Regenerative Medicine for Hip Pain
by David Levi, M.D.
Platelet rich plasma and bone marrow concentrate for hip pain
Regenerative medicine is expanding rapidly in the area of joint pain treatment. Through the use of harvested growth factors and stem cells from the patient’s own blood and bone marrow, regenerative medicine assists the body’s healing process. Platelet rich plasma (PRP) is a growth factor concentration of the patient’s own blood and bone marrow concentrate (BMC), as the name implies, is derived from the patient’s own bone marrow. BMC has a great quantity of growth factors like PRP, but it also contains a high number of the patient’s stem cells. Growth factors and stem cells are your body’s key to repairing itself.
Can these regenerative treatments be used to help my hip joint?
When we discuss the hip joint, we are typically referring to the ball and socket joint called the femoral acetabular joint. This is composed of bone, cartilage, a sealing “gasket-like” structure called a labrum, all surrounded by a thin but very strong enveloping capsule.
The most common problem with the hip joint is wear and tear type degeneration called osteoarthritis. Although research for regenerative medicine is just beginning on the hip joint, there is some evidence that PRP is effective for osteoarthritis. One published study in the journal Orthopedics in 2013 showed improvement of hip pain and function with ultrasound guided PRP injections. This study also showed improvement with hyaluronic acid injections, which is a primary component of your joint fluid. Although there is little research to date testing PRP for hip osteoarthritis, we do know that PRP has been shown in multiple research studies to significantly help a similar type of osteoarthritis, that of the knee.
Bone marrow concentrate (BMC) may be even more effective for more severe degeneration and other conditions of the hip because, in theory, the stem cells in BMC might be able to reverse the degeneration. At this point it is not known how well BMC works, but research is currently underway to answer this question.
What if my pain is coming from outside the hip, such as bursitis?
There are numerous structures around the hip that may be the source of pain. Sometimes small lubricating sacs near tendons may become inflamed and fill with fluid. This is called a bursitis and can be very uncomfortable. Research has shown, however, that most often it is the tendon itself, not a bursitis, that is the pain culprit. Tendons (which attach muscle to bone) commonly become very painful near the hip. A tendon may degenerate, losing its normal strong structured fibers and become very thick and partially torn. This is referred to as tendinosis.
PRP has been shown to be effective for tendinosis. Most of the research of PRP on tendons has been for tennis elbow. Although this is a different joint than the hip, the type of abnormality of the elbow tendon has been shown to be the same problem as the tendons near the hip. Although tendinosis of the hip has not been as well researched, a recent study presented at a major orthopedic conference (AAOS | 2014) did show long lasting effectiveness of PRP for this condition of the hip as compared to a steroid injection.
For very large tendon tears, some physicians feel that bone marrow concentrate may be even more helpful than PRP with the idea that the stem cells can help regenerate the torn tissue. Research is ongoing in this area as well.
The goal of these treatments is self-repair of degenerated or injured structures. Using the body’s own natural healing mechanisms, we may be able to achieve results greater than any other type of treatment.