Hyaluronic acid injection, the "gel injection" many patients have tried, aims to improve joint lubrication and the mechanical fluid environment. It comes before orthobiologics in the order of care.
Viscosupplementation is an injection of hyaluronic acid into the joint to improve joint lubrication and the mechanical fluid environment. Insurance often covers it, with criteria, and the benefit varies from patient to patient.
Injections are one tool in the plan, and they are not interchangeable. Corticosteroid is fast and useful for a flare but temporary. Hyaluronic acid aims to improve lubrication, with results that vary. PRP uses a concentration of your own platelets to target inflammation, and BMAC uses cells from your own bone marrow for more advanced degeneration.
Before orthobiologics, patients may benefit from physical therapy and viscosupplementation. When these basic treatments have not worked, orthobiologics are considered before surgical treatment.
Multiple systematic reviews of PRP for knee osteoarthritis have shown meaningful improvements in pain and function at 6 and 12 months, consistently outperforming hyaluronic acid. Orthobiologics are an active research area, so they should be discussed as part of a broader plan rather than sold as a cure. Which injection, if any, is right for you follows from your imaging, your stage of arthritis and what you have already tried.
When conservative care has not worked, these are considered before surgery.
A concentration of your own platelets, used as part of an orthobiologic treatment strategy for selected joint, tendon and ligament conditions.
Concentrate obtained from your own bone marrow and used in carefully selected orthopedic conditions as part of an individualized joint-preservation program.
For selected patients, Dr. Scheinberg may recommend a combination approach based on the diagnosis, imaging, severity of disease and individual treatment goals.
A consultation with Dr. Scheinberg looks at your imaging, what you have already tried and your goals, and tells you plainly what the next reasonable step is.
