A good visit can tell you not to proceed

The exam may show that this procedure doesn't fit

Ask what may be causing the soreness. The answer must match your exam and X-rays.

Talk through exercise and a brace first. Ask about pain cream or gel rubbed over the joint.

You may still have a simpler choice. Severe loss of movement may call for a surgery talk.

Ask what could rule out this procedure. That could be your exam, X-ray, or health history.

A careful clinic won't recommend the same care for everyone. You'll want the reason in plain words.

Get the whole cost in writing before booking

Ask for the total price before booking. Make sure it includes the visit and follow-up.

Find out what your insurance may cover. Don't assume it covers the whole procedure.

Ask whether you may need another treatment. Another clinic visit can bring another bill.

Take the written total home and read it. You don't need to decide while you're there.

Check who answers questions after the visit. Get that person's name before you pay.

Postpone this treatment when warning signs need urgent care

A hot, swollen joint with fever needs urgent care. Sudden weakness or numbness can't wait either.

Get help after a hard fall or a bent-looking joint. Loss of bladder or bowel control needs prompt care.

Tell the clinic about an infection you have now. Fever, chills, or a draining sore can be signs.

Also report bleeding that won't stop easily. Blood-thinning medicine matters before any needle procedure.

At home, list your questions before calling. Keep the list beside your medicine bottles.

Sources

1. The OARSI non-surgical management guideline evaluated 60 interventions with GRADE methodology and built its recommendations around core treatments - structured exercise, weight management and self-management education - for every patient with knee osteoarthritis, regardless of what else is added.

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

2. A systematic review of 21 studies re-examining the familiar '20 percent are dissatisfied after knee replacement' figure found the actual average dissatisfaction rate was 10 percent, and 7.3 percent when complications were excluded - the surgical benchmark a cash-pay injection is implicitly competing against.

   DeFrance MJ, et al. — Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. J Arthroplasty, 2023. DOI: 10.1016/j.arth.2022.10.011.

3. In orders issued 26 December 2024 and announced 8 January 2025, a federal court permanently banned the co-founders of the Stem Cell Institute of America and their companies from marketing any regenerative medicine treatment, and ordered $5,155,146 in refunds and civil penalties. The court found on summary judgment that they published false and misleading advertisements about the efficacy and approval of stem cell injections for osteoarthritis, neuropathy and joint pain; their clinic charged up to $5,000 per injection and the customers were almost exclusively elderly and disabled people.

   US Federal Trade Commission — Stem Cell Institute Co-Founders and Companies Banned from Marketing Stem Cell Treatments and Ordered to Pay More Than $5.1 Million for Refunds and Civil Penalties. , 2025.

4. In October 2018 the FTC settled charges against a California physician and two companies that earned at least $3.31 million selling 'amniotic stem cell therapy' between 2014 and 2017 - initial injections cost $9,500 to $15,000 with booster treatments at $5,000 to $8,000 - for advertising, without evidence, that it treated Parkinson's disease, autism, macular degeneration, cerebral palsy, multiple sclerosis and osteoarthritis.

   US Federal Trade Commission — FTC Stops Deceptive Health Claims by a Stem Cell Therapy Clinic. , 2018.

5. FDA states in its consumer alert that the only FDA-approved stem cell products in the United States are blood-forming stem cells derived from umbilical cord blood, approved for disorders of the blood-forming system, and that NONE of these products - stem cells, stromal vascular fraction, umbilical cord blood, Wharton's jelly or amniotic fluid - has been approved for the treatment of any orthopedic condition, including osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain or shoulder pain.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. , 2020.

6. 21 CFR 1271.10(a) sets the four criteria a human cell or tissue product must meet to be regulated SOLELY under section 361 of the Public Health Service Act: it must be minimally manipulated; intended for homologous use only, as reflected by labeling and advertising; not combined with another article beyond water, crystalloids or a preserving agent; and either have no systemic effect and not depend on the metabolic activity of living cells, or else be for autologous use, use in a close blood relative, or reproductive use.

   US Code of Federal Regulations, Title 21 — 21 CFR 1271.10 - Are my HCT/P's regulated solely under section 361 of the PHS Act. , 2004.

7. In a 480-patient, four-arm, multicenter randomized phase 2/3 trial, none of three orthobiologic cell injections - autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, or allogeneic umbilical cord tissue-derived mesenchymal stromal cells - was superior to any other, or to a corticosteroid injection control, on pain at 12 months.

   Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nat Med, 2023. DOI: 10.1038/s41591-023-02632-w.

8. A CDC public health investigation confirmed culture-positive bacterial infections in 20 patients who received umbilical cord blood-derived products marketed as stem cell treatment between August 2017 and September 2018; whole-genome sequencing matched patient isolates to the product.

   Hartnett KP, et al. — Investigation of Bacterial Infections Among Patients Treated With Umbilical Cord Blood-Derived Products Marketed as Stem Cell Therapies. JAMA Netw Open, 2021. DOI: 10.1001/jamanetworkopen.2021.28615.