Beyond the Joint: Regenerative Solutions for Hip and Tendon Disorders

APEX Biologix
8 min read

Educational webinar highlight featuring Navneet Boddu, MD | March 2026

Introduction: Looking Beyond the Joint in Hip Pain

Hip pain is often approached through an intra-articular lens focused primarily on cartilage degeneration and joint space narrowing. However, emerging clinical perspectives emphasize a broader, more integrated view.

As discussed by Navneet Boddu, the hip should be considered a functional unit, where surrounding structures, including tendons, ligaments, and subchondral bone, play a critical role in both symptom development and treatment strategy.

This expanded framework may help explain why some patients continue to experience persistent pain despite targeted intra-articular interventions.

The Role of Autologous Biologics in Musculoskeletal Care

Autologous biologics, including platelet-rich plasma (PRP) and bone marrow concentrate (BMC) are commonly explored in musculoskeletal medicine due to their ability to leverage the body’s own biologic environment.

Within this framework:

  • Platelet-based therapies may provide a concentration of growth factors and signaling molecules
  • Protein-rich components may contribute anti-inflammatory and regulatory effects
  • Cell-based approaches may support signaling pathways involved in tissue response

Understanding Osteoarthritis as a Whole-Joint Process

Rather than being solely a condition of cartilage wear, osteoarthritis is increasingly understood as a multifactorial process involving:

  • Synovial inflammation
  • Subchondral bone remodeling
  • Cellular dysfunction within the joint environment

As highlighted in the webinar, early changes in subchondral bone such as increased porosity, reduced structural integrity, and bone marrow lesions may play a meaningful role in symptom development. 

This evolving understanding reinforces the importance of evaluating structures beyond the articular surface.

In this segment, Navneet Boddu, MD reviews how subchondral bone changes contribute to pain and disease progression in osteoarthritis.

Why “Beyond the Joint” Matters Clinically

A key takeaway from the educational webinar is that pain generators are often multifactorial.

In addition to intra-articular pathology, clinicians may consider:

  • Gluteal tendinopathy
  • Trochanteric bursitis
  • Iliopsoas tendon involvement
  • Iliotibial (IT) band dysfunction
  • Ligamentous structures around the joint

Addressing only the joint space may overlook these contributing factors, potentially limiting outcomes.

Imaging and Clinical Decision-Making

Imaging plays a supportive role in guiding treatment considerations:

  • X-ray: may demonstrate joint space narrowing, sclerosis, or osteophytes
  • MRI: may provide additional insight into bone marrow lesions, tendon integrity, and surrounding soft tissue structures
  • Point-of-care ultrasound: may assist in evaluating tendon pathology and guiding injections in real time

Importantly, imaging findings are most valuable when interpreted alongside clinical presentation and physical examination.

Expanding Treatment Considerations

Depending on patient presentation and disease severity, clinicians may explore a range of approaches:

  • Intra-articular strategies: often considered in earlier-stage disease, focusing on the joint environment

  • Subchondral approaches: in certain cases, particularly when bone marrow lesions are present, targeting subchondral bone may be considered as part of a broader strategy 

  • Periarticular and soft tissue targeting: including tendons, ligaments, and surrounding structures that may contribute to pain and dysfunction

This layered approach reflects a shift toward more comprehensive, anatomy-driven treatment planning.

Biologic Considerations by Tissue Type

The webinar also highlights that biologic composition may be adjusted based on treatment goals:

  • Joint applications:  often utilize leukocyte-poor preparations to minimize post-injection inflammation
  • Tendon or ligament applications: may utilize leukocyte-rich preparations to support localized biologic activity

These considerations are part of ongoing clinical exploration and may vary based on practitioner preference and patient-specific factors.

Continue the Learning

Watch the full educational webinar to review the complete clinical discussion, including imaging considerations, procedural approaches, and evolving evidence highlighted throughout the session.

You can also access additional clinician-focused resources, including webinar recordings, clinical insights, and specialty-specific education, within the APEX Resource Library, designed to support ongoing learning in autologous biologics and musculoskeletal care.

Hands-On Regenerative Medicine Training at the XCELL Learning Center

Clinicians interested in hands-on training, procedural education, and practice implementation strategies can explore the upcoming XCELL RISE - Interventional Pain event hosted at the XCELL Learning Center located in Clearwater, Florida. XCELL RISE - Interventional Pain is a purpose-built educational experience designed for pain physicians integrating biologics into spine and musculoskeletal interventional practices.

References

Feng, X., et al. Impact of immune regulation and differentiation dysfunction of mesenchymal stem cells on the disease process in ankylosing spondylitis and prospective analysis of stem cell transplantation therapy. Postgrad Med J. 2023;99(1177):1138-1147. doi:10.1093/postmj/qgad073

Huang, J., et al. Dysregulation of the Wnt signaling pathway and synovial stem cell dysfunction in osteoarthritis development. Stem Cells Dev. 2020;29(7):401-413. doi:10.1089/scd.2019.0260

Sánchez, M., et al. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford). 2012;51(1):144-150. doi:10.1093/rheumatology/ker303

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 Musculoskelet Disord. 2022;23(1):856. doi:10.1186/s12891-022-05787-8

Dallari, D., et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med. 2016;44(3):664-671. doi:10.1177/0363546515620383

Kraeutler, M., et al. Comparing intra-articular injections of leukocyte-poor platelet-rich plasma versus low-molecular weight hyaluronic acid for the treatment of symptomatic osteoarthritis of the hip: a double-blind, randomized pilot study. Orthop J Sports Med. 2021;9(1):2325967120969210. doi:10.1177/2325967120969210

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Fitzpatrick, J., et al. Leucocyte-rich platelet-rich plasma treatment of gluteus medius and minimus tendinopathy: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2019;47(5):1130-1137. doi:10.1177/0363546519826969

Jacobson, J., et al. Greater trochanteric pain syndrome: percutaneous tendon fenestration versus platelet-rich plasma injection for treatment of gluteal tendinosis. J Ultrasound Med. 2016;35(11):2413-2420. doi:10.7863/ultra.15.11046

Fader, R., et al. Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J. 2014;4(4):461-466. doi:10.11138/mltj/2014.4.4.461

Davenport, K., et al. Ultrasound-guided intratendinous injections with platelet-rich plasma or autologous whole blood for treatment of proximal hamstring tendinopathy: a double-blind randomized controlled trial. J Ultrasound Med. 2015;34(8):1455-1463. doi:10.7863/ultra.34.8.1455

Homma, Y., et al. Safety and feasibility of locoregional platelet-rich plasma injection for iliopsoas impingement after total hip arthroplasty: a phase 1 prospective observational study. Regen Ther. 2024;25:61-67. doi:10.1016/j.reth.2023.11.012

This blog post is a summary of an educational session and is provided for informational purposes for healthcare professionals. The perspectives shared reflect the clinical experience and opinions of the speaker(s) and do not necessarily represent the views of APEX Biologix. This content is not medical advice and is not intended to establish a standard of care, diagnose, or recommend treatment for any individual patient. Clinicians should evaluate all therapies using their independent clinical judgment, applicable regulations, and the most current evidence.