Hip regeneration Mesa: blood-based PRP without surgery

The sore spot helps the doctor find the cause

Wear within the hip often causes an ache felt deep in the groin. You'll sometimes notice it in your thigh or knee.

A tendon is a strong band fastening muscle to bone, and one lies near the outer hip. It'll often hurt more when you lie on that side.

A problem in your back can send aching into your buttock or leg. Numbness or weakness makes your back worth checking.

An X-ray can show wear within the joint. It can't prove where all the soreness begins.

I'd tell the doctor which spot hurts and which movement starts it. Movement checks help the doctor tell these causes apart.

Shorter activity and simple notes can make soreness easier to manage

Choose a firm chair that doesn't force a deep hip bend. Rise slowly, and use the armrests if that feels steadier.

Try shorter walks and pause before the ache builds. Don't repeat a movement that leaves the hip worse for hours.

Gentle strength work may make daily movement feel steadier. A physical therapist can help select the first moves.

Heat or cold won't fix the cause, but either may soothe the area briefly. Ask your doctor which medicine is safe with your other pills.

Write down whether sitting, mornings, or longer walks bring on soreness. Note how long the ache lasts after you begin moving.

Make an appointment when night rest, household steps, or usual chores keep getting harder. Take your soreness notes and medicine list so nothing gets forgotten.

Sources

1. A cross-sectional study contacted 273 of 317 US centres offering direct-to-consumer stem-cell therapy, posing as a 57-year-old man with knee osteoarthritis. The mean advertised price of a unilateral same-day stem-cell knee injection was $5,156 (SD $2,446), and centres claimed a mean clinical efficacy of 82% (SD 9.6%) - a figure with no support in the published evidence. The gap between the quoted number and the trial data is the single most useful thing a patient can be told before a consultation.

   Piuzzi NS, et al. — The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.. The journal of knee surgery, 2018. DOI: 10.1055/s-0037-1604443.

2. Medicare's National Coverage Determination covers autologous platelet-rich plasma ONLY for chronic non-healing diabetic, pressure or venous WOUNDS, and only under Coverage with Evidence Development inside an approved clinical research study. There is no Medicare coverage pathway for PRP as a treatment for osteoarthritis or any other joint indication, which is why these injections are quoted as cash prices.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2012.

3. FDA states plainly that no stem cell, exosome, stromal vascular fraction, umbilical cord blood, Wharton's jelly or amniotic-fluid product has been approved for the treatment of ANY orthopedic condition - it names osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain individually. The only FDA-approved stem cell products in the United States are cord-blood-derived blood-forming stem cells for disorders of the hematopoietic system, and there are currently no FDA-approved exosome products.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA, 2020.

4. A Bayesian network meta-analysis of 11 randomized trials (1353 patients) in hip osteoarthritis found that at 2-4 months and 6 months NO injectable - corticosteroid, hyaluronic acid or platelet-rich plasma - significantly outperformed a saline placebo injection for pain or function. Pooled change from baseline exceeded the minimal clinically important difference in every arm including placebo.

   Gazendam A, et al. — Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials.. British Journal of Sports Medicine, 2021. DOI: 10.1136/bjsports-2020-102179.

5. The AAOS evidence-based clinical practice guideline on Management of Osteoarthritis of the Hip states verbatim: STRONG evidence supports intra-articular corticosteroids to improve function and reduce pain in the SHORT TERM; STRONG evidence does NOT support intra-articular hyaluronic acid, because it does not perform better than placebo for function, stiffness and pain; STRONG evidence supports physical therapy for mild to moderate symptoms; STRONG evidence supports NSAIDs for short-term pain and function; and MODERATE evidence does not support glucosamine sulfate.

   American Academy of Orthopaedic Surgeons — Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline.. AAOS, 2017.