Well B4 Joints, spine and sports
Stem Cell Therapy for Hip Pain: What the Process Involves
Contents: 6 sections
For hip arthritis, the evidence for stem cell injections is thinner than for the knee: a 2024 review found 10 studies with 316 patients and no randomized trials. The American College of Rheumatology recommends against stem cell and PRP injections for hip arthritis. If you still consider one, the process means a bone marrow draw from the back of your hip bone and an imaging-guided injection deep into the joint.
Is your pain coming from the hip joint?
Check this first, because a hip joint injection only makes sense for hip joint pain. Pain from hip arthritis is most often felt in the groin, and it can spread to the thigh, buttock or knee (OrthoInfo). Pain on the outside of the hip, or from the lower back, can have other causes that need a different plan.
Younger people with groin pain may have hip impingement, where the bones of the joint rub and can damage the labrum, the ring of cartilage around the socket. OrthoInfo describes activity changes, anti-inflammatory medicine and physical therapy as the first treatments, with surgery considered if tests show joint damage and “your pain is not relieved by nonsurgical treatment” (OrthoInfo).
What are the options for hip arthritis, and what does the evidence say?
| Option | What the evidence shows | ACR/Arthritis Foundation guideline |
|---|---|---|
| Exercise and physical therapy, and weight loss if you carry extra weight | OrthoInfo lists exercises to strengthen the hip muscles and improve flexibility among the first treatments, and says losing weight reduces stress on the joint (OrthoInfo, above) | Strongly recommended, with "a strong body of literature supporting its use for almost all patients with OA" (ACR) |
| Oral anti-inflammatory medicines | Listed among nonsurgical treatments (OrthoInfo, above). Ask your doctor whether they are safe for you | Strongly recommended for hip OA (ACR, above) |
| Steroid (cortisone) injection | Listed among nonsurgical treatments (OrthoInfo, above) | Strongly recommended for hip OA (ACR, above) |
| Hyaluronic acid injection | Weighed in the guideline's evidence review (next column) | "A new strong recommendation against using hyaluronic acid injections in patients with hip OA" (ACR, above) |
| PRP injection | Weighed in the guideline's evidence review (next column) | Recommended against for hip OA (ACR, above) |
| Stem cell injection | A 2024 systematic review found 10 studies with 316 patients: case series, cohort and retrospective studies and one case report, only one with a control group and no randomized trials. The authors called for more research because of "limited high-quality studies" (European Journal of Orthopaedic Surgery & Traumatology, 2024) | Recommended against for hip OA (ACR, above) |
| Total hip replacement | "One of the most successful operations in all of medicine" (OrthoInfo) | Surgery; compared in the section below |
Sources for the table: ACR; European Journal of Orthopaedic Surgery & Traumatology, 2024; OrthoInfo.
That review’s authors describe the results as promising, but without a control group there is no way to know how much of the improvement came from the injection and how much from placebo or the natural ups and downs of arthritis. For the knee, where placebo-controlled trials exist, the benefit was small, as the summary of what the knee trials found shows.
What the procedure involves
- Evaluation. An X-ray grades the arthritis, and some clinics add an MRI. An X-ray grade describes the joint, not whether an injection will help; the page on who is and is not a candidate covers when a surgeon is the better first stop.
- Bone marrow draw. Marrow is drawn with a needle from the back of the hip bone under local anesthetic. For the diagnostic version of this procedure, Mayo Clinic describes “a brief sharp pain or stinging” as the marrow is withdrawn, and lists bleeding, infection and lasting discomfort as risks (Mayo Clinic). Some clinics take fat instead; the risks of each harvest, and what the FDA allows a clinic to do with the cells, are in the overview of stem cell therapy and its rules.
- Preparation. The marrow is spun down the same day into a concentrate. Only a very small share of the cells in it are the stem cells the treatment is named for: one review put it at “only 0.001% of nucleated cells within BMA” (SICOT-J, 2017).
- Injection into the hip joint. The needle is guided by imaging. Ask which imaging will be used and how the doctor confirms the needle is inside the joint before injecting.
- Recovery. Protocols differ. Ask for a written plan with the reason behind each limit, and know the warning signs of infection listed on the recovery and warning-signs page.
Before any of these steps, it is worth putting the clinic through a framework for judging a regenerative clinic and checking it for red flags that should end the conversation.
How does hip replacement compare?
Hip replacement is surgery with a longer recovery and its own risks. OrthoInfo lists infection, blood clots, leg-length difference, dislocation, and loosening and wear of the implant, and says fewer than 2% of patients develop a serious infection (OrthoInfo, above).
It also lasts. In registry data from Australia and Finland, 89.4% of hip replacements were still in place after 15 years, 70.2% after 20 years and 57.9% after 25 years. These figures come from implants put in decades ago, and how long today’s implants will last “is not known” (NIHR summary of a 2019 Lancet review).
There is no age cutoff: “recommendations for surgery are based on a patient’s pain and disability, not age.” Afterwards, “most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports,” while walking, swimming, golf, hiking and cycling remain open (OrthoInfo, above). Surgery as the alternative is weighed in choosing between an injection and a joint replacement.
What if you are young and want to avoid surgery?
Someone who is younger, active, and not ready for surgery may reasonably want to try something less invasive first. The guideline-backed options for that are exercise, anti-inflammatory medicines and steroid injections, not stem cells. None of the evidence cited on this page shows that a stem cell injection delays hip replacement, and the review of hip studies found no randomized trial at all. If your X-ray shows little or no joint space left and pain limits your daily life, OrthoInfo’s threshold for surgery, pain that “causes disability and is not relieved with nonsurgical treatment”, may already apply (OrthoInfo, above).
A stem cell injection for your hip
The evidence does not support it as a standard choice, and the guideline recommends against it. If you are still considering it, the order that makes any result interpretable is to confirm that the pain comes from the hip joint, try the recommended treatments, and get a surgeon’s opinion if the damage is advanced. After that, an injection would at least be treating a known problem, and you would know what you are comparing it against.
This page is general information, not medical advice.