Quick answer
Most hip arthritis can be treated without surgery first, using strengthening and, when needed, ultrasound-guided PRP, BMA or MFAT. A 2023 review found PRP beat hyaluronic acid for pain at six months. For advanced and bone on bone hips, BMA and MFAT are options Dr. Tortland offers, and he refers you to a trusted surgeon only when replacement is the better fit.
Most common conditions
Osteoarthritis, labral irritation, bursitis
Diagnosis method
Live, dynamic ultrasound examination
Non-surgical options
PRP, BMA, MFAT, prolotherapy
Return to activity
Usually within days; depends on treatment
First results
PRP about 4 to 12 weeks; BMA or MFAT about 3 to 6 months
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Mechanical instability, or when other options have not given enough relief
Payment
Out of network and direct pay; HSA / FSA applicable
Definition
How severity and imaging guide choices
And why the right diagnosis matters more than the treatment you pick.
Hip pain has several distinct sources: cartilage wear inside the joint, labral irritation, tendinopathy of the muscles crossing the hip, or bursitis on the outside of the joint. Two patients describing the same "hip pain" can have very different problems underneath, and groin pain versus outer-hip pain often points to entirely different structures. Confirming which structure is actually failing on live ultrasound, rather than assuming from an X-ray alone, is the starting point for any treatment plan.
Not every painful hip needs an injection, and not every injection is appropriate for every hip. Whether conservative care, PRP, a cellular treatment like BMA or MFAT, or a referral for surgery is the right next step depends on how much cartilage remains, whether the pain is coming from inside or outside the joint, and the patient's own goals.
Indications
Hip conditions that may respond
The hip conditions seen most often in this practice, treated without surgery whenever the evidence and the ultrasound findings support it.
Step by step
What hip PRP treatment involves
The Dr. Tortland difference: live ultrasound diagnosis, treatment matched to the finding, performed personally.
01
Diagnostic ultrasound first
Before anything is injected, the joint or tendon is examined dynamically on ultrasound so the treatment target is confirmed rather than assumed. This is a separate visit from treatment.
02
Blood draw - High Volume
The amount of blood collected, when PRP is appropriate, is based on the planned preparation and target dose, the patient's clinical context and the procedure being considered. A larger draw is not necessary for every patient. The goal is an appropriate preparation for the indication, with its characteristics measured where indicated.
03
Centrifugation- Double Spin
Your blood is spun in office with a double-spin protocol to separate and concentrate the platelet fraction. Preparation takes 20-30 minutes while you wait in the room.
04
High Platelet Count & Customization
When PRP is being considered, platelet concentration may be measured with a cell counter rather than inferred from blood volume alone. Preparation protocols and measured concentrations vary. The concentration is one characteristic of a PRP preparation; it does not by itself establish which treatment is best or predict an individual clinical outcome.
05
MSK Ultrasound-guided injection
The area is numbed with local anesthetic, then the needle is advanced under live MSK ultrasound and / or fluoroscopic guidance into the exact structure(s) at fault. You can watch the screen as it happens.
06
Recovery instructions
Recovery instructions depend on the procedure, target tissue and medical history. Temporary soreness can occur, but soreness does not prove that treatment is working. Follow the personalized instructions provided by the treating clinician, including medication guidance, and contact the practice if symptoms are severe or concerning.
07
Follow-up and re-evaluate
Follow-up at six to ten weeks with repeat ultrasound and / or an updated MRI to compare tissue appearance and patient symptom progression against baseline and decide whether a second PRP procedure adds value.
Candidacy
Who may benefit from alternatives
Comparison
Alternatives compared with hip replacement
| Option | What it does | Duration of benefit | Effect on tissue |
|---|---|---|---|
| Cortisone injection | Suppresses inflammation and pain | Weeks to a few months | Can weaken tendon and cartilage with repetition |
| Hyaluronic acid | Adds lubrication to the joint | Months, variable | No repair effect on cartilage |
| PRP | Delivers growth factors that stimulate repair | Varies by person and condition | Aims to improve tissue quality |
| Cellular orthobiologics | Delivers cells plus signaling proteins | Varies; considered for more advanced joints | Stronger biologic signal for degenerated joints |
| Hip replacement | Removes or replaces the joint surfaces | Long-term, definitive for the right case | Structural change with recovery cost |
Go deeper: side-by-side guide
Frequently asked
Hip replacement questions
Can PRP prevent or delay hip replacement?
Can hip osteoarthritis be managed without replacement?
How do PRP, BMA and MFAT differ for the hip?
What injection options exist for bone on bone hip arthritis?
When should I consider hip replacement?
How long does hip treatment take to work, and how long does it last?
Is all hip PRP the same?
Does insurance cover hip treatment, and what does it cost?
Who performs my hip injection?
Sources
Hip alternatives evidence and research
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Dai WL, et al. Efficacy of platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: meta-analysis of randomized controlled trials.
03
Filardo G, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: evidence and indications.
05
Bennell KL, et al. Effect of intra-articular platelet-rich plasma on knee pain and cartilage volume: randomized clinical trial.
06
Everts P, et al. Platelet-rich plasma: new performance understandings and therapeutic considerations for classification and dosing.