Hip Joint Orthobiologic Treatment

What Is Orthobiologic Treatment for the Hip Joint?

Orthobiologic treatments are methods that use biologically active substances (growth factors, cells, etc.), usually obtained from the patient’s own blood, bone marrow, or fat tissue, to support the healing of damaged or inflamed tissues (cartilage, tendon, bone) in the hip joint, reduce inflammation, and relieve pain. The main goal is to reduce pain, improve function, and delay the need for larger surgical interventions such as hip replacement in particular. Because the hip joint is located deep within the body and lies close to major vascular and nerve structures, injections into this area must always be performed under imaging guidance.

Main Orthobiologic Methods Used in the Hip

The main orthobiologic methods being investigated or applied for hip joint and surrounding problems are as follows:

• PRP (Platelet Rich Plasma): Plasma obtained from the patient’s own blood, rich in platelets and growth factors. It is expected to have anti-inflammatory effects and to send signals that stimulate tissue healing. Its use is being investigated in the hip particularly for mild-to-moderate osteoarthritis pain and for tendinitis around the hip (gluteal tendinopathy, etc.).
• “Stem Cell” Therapies (Mesenchymal Stem Cells – MSCs): Cells usually obtained from bone marrow (BMAC) or fat tissue. When injected into the hip, their main effect is thought to be suppressing inflammation and reducing pain through the molecules they secrete (paracrine effect). Strong evidence that they achieve cartilage regeneration in hip osteoarthritis or bone healing in avascular necrosis (AVN) through injection alone is still limited. In AVN treatment in particular, cell-based therapies are generally being investigated in combination with surgery (such as core decompression) and applied directly into the bone. Caution should also be exercised regarding unregulated treatments marketed under the name “stem cell.”
• Other Biologic Treatments: Other biologic approaches also exist and are under investigation, including Bone Marrow Aspirate Concentrate (BMAC – which contains other cells and factors in addition to stem cells), Autologous Conditioned Serum (ACS/Orthokine), and amniotic fluid/membrane products.

In Which Hip Conditions Can Orthobiologic Treatments Be Used?

Scientific data on the areas of use and effectiveness of orthobiologic treatments in the hip are more limited than for the knee or shoulder. The potential areas of application and the current status are as follows:

• Hip Osteoarthritis (Coxarthrosis): In patients with mild to moderate osteoarthritis who do not want surgery or are not suitable candidates for surgery, intra-articular PRP or, less commonly, MSC injections may be tried to reduce pain and improve function. There is no evidence that these treatments halt or reverse osteoarthritis; the goal is to provide symptomatic relief and potentially delay replacement surgery.
• Avascular Necrosis (AVN) – Early Stage: In this condition, where blood supply to the femoral head is impaired, applying cell-based treatments (BMAC or cultured MSCs) together with core decompression surgery (drilling holes into the bone) to support bone healing and reduce the risk of collapse — particularly in early stages before bone collapse has begun — is an active area of research. Injection into the joint alone has low effectiveness.
• Tendinopathies Around the Hip: In conditions such as gluteal tendinopathy (greater trochanteric pain syndrome), a common cause of pain on the side of the hip, or adductor tendinopathy in the groin area, PRP injections may be an option for chronic pain resistant to physical therapy.
• Labral Tears: The primary treatment for symptomatic labral tears (especially those associated with FAI) is generally arthroscopic surgery. There is no evidence that orthobiologic injections alone heal a labral tear. However, their use may rarely be considered to support post-surgical healing or to relieve symptoms in patients who are not suitable candidates for surgery.

Hip Orthobiologic Treatment Application: Imaging Guidance Is Essential!

The hip joint is deeply located and surrounded by important nerve (sciatic, femoral) and vascular structures. For this reason, all injections into or around the hip joint must always be performed under imaging guidance (Ultrasound or Fluoroscopy – moving X-ray). This is essential both to ensure the injection is delivered to the correct location and to minimize the risk of damage to surrounding tissues.

The procedure is generally performed in an outpatient clinic or day-surgery unit setting:

1. If necessary, blood (for PRP) or bone marrow/fat tissue (for cell therapies) is taken from the patient and processed.
2. The patient is positioned appropriately, and the injection site is prepared under sterile conditions.
3. Using an imaging device (Ultrasound or Fluoroscopy), it is confirmed that the needle is directed to the correct location (intra-articular, tendon sheath, etc.).
4. The prepared biologic material is injected into the targeted area.
5. A short period of observation follows the injection, and the patient is generally advised to limit activity and apply ice for the first few days. Short-term use of crutches may sometimes be necessary.

Hip Orthobiologic Treatments: Level of Evidence, Expectations, Limitations, and Risks

It is important to keep the following points in mind when evaluating orthobiologic treatments for the hip:

• Level of Scientific Evidence (Specific to the Hip):
  
  • The number of high-quality studies conducted on the hip joint is lower than for the knee.
  • Although some studies suggest that PRP may be superior to placebo or hyaluronic acid for pain and function in mild-to-moderate hip osteoarthritis, the results are inconsistent and more research is needed.
  • The role of cell-based treatments (MSCs) in hip osteoarthritis is unclear. Their use together with core decompression in early-stage AVN is promising but is not a standard treatment, and the level of evidence is variable.
  • More research is also needed on the effectiveness of PRP in tendinopathies.
• Potential Benefits:
  
  • Reduced pain and inflammation (especially in early-stage osteoarthritis).
  • Improvement in function.
  • Potential to delay hip replacement surgery.
  • Potential to support bone healing and reduce the risk of collapse in early-stage AVN (when combined with surgery).
  • Use of the patient’s own biologic materials.
• Limitations and Realistic Expectations:
  
  • These treatments are not a “cure” or “definitive solution” for hip osteoarthritis or AVN.
  • It has not been proven that they achieve cartilage regeneration in hip osteoarthritis.
  • They do not correct underlying structural problems (FAI, dysplasia, large labral tears).
  • Effectiveness is highly variable, and results may be temporary.
  • Cost: Generally not covered by insurance.
  • There is not yet data as strong for the hip as for the knee regarding effectiveness.
• Risks:
  
  • Although generally low-risk, hip injections performed without imaging guidance or by inexperienced practitioners carry serious risks.
  • Pain, swelling, and bleeding at the injection site.
  • Infection: Hip joint infection (septic arthritis) is a rare but serious complication.
  • Nerve or Vascular Injury: Resulting from the needle being misdirected (imaging guidance reduces this risk).
  • Allergic reaction (rare).
  • Minor risks associated with harvesting bone marrow or fat tissue.
  • The treatment being ineffective.

Orthobiologic Treatments for the Hip in Ankara and Prof. Dr. Murat Bozkurt’s Approach

Interest in regenerative and biologic treatments is growing among patients experiencing hip pain in Ankara. Prof. Dr. Murat Bozkurt bases his approach to these treatments on scientific evidence and patient safety:

• Priority: Accurate Diagnosis and Proven Treatments: Accurately diagnosing the underlying cause of hip pain (FAI, labral tear, stage of osteoarthritis, AVN, etc.) is the primary priority. In treatment, he first evaluates methods with proven effectiveness (physical therapy, hip arthroscopy, hip replacement, etc.).
• Realistic Information: When considering orthobiologic treatments as an option, he explains to his patients — clearly and honestly — the current level of scientific evidence for these treatments in the hip, their potential benefits, limitations, and risks.
• Selective and Careful Application: He may consider these treatments only after very careful patient selection, in appropriate indications (e.g., mild-to-moderate osteoarthritis pain that has not responded to other treatments, chronic tendinopathy), and generally as a supplement to other treatment methods. (Prof. Dr. Bozkurt’s current practice and views, particularly regarding cell-based treatments, should be stated more explicitly here.)
• Imaging Guidance Requirement: He emphasizes that any injection into or around the hip joint must always be performed under ultrasound or fluoroscopy guidance.

Prof. Dr. Bozkurt notes that orthobiologic treatments may play a more significant role in hip problems in the future, but that many applications are still at the research stage today and must be approached with caution.

Orthobiologic treatments for the hip joint are promising methods in certain situations, but their effectiveness and areas of application still require further research. When considering these treatments, it is very important to consult an orthopedic specialist experienced in hip surgery who is well versed in the scientific basis of these treatments, to have realistic expectations, and to make sure the treatment is performed under imaging guidance. You can get an expert opinion from Prof. Dr. Murat Bozkurt for your hip problems in Ankara.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt by phone at 0312 502 70 74.