Told to wait for surgery, for about a decade.

SEVENTEEN MINUTES, NORTH COUNTY

Florissant patients reach us for PRP and orthobiologic injections in about seventeen minutes and nine miles. Most arrive with established knee and hip osteoarthritis. They have spent years being told to wait for surgery. We say plainly where PRP fits, and when a replacement is the right answer.

Florissant is about seventeen minutes and nine miles from us. It sends us a different patient than the warehouse corridor does. They are older and more settled. And they are usually further into the disease before anyone offered them more than a prescription.

Getting here

Straight down Lindbergh, or across on I-270, depending on where in the city you start. Surface parking outside the door, a ground-floor entrance, and a full-size elevator. Do you need something specific to attend in comfort — extra time, somewhere quiet to wait, room for a walker or a companion? Say so when you book, and it gets arranged ahead, not made up on the day.

The pattern we see from north county

Established osteoarthritis, often in more than one joint, in people who have managed it for years. Mostly knees and hips, often shoulders. And a long history of being told to lose weight, take an anti-inflammatory, and come back when it is bad enough for surgery.

That advice is not wrong so much as incomplete, and the gaps compound. A decade of less walking causes quadriceps (thigh muscle) loss. That raises joint contact force and speeds up the arthritis. It causes glycemic drift (blood sugar creeping up), which raises the inflammatory tone the synovium (the joint lining) is bathed in. And it shrinks social life, which is not a soft outcome — isolation on its own raises inflammatory markers and lowers pain thresholds.

Is osteoarthritis just wear and tear?

The familiar story — the cartilage wore out — is the least useful part of the picture. What drives symptoms is an active biological process. An inflamed synovium makes IL-1β and TNF-α. Matrix metalloproteinases (enzymes that break down cartilage) degrade what remains. And the subchondral bone (the bone under the cartilage) remodels into a pain source of its own.

That new framing matters because it points to things you can change. Adipose tissue (body fat) is endocrine tissue, meaning it sends out hormones. It releases leptin, resistin and IL-6 into the blood that reaches the joint, whether or not you stand on it. That is why arthritis shows up in joints that bear no weight in metabolically unwell people. A pure wear-and-tear model cannot explain that. Insulin resistance impairs chondrocyte (cartilage cell) function. It also stiffens collagen through glycation (sugar binding to it).

The joint-by-joint detail is on the knee and hip pages. That includes where PRP performs and where it does not.

When is a knee or hip replacement the right answer?

When the joint has failed structurally, and we will not soften that answer. A hip or knee that is bone-on-bone with deformity has a structural problem, and no injection fixes structure. Where a replacement is wanted, it is the definitive operation. Where it is being put off, treatment at that stage aims at time and medication burden. Those are measurable goals, not a way of postponing the conversation.

If you have been putting one off out of fear rather than for a clinical reason, that is worth looking at directly. This practice gains nothing by keeping you in a chair. How the two actually compare.

Who is a good candidate for PRP for arthritis?

Earlier-stage disease with joint space preserved. A joint that responded briefly to a steroid injection and then did less. Someone with a medical reason to put off surgery. Someone who wants to protect a joint over years, not just get through a season.

• PRP for knee osteoarthritis
• PRP for hip osteoarthritis
• PRP for rotator cuff tendinopathy
• Gluteal tendinopathy — lateral hip pain, often mislabeled bursitis
• Prolotherapy — real evidence in knee arthritis, and cheaper
• PRP compared with gel injections

Why not just keep getting cortisone shots?

It works, and the trade is worth understanding. Corticosteroid suppresses inflammation and usually helps within days. Repeated shots into the joint are associated with cartilage volume loss. In tendon, it reduces tensile strength. In a joint you intend to keep for another twenty years, that is a poor bargain. The familiar sequence — first shot lasts three months, second lasts six weeks, third barely registers — is what it looks like from inside.

The full comparison, including when cortisone is genuinely the better choice.

Why do several of my joints hurt at once?

The most common thing we hear in north county is a list: this knee, that shoulder, the hip on one side, the heel. It gets treated as bad luck, or as aging, and it is usually neither.

Several joints and tendons hurting at once is one of the more reliable clinical signs of a body-wide driver. The tissues are not failing one by one. They are failing in a shared setting of chronic metabolic inflammation and insulin resistance. That setting lowers collagen quality. It keeps the synovium in a breakdown state everywhere at once.

Chasing the loudest joint with a needle in that situation brings a partial success, then another. The patient reasonably concludes nothing works. It is more useful, and less expensive, to treat the worst joint and the reason all of them are failing in the same plan.

Sometimes the answer is an inflammatory arthropathy (joint disease) that has never been named. That needs a rheumatologist, not an injection. We find that instead of treating around it.

The behavioral half of the treatment

Behavioral and metabolic work is roughly 40 to 50 percent of the plan here. Acceptance and Commitment Therapy is given in-house, by a licensed clinician trained in pain. It is not sent out.

That is not a wellness flourish. A nervous system that has spent a decade guarding a joint has changed how it handles signals from that limb. No injection reverses that. The injection buys a window in which movement becomes possible. What fills the window is what changes the path. Sleep, load, food and social contact each have a physical reason to be prescribed. Each is prescribed with the same seriousness as a procedure.

Getting information another way

Anything published on this site can be explained over the phone by a person, including whether it is worth your time coming in. That is not a lesser service. It is not a screening call designed to book you. If the answer is that we are unlikely to help, you will get that answer on the phone, not after a visit.

Frequently asked questions from Florissant

I have arthritis in both knees and a shoulder. Is that treatable?

Sometimes, though several joints at once usually points to a body-wide driver worth treating alongside. How we assess.

Is it too late for me?

For bone-on-bone disease, an injection buys time and reduces medication rather than restoring the joint. We will be exact about the difference. PRP compared with surgery.

Will Medicare pay for this?

No — we do not bill insurance for it. Why.

Is there a cheaper option?

Sometimes prolotherapy, and often a supervised loading program. We will tell you. Prolotherapy.

What is the downside of PRP injections for arthritis?

The main limit is structural. In a hip or knee that is bone-on-bone with deformity, no injection fixes the joint. So treatment there aims at buying time and lowering medication burden. An injection also cannot undo how a nervous system has learned to guard a joint over years. That is why sleep, load, food and social contact are prescribed as part of the plan. And we do not bill insurance for it.

Is PRP a better choice than another cortisone shot?

Cortisone works and usually helps within days. The trade is that repeated shots into a joint are associated with cartilage volume loss. The familiar pattern is a first shot that lasts three months, a second that lasts six weeks and a third that barely registers. A joint that responded briefly to a steroid and then did less is one of the places a regenerative option fits.

Can PRP help me put off a knee or hip replacement?

It can be part of that plan. Someone with a medical reason to put off surgery is one of the people a regenerative option fits. Treatment at that stage aims at time and medication burden, which are measurable goals. Where a replacement is wanted, it is the definitive operation. If you are putting one off out of fear rather than for a clinical reason, that is worth looking at directly.

Related reading

• Areas we serve
• What to expect
• Recovery timeline
• About Dr. Padda
• PRP in Hazelwood, MO