What to try before choosing a procedure

What to do at home first

Use gentle motion each day. Long bed rest can leave the joint stiffer and weaker.

Build strength in small amounts. If the joint is much worse the next day, you've likely done too much.

A cane, brace or slower pace may reduce strain. Physical therapy can also teach safe movement and useful strength work.

These steps take effort, but they cost less than many office procedures. They aren't lesser care because they look ordinary.

When to discuss a non-surgical choice

Arrange an exam when home steps still leave you too sore. An X-ray may show how much the joint has changed.

Orthobiologics is QC Kinetix's broad word for non-surgical care that begins with blood or other material from you. PRP, meaning platelet-rich plasma, is one example.

Staff prepare PRP by drawing and spinning your blood, then gathering its platelet-rich liquid for the joint. Medical provider means whoever checks you and gives the treatment, so ask for that person's title and training.

The office may also discuss knee or hip surgery alternatives. Ask about cost, later effort and what comes next if the ache stays.

What to compare before choosing

Compare time, effort and money. If the ache stays, ask what the clinic would try next.

Get the full price and follow-up terms in writing. Later charges shouldn't be a surprise after treatment starts.

A straight answer includes reasons to wait or say no. Sales pressure isn't a medical reason to move faster.

When to talk about surgery

Discuss surgery when pain is strong at rest or movement is badly limited. The talk doesn't commit you to an operation.

Ask about recovery and rehab. Recovery is the full healing time, while rehab is exercise done at home and with a physical therapist.

Joint preservation means holding on to your own joint, using exercise or non-surgical care. Sometimes those steps help enough, and sometimes surgery deserves a closer look.

Sources

1. The OARSI non-surgical management guideline evaluated 60 interventions with GRADE methodology and built its recommendations around core treatments - structured exercise, weight management and self-management education - for every patient with knee osteoarthritis, regardless of what else is added.

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

2. In a 480-patient, four-arm, multicenter randomized phase 2/3 trial, none of three orthobiologic cell injections - autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, or allogeneic umbilical cord tissue-derived mesenchymal stromal cells - was superior to any other, or to a corticosteroid injection control, on pain at 12 months.

   Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nat Med, 2023. DOI: 10.1038/s41591-023-02632-w.

3. A network meta-analysis of 79 randomized trials in 8,761 patients ranked the intra-articular injectables for knee osteoarthritis on VAS and WOMAC at 1, 3, 6 and 12 months, placing the cell-based options within a crowded field rather than above it.

   Anil U, et al. — The efficacy of intra-articular injections in the treatment of knee osteoarthritis: A network meta-analysis of randomized controlled trials. Knee, 2021. DOI: 10.1016/j.knee.2021.08.008.

4. 21 CFR 1271.10(a) sets the four criteria a human cell or tissue product must meet to be regulated SOLELY under section 361 of the Public Health Service Act: it must be minimally manipulated; intended for homologous use only, as reflected by labeling and advertising; not combined with another article beyond water, crystalloids or a preserving agent; and either have no systemic effect and not depend on the metabolic activity of living cells, or else be for autologous use, use in a close blood relative, or reproductive use.

   US Code of Federal Regulations, Title 21 — 21 CFR 1271.10 - Are my HCT/P's regulated solely under section 361 of the PHS Act. , 2004.

5. On 27 September 2024 the Ninth Circuit held in United States v. California Stem Cell Treatment Center that stromal vascular fraction produced by enzymatically digesting a patient's own fat IS a drug under the Federal Food, Drug, and Cosmetic Act, and that the same surgical procedure exception does not apply because the removed fat and the implanted SVF are not the same thing. The district court's ruling for the clinics was reversed.

   United States Court of Appeals for the Ninth Circuit — United States v. California Stem Cell Treatment Center, Inc., No. 22-56014 (9th Cir. Sept. 27, 2024). , 2024.

6. A randomized trial comparing commercially available systems in 71 patients found microfragmented adipose tissue equivalent to leukocyte-rich PRP on KOOS pain at 12 months.

   Baria M, et al. — Microfragmented Adipose Tissue Is Equivalent to Platelet-Rich Plasma for Knee Osteoarthritis at 12 Months Posttreatment: A Randomized Controlled Trial. Orthop J Sports Med, 2024. DOI: 10.1177/23259671241233916.

7. A double-blind randomized trial testing whether adding bone marrow aspirate concentrate to arthroscopic partial meniscectomy improves outcomes in patients with early knee osteoarthritis used the IKDC score at one year as its primary endpoint, with Kellgren-Lawrence grade as a radiographic secondary.

   Yanke AB, et al. — A Prospective, Randomized, Double-Blind Clinical Trial to Investigate the Efficacy of Autologous Bone Marrow Aspirate Concentrate During Arthroscopic Meniscectomy in Patients With Early Knee Osteoarthritis. Am J Sports Med, 2024. DOI: 10.1177/03635465241275647.

8. A controlled randomized phase I/II trial in 26 patients found repeated dosing of culture-expanded umbilical cord-derived MSCs at baseline and 6 months produced lower WOMAC pain at 12 months (1.1 +/- 1.3) than hyaluronic acid (4.3 +/- 3.5), while a single MSC dose did not separate from hyaluronic acid.

   Matas J, et al. — Umbilical Cord-Derived Mesenchymal Stromal Cells (MSCs) for Knee Osteoarthritis: Repeated MSC Dosing Is Superior to a Single MSC Dose and to Hyaluronic Acid in a Controlled Randomized Phase I/II Trial. Stem Cells Transl Med, 2019. DOI: 10.1002/sctm.18-0053.