An intra-articular orthobiologic injection places your own platelet-rich plasma, bone marrow concentrate or microfragmented fat directly into the joint space of the knee, hip, shoulder or sacroiliac joint. We guide every needle with ultrasound or fluoroscopy so the treatment lands inside the joint, where the lining and cartilage can use it.
A joint is a sealed chamber. The lining of that chamber, the synovium, makes the fluid that feeds your cartilage. When the lining gets inflamed, it floods the joint with chemical messengers that chew on cartilage and set off pain nerves. Whatever you inject has to get inside that chamber and change the conversation. Miss the chamber and the treatment sits in fat and muscle doing nothing.
Cortisone shuts the conversation down for a few weeks. Hyaluronic acid adds lubricant. Orthobiologics send in repair workers. That is the difference, and it is why the same knee can respond so differently to three injections that all look the same from the outside.
“Intra-articular” means inside the joint. The needle passes through the skin and the joint capsule and stops in the fluid-filled space between the bones. We use this route for:
The material we inject depends on the joint and the damage: PRP for most mild to moderate arthritis, bone marrow concentrate or microfragmented fat when the joint needs more cellular support.
Because a blind needle misses more often than people think. A 2025 systematic review of 13 studies found ultrasound-guided knee injections hit the joint 95.4% of the time, against 82.0% for injections placed by feel. Nearly one in five landmark injections never reached the target. In a deep hip or a narrow SI joint, the odds of a blind miss climb further.
We use ultrasound for the knee, shoulder and many hips, and fluoroscopy (live X-ray) when bone landmarks matter, as in the SI joint. You see the needle, we see the needle, and the treatment goes where it was paid for. Read more on why a blind needle misses and our image-guided procedures.
Cortisone is a fire extinguisher. It smothers inflammation fast, and the relief is real for a few weeks. It does nothing to rebuild the house. Repeated, it may damage the structure. In a two-year JAMA trial, knees injected with triamcinolone every three months lost more cartilage than knees injected with saline, and the cortisone group had no better pain scores at the end.
Orthobiologics work the opposite direction. Platelets are repair workers. They release growth factors that calm the inflamed lining and signal the tissue to rebuild what it can. A 2024 network meta-analysis of 48 trials and 9,338 knees ranked PRP, bone marrow concentrate and hyaluronic acid above cortisone for pain and function at six months or longer. More on this in cortisone shot side effects.
Hyaluronic acid replaces some of the slippery fluid an arthritic joint has lost. It is oil in the engine. PRP changes the chemistry of the engine itself. In a meta-analysis of 18 level-one trials, WOMAC scores improved 44.7% with PRP against 12.6% with hyaluronic acid. We still offer viscosupplementation when it fits, and some joints get both.
Because the joint lives inside a body. Three drivers decide how much repair you get:
This is why lifestyle and behavior make up 40 to 50% of our protocol. Supporting care includes laser therapy, rehabilitation and metabolic optimization. The injection opens a window. What you do in that window decides how long it stays open.
We draw your blood (or harvest marrow or fat for those treatments) and process it in an FDA-cleared preparation system. The skin is numbed with local anesthetic. You stay awake the entire time, and most patients drive themselves home. Expect soreness for about 48 hours after PRP. Protect the area for the first few days and follow the rehab plan.
You can’t make a carrot grow faster than it grows. Some feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. There is no pre-booked series.
We treat the knee, hip, shoulder and sacroiliac joint most often. Smaller joints such as the ankle and thumb base are evaluated case by case; see hand pain for the thumb.
The skin is numbed with local anesthetic and you stay awake. Most people feel pressure during the injection and soreness for about 48 hours after PRP.
Cortisone acts faster but fades in weeks. Pooled trial data rank PRP above cortisone for pain and function at six months or longer, and a two-year trial linked repeated cortisone to more cartilage loss.
Yes. Advanced knee arthritis often gets a subchondral injection into the bone beneath the joint at the same visit, along with rehabilitation and metabolic care.
Orthobiologics are not billed to insurance. HSA and FSA funds are generally eligible.
That depends on how the tissue responds. Some patients need one treatment; others need a second or third, decided at follow-up.
If your joint has outlasted cortisone, gel shots and physical therapy, an image-guided orthobiologic injection is the bridge between failed conservative care and surgery. We see patients at our office at 4477 Woodson Rd in St. Louis. Over 90% of our accepted case-study patients see significant improvement. Request our orthobiologics guide or call (314) 481-5000 to talk through your joint.
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