“Hip pain” describes at least four different problems, and where you feel it narrows things down faster than any scan. Start there.
- Groin, deep in the front, worse putting on socks or getting out of a car. That is the hip joint itself — usually arthritis, sometimes a labral or impingement problem.
- Outer side, over the bony point, worse lying on that side at night. That is the gluteal tendons. It gets called bursitis and usually is not. See below — this is the most commonly mismanaged problem in the hip.
- Buttock, deep, worse after sitting a long time. Often the sacroiliac joint or the deep gluteal muscles rather than the hip at all. Covered on the sciatica and radiculopathy page.
- Pain that travels from the back into the buttock and thigh. Lumbar spine referring, which is why a hip assessment that never examines the back misses things. See back and spine.
Lateral hip pain is usually not bursitis
If you have been told you have trochanteric bursitis, this section is the reason to read on.
Pain over the bony point on the outside of the hip was labelled bursitis for decades, and treated with repeated steroid injections into the bursa. Imaging and surgical series have steadily shifted that picture. In most people the primary problem is the gluteus medius and minimus tendons where they attach to the greater trochanter — degenerative change and partial tearing, with bursal inflammation as a secondary finding rather than the cause. The condition is now usually called greater trochanteric pain syndrome, and the shift in name reflects a real shift in what is being treated.
Why this matters practically:
- Repeated corticosteroid into a degenerative tendon is the wrong direction. It relieves pain in the short term and does the tendon no favours over the longer one — the same trade-off described on the patellar tendinitis page.
- Loading rehabilitation is the primary treatment, and it is specific. Abductor strength and the way the pelvis is controlled in single-leg stance are what change the load on that tendon.
- Where an injection is appropriate, the target is the tendon, not the bursa — and it is placed under ultrasound guidance, because the difference between the two is a few millimetres.
The tell is characteristic: worse lying on that side, worse crossing the legs, worse standing on one leg to dress, and tender to firm pressure on exactly one spot. Full detail on treatment is on PRP and orthobiologics for the hip.
Hip arthritis, and being straight about replacement
Hip osteoarthritis produces groin pain, stiffness that is worst starting off, and gradual loss of rotation — often noticed first as difficulty with shoes and socks.
Dr. Buford does not perform hip replacement. That matters in both directions. A well-done hip replacement is one of the most reliable operations in orthopedics, and if your hip is at that point you will be told plainly and referred to a surgeon who does them, with your imaging and workup handed over personally.
What a biologic can reasonably do for a hip that is not yet there: reduce pain and improve function for a period measured in months, in a joint that still has structure worth preserving. What it cannot do, here or anywhere, is regrow a worn joint surface. The evidence base in the hip is also less mature than in the knee, and it would be misleading to present the two as equivalent.
Labral tears and impingement
The labrum is the rim of cartilage around the socket. Tears are common findings on MRI in people with no hip pain at all, which is the same trap the knee meniscus presents: a finding is not automatically the cause.
What makes a labral tear likely to be the problem is agreement between the story, the examination and the scan — deep groin pain, catching or clicking with rotation, pain at the end of range, often in a younger and more active hip, and frequently alongside the bony shape changes of femoroacetabular impingement. Where that agreement is there and symptoms are limiting, arthroscopic treatment has a real role and you will be referred for a surgical opinion.
What is offered here
- Assessment by a board-certified orthopedic surgeon — including examination of the back and the pelvis, because hip pain frequently is not the hip.
- Ultrasound in the room, which for the gluteal tendons is genuinely superior to a static scan: the tendon can be examined under load and in motion, and any injection placed into the abnormal tissue under direct vision.
- Platelet-rich plasma and bone marrow concentrate where indicated. Detail and cost on PRP and orthobiologics for the hip.
- Referral, promptly and with your records, where a replacement or an arthroscopy is the right answer.
What is not offered
- Hip replacement and hip arthroscopy — not performed here; you will be referred.
- Any injectable stem cell product sourced from a donor — amniotic, umbilical cord, placental and “exosome” products are not legal for this use in the United States and are not offered here at any price.
Get seen urgently for these
Inability to bear weight after a fall, particularly in anyone older or with thin bones — a hip fracture can occur with surprisingly little trauma. A hot, swollen, exquisitely painful hip with fever. Groin pain with night pain and weight loss, or in anyone with a history of cancer. None of those is an injection problem.
What we do not offer, and why
This field has a marketing problem, so rather than just listing exclusions it is worth stating the standard being applied.
We do not use any product that lacks a clear FDA regulatory pathway for use in humans and clear human clinical outcomes data showing that it is safe and that it works for the indication being treated. Both halves, not either one. That single sentence accounts for most of what is on the market and not on the menu here.
Amniotic fluid, Wharton's jelly, exosomes and regenerative protein arrays
These are marketed heavily, often as “stem cell” injections, and patients are frequently quoted a great deal of money for them. None of them is used here. There are two reasons, and the second matters more than the first.
The regulatory reason. The FDA regulates these products as biologic drugs. None of them currently holds an approved orthopedic indication. That is a description of their regulatory status rather than a matter of opinion, and it holds whatever a clinic's marketing says about it.
The evidence reason, which is the more significant one. Treatment here is based on evidence, and there is no published literature for any of these injectable allograft options in orthopedics showing that any of them works better than PRP or bone marrow concentrate. Not equivalent-but-cheaper, not better-in-a-subgroup — the comparison that would justify using them has not been made in their favour. PRP and bone marrow concentrate, by contrast, have a substantial published human literature behind them.
So even setting the regulatory question aside entirely, there is no evidence-based argument for choosing one of these over a treatment prepared from your own tissue.
Adipose (fat) based treatments, also called microfat
Texas Orthobiologics does not currently offer adipose-based orthobiologics. That is a practice decision, and it is worth separating from the regulatory picture, because the two kinds of adipose treatment are not in the same position.
Adipose preparations produced with a device carrying FDA clearance or approval are regulatory compliant. An adipose-based biologic is often called microfat, after the way clinicians in the United States must process the tissue. It is a legitimate orthobiologic option and some clinicians have success with it.
Treatments based on stromal vascular fraction — SVF — are not currently regulatory compliant. This is now settled, and it is worth being specific about how it got there, because clinics still advertise these injections.
In 2024 a federal appeals court held that SVF is a drug under federal law, and that it does not qualify for the same-surgical-procedure exception that same-day fat procedures had relied on. The Supreme Court declined to review that decision in 2025. On 28 August 2026 the district court entered a permanent injunction on remand in United States v. California Stem Cell Treatment Center, Inc., which also names Cell Surgical Network Corporation. That is not a warning letter or an opinion — it is a standing federal court order.
The practical meaning for a patient is simple. An SVF injection is an unapproved drug unless it goes through the drug approval pathway, whatever the clinic offering it advertises about same-day processing or minimal manipulation. That argument has been made, and it lost.
Every injection here is made from your own tissue
Every biologic injection performed at Texas Orthobiologics is autologous — prepared from the patient's own blood or bone marrow on the day of treatment.
That is deliberately a statement about injections rather than a blanket position on donor tissue. Donor cartilage used as a structural graft in cartilage transplantation surgery is a different proposition entirely: it is regulated under an established pathway, it is implanted rather than injected, and it carries decades of published human outcomes data. It meets the standard above. An injectable donor cell product does not.
Common questions
I was told I have trochanteric bursitis. Is that right?
Often the label is right about the location and wrong about the tissue. Pain over the bony point on the outside of the hip is, in most people, primarily a gluteus medius and minimus tendon problem — degeneration and partial tearing at the attachment — with bursal inflammation secondary. It is now usually called greater trochanteric pain syndrome. The distinction changes treatment: loading rehabilitation becomes the primary intervention, and repeated corticosteroid into the bursa becomes a much less attractive idea.
Do you perform hip replacement?
No. Hip arthroplasty and hip arthroscopy are not performed at this practice. A well-done hip replacement is one of the most reliable operations in orthopedics, and if your hip has reached that point you will be told so plainly and referred to a surgeon who performs them, with your imaging and workup handed over personally rather than left to you to arrange.
Can PRP help hip arthritis?
It can reduce pain and improve function for a period in a hip that still has structure worth preserving. It does not regrow a joint surface — nothing available today does. The evidence base for the hip is also less mature than for the knee, and we will describe it that way rather than presenting the two as equivalent. Whether it is reasonable for your hip depends on how much joint space is left, which is what the standing X-ray is for.
My MRI shows a labral tear. Do I need surgery?
Not necessarily. Labral tears are common findings in people with no hip pain at all, so the scan alone does not establish the diagnosis. What does is agreement between the story, the examination and the imaging — deep groin pain, catching with rotation, pain at end of range, usually in a younger active hip. Where that agreement exists and symptoms are limiting, arthroscopic treatment has a genuine role and you will be referred for that opinion.
Could my hip pain actually be coming from my back?
Frequently. Lumbar and sacroiliac problems refer into the buttock and thigh, and deep gluteal pain can imitate both. It also runs the other way — hip arthritis refers to the buttock often enough that it gets treated as sciatica. An assessment that does not examine both the hip and the back is incomplete, which is why both are examined here.
