powerful treatment for this condition in its own right.
Week 6 onward (progressive loading): Gradual return to walking programs, gym activity, and sport-specific movement as symptoms allow.
Three to six months (maturation): Maximal benefit typically develops during this window as the tendon remodels. A second injection may be considered if you show partial but incomplete improvement around the three-month mark.

Clinical References

Fitzpatrick J, Bulsara MK, O'Donnell J, McCrory P, Zheng MH. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. American Journal of Sports Medicine. 2018;46(4):933-939. doi:10.1177/0363546517745525
Fitzpatrick J, Bulsara MK, O'Donnell J, Zheng MH. Leucocyte-rich platelet-rich plasma treatment of gluteus medius and minimus tendinopathy: a double-blind randomized controlled trial with 2-year follow-up. American Journal of Sports Medicine. 2019;47(5):1130-1137. doi:10.1177/0363546519826969
Atchia I, et al. Leucocyte-rich platelet-rich plasma injection for greater trochanteric pain syndrome: a randomized, placebo-controlled trial. Journal of Bone and Joint Surgery. 2025. doi:10.2106/JBJS.24.00763
Lee JJ, Harrison JR, Boachie-Adjei K, et al. Ultrasound-guided platelet-rich plasma injection improves outcomes for chronic lateral hip and gluteal pain: a prospective, observational study. Orthopaedic Journal of Sports Medicine. 2016;4(11). doi:10.1177/2325967116671692
Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic review. Journal of Hip Preservation Surgery. 2018;5(4):209-219. doi:10.1093/jhps/hny027
Walker-Santiago R, Wojnowski NM, Lall AC, et al. Platelet-rich plasma versus surgery for the management of recalcitrant greater trochanteric pain syndrome: a systematic review. Arthroscopy. 2020. americanhipinstitute.com
Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. doi:10.1136/bmj.k1662
Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. British Journal of General Practice. 2017;67(663):479-480. doi:10.3399/bjgp17X693041

Maryland Orthopedic Specialists. Board-certified orthopedic care in Bethesda and Germantown, MD, with physical therapy in Rockville. Serving patients throughout Montgomery County and the Washington metropolitan area. This page is for educational purposes only and does not constitute medical advice. Individual treatment decisions require evaluation by a licensed physician. Page reviewed July 2026.

Frequently Asked Questions

Does PRP work better than a cortisone shot for hip tendon pain?

For lasting relief, the best available evidence favors PRP. In a two-year double-blind randomized trial, a single leukocyte-rich PRP injection produced greater improvement in hip function than a cortisone injection, and that advantage widened over time. Cortisone tends to help within the first few weeks, but its benefit typically fades by three to six months, while PRP works more slowly and lasts longer. That said, a separate placebo-controlled trial found PRP was no better than saline, so we describe PRP as a low-risk option that outperforms cortisone for durability, not as a certain cure.

How long does PRP take to work for gluteus medius tendinosis?

PRP does not provide the quick relief a cortisone shot can. Because it works by stimulating your tendon to rebuild disorganized collagen, the benefit develops gradually. Most patients notice meaningful improvement over the first two to three months, with maximal benefit typically reached between three and six months as the tendon remodels. Setting this expectation matters, because patients who expect immediate relief can feel discouraged during the normal, slower healing timeline. A brief flare of soreness in the first few days after the injection is expected and is not a sign of a problem.

Can PRP treat a partial gluteus medius tendon tear?

Yes, for partial-thickness tears PRP is a reasonable option, especially after physical therapy has not resolved the pain. A prospective study of patients with moderate-to-severe tendinosis and partial tears showed significant improvement in hip function scores sustained beyond a year, with only minor injection-site soreness reported. Full-thickness, retracted tears are different. Those generally require surgical evaluation rather than injection, because the torn tendon ends have pulled apart and need to be reattached. An MRI helps us determine which category your tear falls into and guide the right treatment.

Is PRP safer than surgery for lateral hip pain?

PRP carries a much lower risk profile than surgery. In a systematic review comparing the two, PRP was associated only with temporary injection-site soreness, while surgical repair carried complication rates as high as 19 percent in one series, including blood clots, infection, retears, and fracture. Both approaches can improve symptoms in the right patients, so the decision depends on the severity of the tendon damage. For tendinosis and partial tears that have failed conservative care, PRP is a sensible next step before considering surgery, which we reserve for tears that genuinely require repair.

What should I do before trying PRP?

Structured physical therapy is the foundation and should come first. The evidence for gluteal tendinopathy is clear that education and a progressive exercise program focused on hip abductor strengthening produce durable improvement, often outperforming a cortisone injection at one year. We generally recommend a dedicated course of physical therapy and activity modification before considering PRP, and our Rockville office offers physical therapy for exactly this purpose. If pain persists despite a proper rehabilitation effort, and imaging confirms tendinosis or a partial tear, PRP becomes a well-supported next option.

Medically reviewed by Christopher S. Raffo, MD

Last reviewed July 20, 2026

References

American Academy of Orthopaedic Surgeons (AAOS). orthoinfo.aaos.org