Intraosseous platelet-rich plasma for osteoarthritis: a comprehensive review

Intraosseous platelet-rich plasma (IO-PRP) therapy is an emerging biologic approach targeting the osteochondral unit in osteoarthritis (OA), especially of the knee and hip, by addressing subchondral bone pathology implicated in disease progression. This review synthesizes clinical and preclinical evidence on IO-PRP from PubMed and Scopus (up to May 2025), focusing on its biological rationale, therapeutic efficacy, and applications in osteoarticular disease. Evidence from randomized trials, observational studies, and experimental models indicates that IO-PRP - particularly when combined with intra-articular PRP - improves pain, function, and joint structure in moderate-to-severe OA. Preclinical studies demonstrate IO-PRP's role in subchondral bone remodelling, mesenchymal stromal cell modulation, and inflammation reduction, supporting its disease-modifying potential. IO-PRP represents a promising, biologically grounded intervention for OA management; however, further standardized, long-term clinical trials are needed to determine optimal protocols and validate long-term benefits.