Quick answer: The three nonsurgical alternatives we reach for most are high-dose PRP, SuperPRP+, and MFAT cell therapy (often referred to by patients as "stem cell therapy"). That doesn't mean regenerative medicine is a guaranteed way to avoid surgery forever — candidacy is everything, and this post explains how we choose.

By: Dr. Matthew Kanaan

If joint pain is keeping you from the activities you love, surgery may not be your only option. In fact, the latest advancements in orthopedics actually aren't surgical at all. Regenerative medicine—also called orthobiologics—is an increasingly popular area of orthopedic care. These treatments use substances derived from your own body, including blood or fat tissue, as part of an individualized treatment strategy.

For many people with knee, hip, shoulder, elbow, ankle, or other joint pain, the conversation eventually becomes: “Do I need surgery?”

But before scheduling an operation, it can be worth asking a different question: “What nonsurgical options do I have?”

Our physicians specialize in nonsurgical orthopedic care and regenerative medicine. Our goal is to identify the source of your pain and determine whether a nonsurgical treatment plan can help you reduce pain, improve function, and potentially delay the need for surgery.

Regenerative treatments such as high-dose PRP, SuperPRP+, and MFAT cell therapy (often referred to by patients as “stem cell therapy”) are the 3 most effective nonsurgical alternatives we offer.

Although joint replacement and other orthopedic surgeries can be highly effective when they are appropriate, surgery still involves risks and down time. It can involve anesthesia, incisions, rehabilitation, time away from work or exercise, and a recovery period that may last weeks or months. And sometimes, surgery simply isn't necessary yet.

If your pain can be managed and your function improved with a nonsurgical approach, you may prefer to postpone an operation while continuing to stay active.

That doesn't mean regenerative medicine is a guaranteed way to avoid surgery forever. Some injuries and advanced joint conditions ultimately do require surgery. The goal is to determine whether you have a reasonable nonsurgical option before jumping straight to an operation.

At Carolina Nonsurgical Orthopedics, our approach is customize every treatment approach to each patients' unique diagnosis and severity of condition.

1. High-Dose PRP: Using Your Body's Own Healing Signals

PRP, or platelet-rich plasma, has become one of the best-known regenerative medicine treatments for joint and tendon pain.

The concept is relatively straightforward. A small amount of your blood is drawn and processed in a centrifuge to concentrate platelets and the growth factors they contain. The resulting platelet-rich plasma is then injected into the area being treated using ultrasound guidance (which makes the injection more accurate and therefore more effective).

Because PRP is made from your own blood, it is considered a highly safe treatment since it is not relying on donated samples that aren't approved by the FDA.

But not all PRP is the same.

One of the important differences between PRP treatments is the dose and concentration of the final product.

At Carolina Nonsurgical Orthopedics, we use customized, high-dose PRP protocols rather than relying on a one-size-fits-all approach. The amount of blood processed, concentration of platelets, volume injected, and treatment location are all be considered when developing an individualized treatment plan.

PRP may be considered for conditions such as:

Knee osteoarthritis

Shoulder pain

Hip pain

Tendon injuries

Chronic tendinopathy

Certain ligament injuries

Sports-related injuries (including for student athletes)

Other sources of joint and musculoskeletal pain

2. SuperPRP+: Taking PRP a Step Further

SuperPRP is an even higher concentrated version of PRP that requires additional steps to make the final sample especially potent. We utilize a double-spin SuperPRP+ protocol to concentrate not only platelets but also proteins naturally found in plasma. The practice may also combine high-dose PRP with hyaluronic acid in selected treatment plans.

Why does that matter? Think of PRP as a biological treatment whose composition can be adjusted. Rather than assuming every patient needs the exact same concentration, you need to consider the diagnosis, the tissue being treated, the severity of the condition, and the desired treatment dose. This is one reason it is important to ask what kind of PRP a clinic actually uses. “PRP” can describe very different preparation methods.

3. MFAT Cell Therapy: What Patients Often Call “Stem Cell Therapy”

The term “stem cells” gets used frequently in regenerative medicine—and it can be confusing. At our practice, the treatment commonly referred to as “stem cell therapy” is MFAT, or micronized adipose tissue (derived from a patient's own fat tissue).

The procedure involves obtaining a small amount of adipose tissue through a minimally invasive mini-liposuction procedure. The tissue is then processed and used as part of the treatment. The practice describes MFAT as a treatment primarily considered for conditions such as more advanced knee arthritis, including some patients with “bone-on-bone” knee pain, as well as selected hip and shoulder conditions.

Why use fat tissue?

Adipose tissue contains a variety of cells and biological components that are being studied for their potential role in musculoskeletal treatment.

However, it is important to be precise about what MFAT can—and cannot—do.

MFAT should not be thought of as a guaranteed way to regrow lost cartilage or permanently reverse arthritis.

Research into adipose-derived cell therapies is ongoing, and the evidence varies depending on the specific preparation, condition, and treatment protocol.

The FDA also cautions consumers that regenerative medicine products marketed as “stem cell” treatments (particularly stem cells from donated sources, which is technically illegal in most states) have not been FDA-approved to treat orthopedic conditions such as osteoarthritis, knee pain, hip pain, or shoulder pain. That makes physician expertise, appropriate patient selection, and honest expectations especially important.

At Carolina Nonsurgical Orthopedics, the goal of MFAT treatment is not to promise that every patient will avoid surgery forever. Rather, the goal is to determine whether cell therapy may be a reasonable option to reduce pain, improve function, and potentially delay surgery when appropriate.

What About “Bone-on-Bone” Arthritis?

One of the most frustrating diagnoses for patients is hearing that they have “bone-on-bone” arthritis and that a joint replacement is their only option.

Sometimes surgery really is the appropriate answer.

But not every patient with advanced arthritis is ready for surgery—or wants surgery right now.

Some patients want to keep playing golf. Others want to continue hiking, exercising, traveling, gardening, or simply walking without significant pain.

For those patients, it may be reasonable to discuss whether a nonsurgical treatment can provide enough improvement to make surgery unnecessary for now.

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Meet the Physicians Behind Carolina Nonsurgical Orthopedics

Dr. Matthew Kanaan

Dr. Matthew Kanaan is a Duke-trained nonsurgical orthopedic physician who has been treating patients in the Triangle since 2013. His practice focuses on nonsurgical orthopedic treatments and regenerative medicine, including PRP and cell therapy.

Dr. Pierce Knox

Dr. Pierce Knox is a Penn Medicine-trained nonsurgical orthopedic physician specializing in nonoperative orthopedics, sports medicine, ultrasound-guided procedures, and orthobiologic treatments including PRP and MFAT. He sees patients at the Raleigh and Cary locations.

Together, the physicians focus on diagnosing the underlying problem and developing individualized nonsurgical treatment plans. Dr. Kanaan and Dr. Knox have performed more than 50,000 procedures since the practice was founded in 2013, with a focus on nonsurgical orthopedic and regenerative care.

If you're in Raleigh, Cary, Apex, Wake Forest, Morrisville, or the surrounding Triangle, and you're looking for alternatives to joint surgery, a nonsurgical orthopedic evaluation may be a good place to start.

Your Joint Pain Doesn't Automatically Mean Surgery

Surgery has an important place in orthopedic medicine—but it doesn't have to be the first conversation.

If you're hoping to stay active, reduce your pain, and potentially delay surgery, find out what nonsurgical options may be available before making that decision.

Carolina Nonsurgical Orthopedics offers physician-led evaluation and regenerative medicine treatments at their clinics in Raleigh and Cary, NC, including high-dose PRP, SuperPRP+, and MFAT cell therapy.

Scheduling Options: 1. Call 919.719.2270 2. Self-schedule online