SEVENTEEN MINUTES, NORTH COUNTY
Florissant is about seventeen minutes and nine miles from us, and it sends us a different patient than the warehouse corridor does. Older, longer-settled, and usually further into the disease before anyone offered them anything but 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, ground-floor entrance, full-size elevator. If you need something specific to attend comfortably — extra time, somewhere quiet to wait, room for a walker or a companion — say so when you book and it gets arranged rather than improvised on the day.
The pattern we see from north county
Established osteoarthritis, frequently in more than one joint, in people who have been managing it for years. Knees and hips predominantly, shoulders often, 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 incompleteness compounds. A decade of reduced walking produces quadriceps loss, which increases joint contact force and accelerates the arthritis. It produces glycemic drift, which raises the inflammatory tone the synovium is bathed in. And it narrows social range, which is not a soft outcome — isolation independently raises inflammatory markers and lowers pain thresholds.
Osteoarthritis is an active disease, not a wearing-out
The familiar description — the cartilage wore out — is the least useful part of the picture. What drives symptoms is an active biological process: an inflamed synovium producing IL-1β and TNF-α, matrix metalloproteinases degrading what remains, and subchondral bone remodeling into a pain generator of its own.
That reframing matters because it identifies things you can influence. Adipose tissue is endocrine tissue, secreting leptin, resistin and IL-6 into the circulation that reaches the joint whether or not you are standing on it — which is why arthritis appears in non-weight-bearing joints in metabolically unwell people, something a pure wear-and-tear model cannot explain. Insulin resistance impairs chondrocyte function and stiffens collagen through glycation.
The joint-by-joint detail is on the knee and hip pages, including where PRP performs and where it does not.
When an operation is the right answer
Whenever it is the right answer, and we will not soften it when it is. 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 deferred, treatment at that stage is aimed at time and medication burden, and those are measurable goals rather than a way of postponing the conversation.
If you have been deferring one out of fear rather than for a clinical reason, that is worth examining directly, and this practice does not benefit from keeping you in a chair. How the two actually compare.
Where a regenerative option does fit
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 defer surgery. Someone who wants to protect a joint over years rather than 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
On cortisone, which most people here have already had
It works, and the trade is worth understanding. Corticosteroid suppresses inflammation and usually helps within days. Repeated intra-articular exposure is associated with cartilage volume loss, and in tendon it reduces tensile strength. In a joint you intend to keep for another twenty years that is a poor bargain, and 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 several 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.
Multiple simultaneous joint and tendon involvement is one of the more reliable clinical signals of a systemic driver. The tissues are not failing independently; they are failing in a shared environment of chronic metabolic inflammation and insulin resistance, which degrades collagen quality and keeps synovium in a catabolic state everywhere at once.
Chasing the loudest joint with a needle in that situation produces a partial success, then another, and a patient who 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.
Occasionally the answer is an inflammatory arthropathy that has never been named, and that needs rheumatology rather than an injection. We find that than treat around it.
The behavioral half of the treatment
Behavioral and metabolic work is roughly 40 to 50 percent of the protocol here, and Acceptance and Commitment Therapy is delivered in-house by a licensed pain-trained clinician rather than referred out.
That is not a wellness flourish. A nervous system that has spent a decade guarding a joint has changed how it processes signal from that limb, and no injection reverses that. The injection buys a window in which movement becomes possible; what fills the window is what changes the trajectory. Sleep, load, food and social contact each have a physiological reason to be prescribed, and 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 and 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 rather than after a visit.
What people from Florissant ask
I have arthritis in both knees and a shoulder. Is that treatable?
Sometimes, though multiple joints at once usually points at a systemic 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, and 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.
Related reading
Find out whether the drive is worth it
Whether PRP is reasonable for you depends on your tissue, your metabolic health and what you have already tried. That is a conversation, not a form.
12174 Natural Bridge Rd, Suite 303
St. Louis, MO 63044