When an exam should come before treatment

When to seek care before booking

A joint that becomes hot and swollen during a fever needs prompt care. A bad fall, changed joint shape or unusable leg also needs quick help.

Swelling in several joints, along with rash or stiffness through the morning, can suggest wider illness. A doctor may check for infection or a disease causing swelling throughout the body.

What to bring about medicines and illness

Blood thinners can raise bleeding risk during a blood draw or procedure. Bring a written medicine list or the bottles themselves.

The doctor who prescribed them and the clinician doing the procedure should discuss changes. Don't stop medicine because a clinic handout says so.

Recent illness, infection and past bad reactions also matter. The person doing the procedure needs those facts before care begins.

When to ask for a surgery opinion

A badly worn joint may ache at rest, change shape and lose much movement. Research on milder knee wear can't answer every question about that joint.

Ask whether a surgery opinion makes sense before spending money. Knee or hip surgery alternatives are non-surgical choices, but the exam and X-ray must support them.

What to settle before choosing a procedure

Ask whether staff will draw blood, take marrow from the pelvis or remove fat. Find out whether the joint, pelvis, belly or thigh may hurt afterward.

Get the full price, ride rules and after-hours number in writing. If the answers stay unclear, don't book the procedure yet.

Sources

1. The ESSKA-ORBIT European consensus on blood-derived orthobiologics graded 28 question-statement sets; only 9 of 28 had high-level scientific support. Three statements reached grade A: that there is enough preclinical and clinical evidence to support PRP use in knee OA; that clinical evidence shows effectiveness in MILD TO MODERATE knee OA (KL grade 3 or lower); and that PRP provides a longer effect than the short-term effect of corticosteroid with a safer profile. The panel regarded PRP as a valid and possible first-line injectable option for KL grades 1-3.

   Laver L, et al. — The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma).. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12077.

2. The largest head-to-head trial of cell-based orthobiologics to date randomised 480 patients with KL II-IV knee OA across four arms: autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, allogeneic umbilical cord tissue-derived MSCs, and a corticosteroid injection control. At 12 months NONE of the three orthobiologic injections was superior to another or to the corticosteroid control on either co-primary endpoint (VAS pain, KOOS pain), and none of the four groups showed a significant change in MRI osteoarthritis score from baseline. No procedure-related serious adverse events were reported.

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

3. The 2025 Cochrane review of stem cell injections for knee osteoarthritis pooled 25 randomised trials (1,341 participants) and found that, compared with placebo injection, stem cell injection MAY slightly improve pain (1.2 points better on a 0-10 scale, 7 studies, 445 participants) and function (14.2 points better on a 0-100 scale, 7 studies, 432 participants) up to six months - both rated LOW-certainty evidence, downgraded for indirectness (cell source, preparation and dose varied across studies) and suspected publication bias, since up to three larger RCTs were conducted and withdrawn before reporting results. Radiographic progression was not assessed in any included study.

   Whittle SL, et al. — Stem cell injections for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2025. DOI: 10.1002/14651858.CD013342.pub2.

4. A multicenter prospective crossover randomized trial randomised 40 patients with discogenic chronic low back pain to a saline trigger-point control, intradiscal PRP, or intradiscal bone marrow concentrate, with crossover permitted for non-responders. Both PRP and BMC produced statistically significant improvement in pain and function with no adverse events, hospitalisations or surgery at 12 months - but ALL placebo patients reported under 50% relief and crossed over, and the trial was small and open-label.

   Navani A, et al. — The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up.. Pain Physician, 2024.

5. A meta-analysis of 24 RCTs (1,653 participants) with plantar fasciitis found PRP produced significantly better VAS pain than corticosteroid at 3 and 6 months but not at 1 month or 12 months, and better AOFAS function scores at 3, 6 and 12 months. Plantar fascia thickness did not differ significantly at any time point.

   Zuo A, et al. — Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis.. American Journal of Physical Medicine & Rehabilitation, 2025. DOI: 10.1097/PHM.0000000000002677.

6. The AAOS patient-education FAQ on orthobiologics states that because orthobiologics are relatively new the evidence supporting their use is LIMITED, that rigorous testing of effectiveness in most orthopedic conditions is lacking, and that preliminary results are encouraging but hard to evaluate. It names tendinopathies such as tennis elbow, pain from early knee osteoarthritis, adjunct healing after rotator cuff repair, and avascular necrosis as the settings where biologic therapies have shown promise, and notes that stem cell treatments not derived from the patient's own body and further manipulated in a laboratory can only be offered inside an FDA-approved clinical trial.

   American Academy of Orthopaedic Surgeons — Orthobiologics (Regenerative Medicine) FAQ. OrthoInfo (AAOS), 2024.

7. RESTORE, the largest and most rigorously blinded placebo-controlled PRP trial in knee OA (n=288, participant-, injector- and assessor-blinded), gave three weekly injections of a commercial leukocyte-poor PRP or saline. At 12 months the change in knee pain was -2.1 vs -1.8 points (difference -0.4; 95% CI -0.9 to 0.2; P=.17) and the change in medial tibial cartilage volume was -1.4% vs -1.2% (difference -0.2%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no between-group difference. The authors concluded the findings do not support the use of PRP for knee OA.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

8. FDA states verbatim of stem cell products, stromal vascular fraction (adipose-derived cells), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

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