Alternatives to Hip Replacement: What the Evidence Shows
Short Answer
- Hip replacement is not the only option for hip osteoarthritis (the gradual wear of the cartilage and surrounding tissues in the hip joint), because platelet-rich plasma (PRP) and stem cell therapy are non-surgical alternatives that may reduce pain and improve function for the right candidate
- PRP and stem cell therapy both use your own platelets or cells, which release growth factors and anti-inflammatory compounds that can support healing when injected into the joint and the tissues around it under ultrasound or x-ray guidance
- In a randomized trial in mild-to-moderate hip osteoarthritis, patients treated with PRP, alone or combined with hyaluronic acid (a gel-like lubricant injected into the joint), kept their improvement in pain and function for six months, longer than patients treated with hyaluronic acid alone
If hip pain has changed how far you walk, how you sleep, or how you get into a car, and you are weighing a hip replacement somewhere in the Phoenix area, it helps to know which non-surgical options exist before you decide.
You may have tried physical therapy, chiropractic care, anti-inflammatory medication, or a cortisone injection into the hip joint that helped for a while before the relief wore off. A surgeon may now have suggested hip replacement, but replacement is one path among several. Once the pain is traced to its source, a non-surgical option may still be appropriate.
Non-surgical alternatives to hip replacement for hip osteoarthritis include ultrasound- and x-ray-guided platelet-rich plasma (PRP) injections and stem cell therapy using bone marrow aspirate concentrate (BMAC) or microfragmented adipose tissue (MFAT), which use a patient's own platelets or cells to support healing in the joint and the tissues around it. At our Gilbert, AZ clinic, these options are typically considered for adults whose hip pain has not responded to physical therapy, medication, or cortisone and who want to explore options before surgery. Research on these treatments in the hip now includes 15-year bone marrow data, and replacement remains the right choice for some patients, so the first step is confirming that the hip joint is the source of the pain.
If you have hip pain that has not improved with physical therapy, chiropractic care, or cortisone, the next step is a detailed, in-person assessment to identify the exact tissues causing your pain and review non-surgical orthobiologic options (treatments made from your own blood or cells) like ultrasound-guided PRP therapy and stem cell therapy.
Schedule a 2-hour evaluation for your hip pain at our Gilbert, AZ clinic (also serving Chandler, Tempe, Scottsdale, and the greater Phoenix area).
We limit how many new regenerative patients we accept each month to devote sufficient time and attention to each case.
At our Gilbert, AZ clinic, ultrasound- and x-ray-guided PRP and stem cell therapy are the main non-surgical alternatives to hip replacement we use for Phoenix-area patients with hip osteoarthritis. Patients also travel to us from across the US, Canada, and internationally, and many want a second opinion on their hip before deciding on surgery.
Key Facts About Alternatives to Hip Replacement
Here is what is worth knowing about non-surgical alternatives to hip replacement before deciding whether they fit your situation.
- Non-surgical alternatives: PRP, or stem cell therapy using your own bone marrow (BMAC) or fat (MFAT), with the choice confirmed at your evaluation.
- What the research shows: in a randomized trial in mild-to-moderate hip osteoarthritis, PRP, alone or combined with hyaluronic acid, improved pain and function for six months, longer than hyaluronic acid alone. In a 15-year study of adults who had their other hip replaced, hips treated with bone marrow concentrate injected into the bone beneath the cartilage were replaced less often than in matched patients given conservative care (a non-randomized comparison).
- Who it may help: adults whose hip, groin, or buttock pain may be coming from the hip joint or the structures around it and has not improved with physical therapy, medications, or cortisone, including people who have been told they may need a hip replacement.
- First step: confirming where the pain is coming from, using a detailed history, a hands-on physical exam, and diagnostic ultrasound when indicated. Any x-ray or MRI is reviewed alongside these findings, not in place of the exam.
- What affects results: your overall health, how severe the pain and tissue damage are, and whether the right structures were identified and treated.
- When replacement is still the right choice: when non-surgical treatment has been tried and pain or function has not improved enough to make daily life workable, or when an evaluation finds that an injection is unlikely to help the hip. A surgical referral is the right recommendation in those cases.
- Timeline: Most patients treated with PRP begin to notice changes within the first month, with most of the improvement over the first three months. For stem cell therapy, most patients start to see improvements within the first month, with most of the improvement over the first six months and healing continuing out to a year. Timing may vary from person to person.
- Where: Regenerative Performance, Gilbert, AZ, serving Chandler, Tempe, Scottsdale, and the greater Phoenix area.
- Next step: Call 480-508-4226 to schedule a 2-hour evaluation for your hip pain in Gilbert, AZ.
This article is especially useful if you have been told you may need a hip replacement, your cortisone or hyaluronic acid injections have stopped working, and you want to know what is left to try before surgery.
How Do You Know If Hip Pain Is From Hip Arthritis?
Telling whether hip pain is from hip arthritis takes a hands-on exam, because the same pain can come from the hip joint itself, a labral tear (a tear in the ring of cartilage that rims the hip socket), femoroacetabular impingement (a mismatch in how the top of the thigh bone fits into the hip socket), the tendons around the hip, the sacroiliac (SI) joint where the spine meets the pelvis, or the lower back.
Pain in the buttock or the back of the hip that travels down the leg may be coming from the SI joint, the gluteal tendons (the tendons of the buttock muscles), the lower back, or the hip itself. Pain felt in the groin can vary in origin just as easily. An injection or an operation aimed at the wrong structure will not relieve pain that is coming from somewhere else, so the diagnosis comes first.
A useful workup starts with a detailed history and a hands-on physical exam of each structure that could be causing the pain.
Part of the exam is finding the movements that reproduce your familiar pain. Combined with your history and, when needed, imaging, those findings help show which structure is most likely contributing to the pain.
Diagnostic ultrasound, added when indicated, allows sonopalpation, in which the examiner presses directly under the probe on a suspect tissue and asks whether the pressure reproduces your familiar pain. A match makes it more likely that the tissue is contributing to the pain. Imaging does not show pain, and wear-related changes are common in people with no pain, so an x-ray or MRI read on its own can point to the wrong structure.
Can You Avoid Hip Replacement Surgery?
Some people with hip osteoarthritis can put off hip replacement surgery, because for patients who have not yet exhausted non-surgical care, options such as PRP and stem cell therapy may still be a reasonable place to start before an operation that replaces the joint itself.
Cortisone injections into the hip joint suppress inflammation for days to a few months without addressing the root cause, and the relief is often shorter with each repeat injection.
Replacement is the right choice when non-surgical treatment has been tried and pain or function has not improved enough to make daily life workable. If you have been told you are not yet a surgical candidate, or you are a candidate and want other options first, it is reasonable to ask what non-surgical care is left.
Can PRP Help Hip Osteoarthritis?
PRP may help hip osteoarthritis by delivering platelets concentrated from your own blood, along with the growth factors they release, into the hip joint and the tissues around it. Platelets store and release growth factors, and a concentrated injection can deliver more growth factors than the same amount of regular blood carries.
One randomized trial in mild-to-moderate hip osteoarthritis (Nouri et al., BMC Musculoskeletal Disorders, 2022), in which patients were randomly assigned to a treatment, compared ultrasound-guided injections of PRP, hyaluronic acid (a gel-like lubricant injected into the joint), and the two combined. The trial reported that all three injections improved pain and function, and that PRP, alone or combined with hyaluronic acid, produced effects that lasted six months, a longer duration than hyaluronic acid alone.
Important note: In the United States, PRP for hip osteoarthritis is typically an off-label use of devices cleared to prepare platelet concentrates, not an FDA-approved treatment for hip osteoarthritis.
Can Bone Marrow Stem Cell Therapy Help Hip Osteoarthritis?
Bone marrow stem cell therapy may help hip osteoarthritis by delivering bone marrow aspirate concentrate (BMAC), a concentrate of your own marrow cells, into the hip joint and, when the bone beneath the cartilage is involved, into that bone. The injected cells release natural anti-inflammatory compounds and growth factors that influence cartilage, bone, and connective tissue.
One 15-year study followed adults ages 18 to 60 who had arthritis in one hip and a hip replacement on the other side (Hernigou et al., International Orthopaedics, 2026). Patients were matched to a comparison group rather than randomly assigned. Among those whose arthritic hip received bone marrow concentrate injected into the bone beneath the cartilage, 16.1% had that hip replaced within 15 years, compared with 40.1% of matched patients whose arthritic hip received conservative care such as physical therapy and pain medication.
Inflammation within the bone beneath the cartilage, or arthritis that warrants an injection into that bone, points toward using bone marrow stem cells, because injections into bone are done with bone marrow concentrate and PRP rather than with fat.
When Is Microfragmented Fat (MFAT) Used for Hip Osteoarthritis?
Microfragmented fat (MFAT) is stem cell therapy from your own fat. It is used for hip osteoarthritis when bone marrow is not a good option or when a patient prefers a small fat harvest to a bone marrow aspiration. A small amount of fat, usually 30 to 120 mL, is collected from the lower abdomen or upper buttocks (a procedure called lipoaspiration), processed the same day, mixed with PRP, and injected under ultrasound or x-ray guidance.
The choice between fat and bone marrow is often based on patient preference. Fat may be favored for people with osteoporosis, because collecting bone marrow means drawing it from bone that may be weak, while bone marrow may be preferred for very lean patients, who have little fat to collect. Head-to-head research comparing the two is limited, so the choice rests on clinical judgment rather than a proven advantage of either.
Important note: Bone marrow aspirate concentrate (BMAC) and microfragmented adipose tissue (MFAT) are prepared from your own tissue during your visit. The device used to prepare BMAC is FDA-cleared, and that clearance applies to the device, not to the treatment of hip osteoarthritis. There is no FDA-approved bone marrow or adipose product for hip osteoarthritis, and these uses are considered investigational. The evidence is still developing. We offer them as options for appropriately selected patients, not as a guaranteed or proven cure.
In a one-year observational study of hip osteoarthritis (Heidari et al., Journal of Clinical Medicine, 2022), in which patients were followed after treatment rather than randomly assigned to groups, about 6 out of 10 patients treated with MFAT alone (63%) had reduced pain, and about 8 out of 10 (81%) improved on the Oxford Hip Score, a hip-specific questionnaire about pain and function.
Schedule a 2-hour evaluation for your hip pain at our Gilbert, AZ clinic.
How Does Regenerative Performance Treat Hip Osteoarthritis Without Surgery?
At Regenerative Performance, treatment for hip osteoarthritis starts with the diagnosis and addresses the whole joint complex, meaning the cartilage, the tendons and ligaments around the hip, the nerves, and the bone beneath the cartilage. We use ultrasound or x-ray guidance to treat each structure that is contributing to the pain.
Our PRP processing is standardized to deliver a platelet dose in the therapeutic range for the structure being treated, and each sample is tested in-house to confirm it meets that range. When bone marrow or fat is part of your plan, it is mixed with PRP, and in select cases bone marrow concentrate, fat, and PRP are combined in one treatment, each injected into the structure it suits.
In our experience, PRP and stem cell therapy can reach similar pain relief in most situations, with PRP usually requiring more treatments to match the relief that stem cell therapy reaches sooner. For select cases, we also offer culture-expanded cells under the federal Right to Try Act, an investigational pathway processed in an FDA-compliant cGMP manufacturing facility. Learn more about culture-expanded mesenchymal stem cell therapy.
Outcome Snapshot
Our outcome registry through DataBiologics, updated July 2026, pools hip cases treated with orthobiologic injections, including hip osteoarthritis and labral conditions.
- Across those hip cases, the average patient reports a 48% reduction in pain.
- Among hip patients with a 6-month follow-up, 89% report significant pain relief.
What to Expect at Our Gilbert, AZ Clinic for Orthobiologic Hip Treatment
Care for hip osteoarthritis at Regenerative Performance follows four steps, from a 2-hour evaluation through follow-up, and the evaluation confirms the diagnosis before any injection is planned.
The 2-Hour Evaluation
Every new patient starts with a detailed 2-hour evaluation that includes a thorough history, a hands-on physical examination, and diagnostic ultrasound when indicated. We test the suspected structures directly to determine whether they are the source of your pain, rather than relying solely on imaging.
The primary purpose of this evaluation is to identify the specific tissues causing your pain. This step is crucial because proper diagnosis is the single most important factor in regenerative treatment success.
Individualized Treatment Plan
Based on the evaluation, we determine whether you are a candidate for PRP, stem cell therapy, or another regenerative approach. From there, we develop an orthobiologic plan specific to your case, including which structures will be treated, the expected timeline, and your role in recovery.
Because the first three months after an orthobiologic injection are the critical window where most healing occurs, we typically recommend supplements and peptides to support the healing process. Our goal is to give your body every advantage during that healing window.
Ultrasound- and X-ray-Guided Hip Injection
On your treatment day, we draw 120 to 300 mL of your blood for PRP, depending on how many structures we are treating. The preparation process typically takes one to one and a half hours because of how meticulous we are with processing. During this time, you relax in our IV lounge while we prepare your PRP to the highest standard, and when bone marrow or fat is part of your plan, we collect it the same day.
We treat each structure that is contributing to your pain, not only the joint. Image guidance matters because it places the injection directly into the tissue causing your pain. Without it, an injection goes to a standard spot that is the same for every patient, and the tissue causing the pain is often somewhere else. Ultrasound and x-ray guidance place the injection into the hip joint itself, ultrasound guides injections into the tendons and ligaments around it, and x-ray guidance is used for injections into the bone beneath the cartilage.
Recovery and Follow-Up
After your injection, we recommend resting for the remainder of that day so your body can begin the healing process. Physical activity restrictions typically last 1 to 4 weeks, with a gradual return to full activity guided by your response. For most patients, we refer to a physical therapist who will design and adjust a rehabilitation plan specific to your treatment and goals.
We schedule follow-up assessments and track your outcomes in our registry, giving both you and our team objective data on how your treatment is working.
The 2-hour evaluation is designed to identify the structures most likely contributing to your hip pain, whether PRP or stem cell therapy fits, and what the plan is if neither does.
Schedule a 2-hour evaluation for your hip pain at our Gilbert, AZ clinic.
Who Is a Good Candidate for Orthobiologic Treatment of Hip Osteoarthritis in Phoenix, AZ?
Orthobiologic treatment of hip osteoarthritis is typically a good fit for adults with chronic hip pain that has not responded to physical therapy, medications, or cortisone injections and who want to explore options before surgery. Our 2-hour evaluation identifies the tissues most likely causing your pain, and that diagnosis is what confirms whether this is a good fit for your specific situation.
If you see yourself in the list below, an orthobiologic approach may be worth exploring.
- Your hip pain has lasted 3 months or longer.
- Non-surgical care such as physical therapy, chiropractic care, massage, or medication has not helped enough.
- Cortisone or hyaluronic acid injections helped temporarily and then wore off, or you have chosen to avoid them.
- A surgeon has recommended hip replacement, and you want a second opinion before deciding.
- You want non-surgical options before surgery.
- You want structure-specific treatment that targets the exact joint, tendons, ligaments, or nerves involved.
- You are willing to invest in your health, as these are cash-pay procedures.
Our clinic is in Gilbert, AZ, where we treat hip, knee, and other joint pain for patients across the greater Phoenix area, and patients travel in from out of state and internationally; we schedule the evaluation and procedure in a single trip.
Once the source of the pain is identified, we will assess whether PRP or stem cell therapy is the right one for your hip, or whether a different treatment, including a surgical referral, might be more appropriate.
If you are unsure whether orthobiologic injections like PRP or stem cell therapy are appropriate, or you are traveling from outside the Phoenix area, you can also call and ask about a brief 15 minute discovery call.
Frequently Asked Questions About Hip Replacement Alternatives
How can hip osteoarthritis be treated without a hip replacement?
Hip osteoarthritis can be treated without a replacement through a combination of physical therapy and strengthening, activity and weight management, medications, and injections. Injection options include orthobiologics, which are made from your own blood or cells, such as platelet-rich plasma (PRP) and stem cell therapy from bone marrow or fat. Because the right combination depends on which structures are generating the pain, a hands-on exam and diagnosis come first.
Can a bone-on-bone hip avoid replacement with non-surgical treatment?
Bone-on-bone changes in the hip on an x-ray do not automatically mean you need surgical intervention, because the decision rests on the full workup of history, exam, and imaging rather than on the image alone. For some patients hip replacement is still the right choice, and for others an option such as PRP or stem cell therapy is worth trying first. How much any treatment helps also depends on your overall health and how severe the pain and tissue damage are.
What is the newer alternative to hip replacement?
The newer non-surgical alternatives to hip replacement are orthobiologic injections, which use a patient's own platelets or cells to support healing in the hip joint and the tissues around it. Platelet-rich plasma (PRP) concentrates platelets from your own blood, and stem cell therapy uses cells from your own bone marrow, called bone marrow aspirate concentrate (BMAC), or your own fat, called microfragmented adipose tissue (MFAT). PRP and stem cell therapy are options for appropriately selected patients.
What is the difference between PRP, bone marrow stem cell therapy, and microfragmented fat (MFAT) for hip osteoarthritis?
Platelet-rich plasma (PRP) concentrates the platelets in your own blood, along with the growth factors they release, while stem cell therapy uses cells from your own bone marrow (bone marrow aspirate concentrate, BMAC) or your own fat (microfragmented adipose tissue, MFAT), and those cells release anti-inflammatory compounds. PRP is different from stem cell therapy because it delivers no stem cells. The choice between bone marrow and fat is often based on patient preference. Bone marrow is favored when inflammation in the bone beneath the cartilage needs treatment, and fat is favored when bone marrow is not a good option. Head-to-head research comparing the two is limited.
When should someone stop non-surgical treatment and consider hip replacement for hip osteoarthritis?
Hip replacement is worth considering when non-surgical treatment has been tried and pain or function has not improved enough to make daily life workable, or when an evaluation finds that an injection is unlikely to help the hip. A well-targeted treatment that produces no response is a reason to re-examine the diagnosis first, and after that a surgical referral is a reasonable next step. The timing of surgery is a decision to make with both the evaluating physician and the surgeon.
What are the risks of PRP and stem cell injections for hip osteoarthritis?
The main risks of PRP and stem cell injections for the hip are those of any injection, including temporary soreness and swelling at the injection site for several days, as well as uncommon complications such as bleeding, infection, or injury to nearby structures. Collecting bone marrow or fat can also cause temporary soreness or bruising where it is taken. Because the material comes from your own blood, bone marrow, or fat, the risk of adverse reaction is extremely low, and there is no donor, so there is no donor-to-patient disease transmission. In a one-year observational study of MFAT in hip osteoarthritis, the authors (Heidari et al., Journal of Clinical Medicine, 2022) observed no infections or thromboembolic events (blood clots).
How many PRP or stem cell treatments does Regenerative Performance use for hip osteoarthritis?
Regenerative Performance starts hip osteoarthritis patients with one PRP or stem cell treatment and tracks the response rather than planning a fixed series. For PRP, a second session is considered 12 weeks later based on how you responded. For stem cell therapy, your response is tracked over one year, and in a small percentage of cases a booster PRP injection is added around 3 to 6 months. If one treatment produces no positive response, the next step is re-examining the diagnosis rather than repeating the same injection.
Is PRP or stem cell therapy for hip osteoarthritis covered by insurance in Arizona?
PRP and stem cell therapy for hip osteoarthritis are typically not covered by insurance, in part because of how they are regulated. PRP for hip osteoarthritis is typically an off-label use of devices cleared to prepare platelet concentrates, not an FDA-approved treatment. There is no FDA-approved bone marrow product for hip osteoarthritis, and its use for this purpose remains under investigation. Patients can often use health savings account (HSA) or flexible spending account (FSA) funds, and third-party financing such as Advance Care Card is commonly available. Cost depends on the number and complexity of structures treated and is reviewed at the evaluation rather than quoted in advance. You can read more on whether insurance or a health-share ministry helps cover this. Regenerative Performance is not contracted with any insurance providers; we are a cash-pay clinic.
Still have questions? The best way to get answers is a conversation. Call 480-508-4226.
About Dr. Jack Meister
About Dr. Jack Meister
Dr. Jack Meister, ND, is a naturopathic physician completing his residency at Regenerative Performance in Gilbert, AZ, mentored by Dr. Timmermans. He treats chronic musculoskeletal and nerve pain with ultrasound-guided orthobiologic injections, and prescribes integrative supplement and peptide protocols intended to support recovery and tissue healing around those treatments.
Patients see him for the same 2-hour evaluation and structure-by-structure diagnostic process the clinic's musculoskeletal side uses for every new patient.
References
- Nouri F, et al. Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial. BMC Musculoskeletal Disorders, 2022. DOI: 10.1186/s12891-022-05787-8.
- Heidari N, et al. Comparison of the effect of MFAT and MFAT + PRP on treatment of hip osteoarthritis: an observational, intention-to-treat study at one year. Journal of Clinical Medicine, 2022. DOI: 10.3390/jcm11041056.
- Hernigou P, et al. Intraosseous bone marrow concentrate delays total hip arthroplasty in osteoarthritis: a fifteen year matched cohort study with dose-response analysis. International Orthopaedics, 2026. DOI: 10.1007/s00264-026-06908-x.
NOTE: This article provides general information to help the reader better understand regenerative medicine, nerve and musculoskeletal conditions, naturopathic approaches to pain, and related subjects. All content provided in this article, website, or any linked materials, including text, graphics, images, research, and outcomes, are not intended, and should not be used, as a substitute for direct medical advice, diagnosis, or treatment. Please always consult with a professional and licensed healthcare provider to discuss if any treatment is right for you.
Registry data from our single practice, powered by DataBiologics, is not a randomized clinical trial. Individual results may vary.