What are orthobiologics, in plain words?

An orthobiologic is a treatment made from your own blood, marrow or fat. We take a small amount, prepare it in the room, and place it where the damage is. Nothing is grown in a lab, and nothing comes from a donor.

Think of it as sending a work crew to a job site that has been left alone for years. A worn joint is not just dry. Its lining is angry, its fluid is thin, and the enzymes in that fluid keep chewing on what cartilage is left. A steroid shot tells the crew to stop yelling. An orthobiologic tries to change the work order.

We are a pain practice first, and that shapes how we use these tools. Plenty of knee pain starts in the hip, and plenty of hip pain starts in the low back. A shoulder can hurt because of a nerve in the neck. So before we treat a joint, we prove the joint is the source. Then the orthobiologic goes where the pain truly lives.

Most people who reach us have already done the sensible things. They tried pills, therapy and a few cortisone shots. The shots helped less each time. A surgeon may have said the joint is not bad enough to replace yet. That gap, between failed basics and surgery, is where orthobiologics live.

Conditions we treat with orthobiologics

Each page below explains one problem in detail, from how we find the source to what the rehab looks like. Start with the joint that hurts.

Knee

• Knee pain: the full workup, and the orthobiologic options for a knee that is wearing out.
• Bone-on-bone knee: what is still possible when the X-ray says the cartilage is gone.
• Genicular nerve block: quieting the knee nerves, and how that fits next to PRP.

Hip

• Hip pain: groin pain, buttock pain and side pain point to different structures.
• Hip arthritis: PRP inside the hip joint once cortisone has worn thin.

Shoulder

• Shoulder arthritis: PRP or bone marrow concentrate in the ball and socket, plus cuff rehab.

Any joint

• Image-guided joint injections: why every needle we place is guided by ultrasound or X-ray.
• When injections stop working: what a fading steroid shot is telling you.

After an injury

• After a car accident: which crash injuries can be treated this way, by the evidence.
• Injured at work: orthobiologics inside a Missouri workers’ comp claim.
• For attorneys: how an orthobiologic entry is written into the medical record.

Pick your guide

We wrote a short guide and an email series for each kind of problem. Pick the one that matches yours.

• Knee, hip or another worn joint: the knee guide, on bone-on-bone knee. The form on this page sends the same guide.
• Shoulder, elbow or a tendon that will not heal: the tendon guide, on shoulder arthritis.
• Hurt in a car crash: the injury guide, on after a car accident.
• Hurt on the job: the work injury checklist, on injured at work.

Which three orthobiologics do we use?

Platelet-rich plasma (PRP)

We draw blood from your arm and spin it to pack the platelets together. Platelets carry signals that calm an inflamed joint lining and help a tendon finish a repair it stalled on. PRP is our first choice for most joints and tendons.

Bone marrow concentrate

We numb the back of the pelvis and draw a small amount of marrow. Once it is concentrated, it carries repair cells and signals that blood does not. We use it for more worn joints, and when the bone under the cartilage is part of the pain.

Microfragmented fat

We take a little fat from the belly or flank through a thin cannula. It is rinsed and broken into tiny clusters, then placed in the joint. It adds cushion and a slow, steady signal. We choose it when the joint calls for it, not by habit.

Where does the injection go?

The right product in the wrong spot does nothing. So we aim at one of three targets, and we use imaging to prove we got there.

• Into the joint. This treats the lining and the fluid that bathe the cartilage. It is the usual target for knee, hip and shoulder arthritis.
• Into the tendon. This treats a tendon that has frayed where it meets bone, like the outer hip or the rotator cuff. Ultrasound shows the damaged strip so the dose lands in it.
• Under the cartilage. In a badly worn knee, the bone just under the surface can swell and ache. We can place marrow or PRP right into that bone. This is called a subchondral injection.

Who is a good candidate?

You may be a good fit if a joint or tendon has hurt for months, therapy and steroid shots have stopped holding, and you want more years before surgery. Bone on bone does not rule you out. At that stage the goal is time and fewer pills, not new cartilage, and that goal is worth having.

Some people are a poor fit. A joint that has collapsed, a limb that is badly bent, or an infection points elsewhere. So does pain that is really coming from the spine. That is why the first visit is an exam, not an injection. Over 90% of our accepted case-study patients see significant improvement. These are practice-reported figures from our own population, not trial outcomes, and individual results vary.

What are the visit and the recovery like?

The first visit is a history, an exam and a look at your images with you. If a numbing test is needed to prove the source, we do it. Then we tell you plainly whether the joint needs an orthobiologic, a different procedure, or a surgeon.

On treatment day you stay awake. We use local anesthetic, not sedation, and most people drive themselves home. Expect soreness for about 48 hours after PRP. You walk out the same day, and most people go back to desk work within a day or two. The number of injections follows how your joint responds. There is no set series sold in advance.

The risks are small and mostly local. The draw site can bruise. The treated joint can swell and ache for a few days. Infection is rare, and we use sterile technique and imaging to keep it that way. Because the material is your own, there is no allergy to a donor product. Call us if the joint turns hot and red, or if you run a fever.

Why do dose and rehab matter so much?

PRP is not one product. A weak spin barely beats plain blood. In a 2025 review of 18 knee trials, high-platelet PRP gave real pain relief, while low-platelet PRP did not. So we prepare a high dose and check it, rather than trust a kit.

The injection is also only half the job. The muscles around a joint take most of each step, so we rebuild them in the weeks after. We look at blood sugar and sleep, because they set how well tissue heals. A good injection in a weak, inflamed body fades fast. The same injection in a stronger body tends to last.

Frequently asked questions

Is PRP the same thing as a stem cell shot?

No. PRP is made from blood and works mostly through platelet signals. Bone marrow concentrate is the one that carries repair cells. We tell you which one we are using and why, before the day of treatment.

Will I be awake, and can I drive home?

Yes, and yes for most people. We numb the skin and the path with local anesthetic. You are awake the whole time, and most people drive themselves home.

How soon will I know whether it worked?

Most people feel a change in four to eight weeks, once the soreness passes and the rehab is underway. We check your pain and your function at follow-up and decide the next step together.

Does insurance pay for orthobiologics?

Most plans do not cover PRP. That is a choice about what a plan funds, not a verdict on the treatment. HSA and FSA funds can generally be used, and we go over your options at the visit.

Do I have to give up my own doctor or therapist?

No. We send notes to your primary doctor and work with your therapist. If you do not have a therapist, we will point you to one who knows how to load a treated joint.

Where is the treatment done?

Orthobiologic procedures are done at 4477 Woodson Rd in St. Louis, near Lambert airport, in the same complex as our main office. Our staff will walk you over from the lobby.

Related reading

• What to expect at the first visit
• Metabolic health and pain
• Sleep, movement and behavior
• About Dr. Padda