Hip Pain and Orthobiologics

The hip is one of the largest joints in the body, and it takes decades of load before most people ever complain about it. About 14 percent of people over the age of 60 report hip pain, roughly 10.4 million Americans. This page collects what we have written about treating that pain with orthobiologics, meaning injections prepared from your own blood or bone marrow, and it is written for two audiences: patients who have been told the next step is a hip replacement, and physicians who want to know what these treatments can and cannot do for the hip.

Hip pain is not always coming from the hip joint

The single most common reason a hip injection fails is that the wrong structure was treated. Pain felt in the groin usually does point to the ball and socket joint itself, where arthritis and labral tears live. Pain felt on the outside of the hip, over the bony prominence, is frequently not arthritis at all. It is often tendinopathy of the gluteus medius and gluteus minimus, the tendons that stabilize the pelvis when you stand on one leg. One patient described here had been treated for ten years with steroid shots and medications for intractable hip region pain before an ultrasound examination identified gluteal tendinopathy as the source.

Chronic hip pain also spreads. When a hip hurts, people shorten their stride, stand asymmetrically and load the opposite knee and the low back differently, which is why the complaint that arrives in the office is often broader than the hip. Sorting the joint from the tendon, and both from referred spine pain, is the first job of the visit and it changes the treatment entirely.

Platelet rich plasma for the hip

Platelet rich plasma is concentrated from a blood draw on the day of the procedure and injected under ultrasound guidance. Dose matters. The gluteal tendinopathy patient described above received leukocyte poor PRP prepared from 60cc of blood, not the small volume preparations sold as office add ons. We have used PRP in the hip for arthritis, for labral tears and for gluteal tendon disease, and the posts below include a patient describing her status a year and a half after a single high dose PRP treatment into both hips.

One case in this library is worth reading for what it says about the wider market. A patient came in with labral tears in both hips after an umbilical cord blood and placental tissue injection elsewhere had not helped her a year earlier. Those products are widely advertised as containing living stem cells. They are not, and we have written about that at length in our FDA and safety hub.

Bone marrow concentrate, and the one hip diagnosis with the strongest case

Bone marrow concentrate is aspirated from the iliac crest in the office and injected the same day. For hip arthritis it is a reasonable option for patients who have exhausted less invasive treatment and who do not want, or are not ready for, a replacement. The testimonials collected below include a man in his 50s with arthritis advanced enough that a surgeon had already recommended replacement, treated in the office without general anesthesia.

The clearest indication is different. For avascular necrosis of the femoral head at Ficat stage 2, where the bone has lost its blood supply but has not yet collapsed, replacing the dead marrow with concentrated bone marrow taken from the iliac crest is supported by level 1 data, and that post explains the reasoning. Stage matters enormously here. Once the femoral head has collapsed, the conversation changes. More on the preparation itself is in the bone marrow concentrate hub.

What a realistic result looks like

Results vary, and we say that in front of every patient video we publish. Most patients who respond start to notice a benefit by about six weeks, although some report improvement sooner. A response is a reduction in pain and a return of function, not a new joint. We do not promise that any injection will make arthritis go away, and where the evidence is thin, as it still is for labral tears specifically, we say so rather than fill the gap with marketing.

Because a single bone marrow aspiration yields enough material to treat more than one joint, patients with both hips involved, or hips and knees involved, are frequently treated in one session. That is a practical point rather than a clinical claim, but it is the question patients ask most often once they understand the procedure.