range of $5,000-$10,000. However, studies have found high variability in the number and quality of stem cells actually obtained from these extraction techniques, which makes studying the reliability of this treatment technique particularly challenging when the “dose” is not held constant. Viscosupplementation Sometimes called the “gel shot,” this treatment involves injecting laboratory-derived hyaluronic acid, which is a chemical typically found in cartilage and joint structures, into a joint to rehydrate the cartilage structures (typically in the knee) and decrease the inflammatory pain signals thought to account for arthritis pain. This treatment has been around and in widespread use much longer than PRP, and accordingly, has more developed studies. Some support greater efficacy and longer pain relief than steroid injections, while others tend not to show much of a difference. Because it uses FDA-regulated materials for injection, Medicare will often cover the cost in approved clinical situations, and commercial insurances often follow suit. However, these vials of hyaluronic acid can cost over $1,000 each (and were studied and approved as a three-shot series), and it may be difficult to get insurance company approval. Out-of-pocket, these can end up at a comparable cost to PRP injections, and the newer research, particularly for mild-to-moderate osteoarthritis of the knee, may in fact favor PRP as more likely to help overall and for a longer duration. ESWT ESWT is a non-invasive, non-injectable treatment that is sometimes grouped with orthobiologics because of the theoretical regenerative potential. This treatment uses high-energy sound waves to send pulses of vibration deep into the damaged tissues, stimulating the body’s intrinsic healing mechanisms or otherwise modulating an abnormal inflammatory response. These high-energy vibrations are reported to stimulate cellular repair pathways and increase blood flow to the affected area. The cost of treatment varies depending on the duration of treatment and the type of machine used. The machines can cost $20,000-$60,000. The probe that contacts the skin and delivers the sound waves wears out over time and needs to be replaced periodically, adding an additional hardware cost of around $3,000 per probe. Most benefits are realized between three to five treatments, depending on the condition being treated, with each treatment typically costing the patient about $250. For the needle-averse patients with chronic tendinopathy or plantar fasciitis, this may be a superior treatment option and may in fact be more effective as an intervention than traditional orthotics, physical therapy, home stretching and analgesics. There is also a 2023 meta-analysis to support its use in chronic low back pain, demonstrating better pain relief and lumbar dysfunction at both four and 12 weeks with the use of ESWT compared to control groups. While “regenerative” may be an overstatement, there certainly is potential for symptomatic and (in some cases) structural benefits from these newer, yet established, treatment options. Studies demonstrating reliable regeneration of cartilage or cellular tissue repair is missing, but these treatments do have a robust body of literature demonstrating their potential for pain relief and/or improved physical function. When a patient asks if they need surgery, these options, and their financial cost, should be weighed against the financial and other costs of surgical intervention. However, it is important to help manage patient expectations as results are certainly not guaranteed. REFERENCES ARE AVAILABLE ONLINE BY SCANNING THE QR CODE. https://www.ohioafp.org/ news-publications/the-ohiofamily-physician-references/ This has been reprinted from the spring 2025 issue of The Ohio Family Physician, the quarterly publication of the Ohio Academy of Family Physicians. 21
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