If your hip aches when you walk, wakes you at night and has started to change how you move, sooner or later someone will mention a hip replacement. For many people that is the right answer. But it is major surgery, and a growing number of patients ask a reasonable question first: could a stem cell injection buy time, or avoid the operation altogether? The short answer from the evidence so far: for some people with milder arthritis it may help delay surgery, but there is no good evidence that it lets most people avoid a hip replacement.
This article compares the two options honestly. Hip replacement is one of the best-studied operations in medicine. Stem cell therapy for the hip is promising but rests on a far thinner body of evidence. Both facts matter, and neither should be glossed over by a clinic that offers only one of them.
The honest headline: total hip replacement has decades of evidence and very durable results for advanced arthritis. Stem cell injections for the hip have shown encouraging pain and function improvements in small, mostly uncontrolled studies, but recent systematic reviews conclude the evidence is not yet strong enough to establish how well they work. They are a possible option for selected people with milder disease, not a substitute for a replacement in a worn-out joint.
The quick answer
For advanced, bone-on-bone hip arthritis, a replacement is the evidence-based treatment. For mild-to-moderate arthritis in someone who wants to delay surgery, a stem cell injection is a reasonable thing to discuss, as long as you understand the evidence is early and results vary.
A 2026 systematic review of mesenchymal stem cell (MSC) treatments for hip osteoarthritis found encouraging short-term improvements in pain and function, but noted that small samples, mixed products and mostly uncontrolled designs "preclude conclusions" about efficacy or about changing the course of the disease.[5] By contrast, registry data on modern hip implants suggest more than 90% are still in place 20 years after surgery.[3]
What each option actually is
Total hip replacement
The surgeon removes the damaged ball at the top of the thigh bone and resurfaces the socket in the pelvis, replacing both with artificial components. A 2007 review in The Lancet called it "the operation of the century" because of how completely it changed the outlook for people disabled by hip arthritis, and noted that younger, more active patients now seek it too.[1] Most people are walking with support within a day or two and return to normal daily activities over roughly six to twelve weeks, although full recovery can take longer.
Stem cell therapy for the hip
Cells are collected, usually from your own bone marrow (from the back of the pelvis) or fat, processed, and injected into the hip joint. Some protocols use cells that have been grown in a laboratory to larger numbers; others use a same-day concentrate. Because the hip is a deep joint, the injection should be guided by ultrasound or X-ray so the cells reach the right place. The aim is to reduce inflammation and pain and to improve function. Whether it changes the structure of the joint is still an open question.
Side by side
| Total hip replacement | Stem cell injection | |
|---|---|---|
| What it does | Replaces the worn joint surfaces with an implant | Aims to calm inflammation and improve pain and function in the existing joint |
| Strength of evidence | Very strong: decades of follow-up and national joint registries covering hundreds of thousands of hips | Limited: small studies, few randomized trials, short follow-up |
| Best suited to | Advanced arthritis, collapsed or badly deformed joints, severe pain and lost function | Mild-to-moderate arthritis with joint space still preserved |
| Procedure | Surgery under anaesthetic, usually a short hospital stay | Outpatient cell collection and image-guided injection, typically same day or over a few days |
| Recovery | Walking aids for a few weeks; normal activities over roughly 6–12 weeks | Walking the same day; a few days of soreness; any benefit usually judged over 3–6 months |
| Durability | Most modern implants last 20 years or more | Unknown; reported benefits often measured over months to a few years |
| Main risks | Infection, blood clots, dislocation, leg-length difference, eventual revision | Soreness and swelling at the harvest and injection sites; serious events uncommon but poorly reported |
What the hip replacement evidence shows
The key question for most patients is how long a new hip lasts. A 2019 Lancet meta-analysis of case series and national registries found that around 58% of hip replacements were still working at 25 years, based on registry data that the authors considered less biased.[2] Those figures mostly reflect implants put in decades ago.
Newer bearing materials appear to do better. A 2026 Lancet analysis of eight national joint registries, covering nearly 1.9 million modern hip replacements, estimated that 93.6% had not needed revision at 20 years, and extrapolated that around 92% might still be in place at 30 years.[3] That last figure is a projection rather than an observed result, but the direction is clear: a modern hip replacement is a very durable operation.
That durability is the main reason replacement remains the standard for advanced disease. It is also why "avoiding a hip replacement" is not automatically a good goal. For someone whose joint has collapsed, delaying a successful operation can mean years of avoidable pain and lost mobility.
What the stem cell evidence shows
The research on cell therapy in the hip is much smaller than in the knee. Three recent systematic reviews give a fair picture:
- Giorgino et al., 2024. Ten studies with 316 patients. The studies reported improvements in pain and function with few adverse events, but the authors stressed the shortage of high-quality studies and called for more research before definitive treatment guidelines can be set.[4]
- Scott et al., 2025 (Mayo Clinic). Thirty-six studies of injected "orthobiologics" for hip arthritis, but only three on bone marrow aspirate or concentrate, three on fat-derived tissue and two on cultured cells. Patient-reported scores generally improved, and the authors called for randomized trials to establish efficacy.[6]
- Steiner et al., 2026. Nine studies with 307 patients. In the cohorts that could be pooled, average pain scores fell from 6.7 to 3.7 out of 10. The authors emphasised these were changes within each group, not comparisons with a control treatment, and that the evidence does not allow firm conclusions about efficacy or structural change.[5]
Notable individual studies
| Study | Design | What it found |
|---|---|---|
| Mardones et al., J Hip Preserv Surg, 2017[7] | 10 patients; three weekly injections of their own lab-expanded bone marrow MSCs; no control group | Better function and range of motion; X-ray arthritis grade unchanged in 9 of 10 patients |
| Hernigou et al., Int Orthop, 2026[8] | 434 hips, matched cohort (not randomized), up to 15 years; bone marrow concentrate injected into the bone of the femoral head | 16.1% went on to hip replacement vs 40.1% of matched conservative-care patients, with better results in mild arthritis and at higher cell doses. An association in a non-randomized study, not proof the injection caused the difference |
The Hernigou study is the result most often quoted by people hoping to delay surgery, and it deserves a careful reading. It was not randomized, so the two groups may have differed in ways the matching did not capture. Several authors are affiliated with Regenexx, a company that sells orthobiologic treatments, a conflict of interest they declared. And it tested a specific technique, injecting concentrate into the bone beneath the cartilage under X-ray guidance, which is not the same as an injection into the joint space. It is an encouraging signal that needs confirming in a randomized trial, not proof that an injection will keep you out of the operating room. The fair reading is that this technique may help some people with milder arthritis put off a replacement, not that it lets you avoid one.[8]
Our longer guide to stem cells for hip osteoarthritis goes into how hip arthritis is graded and what timeline patients can expect.
Where both sides should be honest
Stem cell clinics, including ours, should say plainly that cell therapy for the hip is not part of mainstream guidelines. The 2019 American College of Rheumatology and Arthritis Foundation guideline strongly recommends exercise, weight loss for people with hip or knee arthritis who are overweight, self-management programmes, tai chi, cane use and oral anti-inflammatory medicines; cell injections are not among the treatments it recommends.[9]
It is also fair to say that none of the non-surgical options is a large lever in hip arthritis. A 2026 Cochrane review found that exercise, compared with no treatment, probably improves hip pain and function only slightly, by amounts that may not be clinically meaningful.[10] That is part of why people with a painful hip but a joint still worth preserving look for something in between physiotherapy and surgery, and why the question in this article is worth asking at all.
Who may be a reasonable candidate for cell therapy
Based on the published studies, the patients most likely to benefit tend to:
- Have mild-to-moderate hip arthritis, with joint space still visible on a recent X-ray and the shape of the femoral head preserved
- Have pain that limits activity but have not lost most of their range of motion
- Have already tried exercise therapy, weight management and standard pain relief without enough benefit
- Want to delay surgery for a clear reason, such as age, work or timing, and accept that delay is not guaranteed
- Be in reasonable general health, with no active infection or cancer
Early-stage avascular necrosis, where the bone of the femoral head loses its blood supply before it collapses, is a separate situation with its own evidence. We cover it in stem cells for avascular necrosis.
When this may not be right for you
We would recommend seeing a hip surgeon rather than travelling for an injection if:
- Your X-ray shows bone-on-bone arthritis, a collapsed femoral head or significant deformity. A replacement is the evidence-based option and usually works very well.
- Pain is severe at rest and at night, or you can no longer walk a block, put on socks or get in and out of a car without real difficulty.
- The hip catches, locks or gives way, which can point to a mechanical problem such as a labral tear or loose body that needs a surgical assessment.
- You have hip dysplasia or another structural problem that may be better addressed with corrective surgery.
- You have an active infection, active cancer, are pregnant or breastfeeding, or have a bleeding disorder that makes collection or injection unsafe.
- You would only consider it worthwhile if it guaranteed you would never need surgery. No honest clinic can promise that.
If surgery might be needed in the near future, talk to your surgeon about timing before any hip injection. Surgeons often prefer a gap of several months between an injection and a replacement.
How to think about the decision
It can help to frame it as two separate questions. First: is my hip still worth preserving? That depends mainly on imaging and how much function you have left, and a surgeon's opinion is valuable here even if you lean towards a non-surgical route. Second: if it is, what am I hoping an injection will do, and for how long? A realistic hope is less pain and better function for a period, possibly delaying surgery. An unrealistic one is a rebuilt joint.
We use the same reasoning for other joints. If you are weighing the equivalent decision for a knee, our article on stem cells vs knee replacement covers the knee evidence, which is larger than the hip evidence but similarly mixed.
How our medical team assesses hips, knees, shoulders and other joints, and what treatment involves in Medellín, is set out on our page on stem cell therapy for hip, knee and joint conditions.
The bottom line
Hip replacement and stem cell therapy are not really competing for the same patient. Replacement is a highly effective, very durable operation for a hip that is worn out. Cell therapy is an option still being studied for people whose hip is painful but not yet at that stage, with encouraging early results and real uncertainty about how well, and how long, it works.
If you are somewhere in between and unsure which side of that line you are on, send us a recent X-ray or MRI. We will tell you honestly whether we think an injection is reasonable for your hip, what it might and might not achieve, and when we think you would be better served by a surgeon.
