Medical Breakthroughs Don't Wait for Insurance: Why Today's Orthobiologic Research May Change the Future of Joint Preservation

By Deborah Westergaard, M.D. Dallas | Regen Experts Dallas & Plano

If I Could Go Back to 2008...

If I could travel back to 2008, I would ask my younger self one simple question.

"Should I have one more conversation before having hip surgery?"

At that time, the procedures I perform today simply weren't available.

The landmark intraosseous bone marrow concentrate research hadn't yet been published. Physicians weren't discussing subchondral bone as an important contributor to osteoarthritis. Precision image-guided biologic procedures directed into bone had not yet become part of the conversation.

Given the knowledge available at that time, I believe I made the right decision.

And I remain profoundly grateful to my orthopedic surgeon.

His skill allowed me to regain function, return to an active lifestyle, and ultimately walk without a limp after my hip replacement. Orthopedic surgery remains one of the greatest achievements in modern medicine, restoring mobility and quality of life for millions of people every year.

But medicine doesn't stand still.

The questions we ask today are very different from the questions we asked twenty years ago.

The Pace of Medical Innovation

One of the greatest misconceptions in healthcare is that insurance determines the value of medical innovation.

It doesn't.

History has repeatedly shown that scientific discovery almost always comes first. Physician education follows. Clinical experience expands. Long-term research accumulates. Only then do reimbursement systems begin to evolve.

That process takes years.

Sometimes decades.

This does not mean every new treatment is appropriate or supported by strong evidence. Nor does it mean every established treatment should be replaced.

It simply means that innovation often arrives before widespread adoption.

Today, we are witnessing that process again in the field of orthobiologics.

A Different Way of Looking at Osteoarthritis

For decades, osteoarthritis was viewed primarily as a disease of cartilage.

As cartilage wore away, joint replacement became the logical solution for many patients.

But researchers began asking a different question.

What if the bone beneath the cartilage also plays an important role?

That question has led to an exciting area of investigation focusing on the entire joint as a functional unit—including cartilage, ligaments, tendons, muscles, synovium, and subchondral bone.

This broader understanding has opened the door to image-guided orthobiologic procedures designed to address multiple structures rather than focusing on cartilage alone.

The Research That Changed My Thinking

Much of my enthusiasm comes from the pioneering work of Professor Philippe Hernigou, MD, PhD, an internationally respected orthopedic surgeon, scientist, and researcher whose work has helped reshape how many physicians think about osteoarthritis.

Rather than viewing arthritis solely as cartilage loss, Dr. Hernigou explored the role of subchondral bone and investigated whether concentrated bone marrow placed into carefully selected areas of bone might influence pain, function, and long-term outcomes.

His research has been thoughtful, methodical, and, perhaps most importantly, includes remarkably long follow-up periods.

In an era when many orthopedic studies report outcomes at one or two years, Professor Hernigou followed patients for as long as 15 years.

That long-term perspective is one reason his work has attracted attention from physicians around the world.

From the Knee...to the Hip...and Now the Shoulder

Professor Hernigou's landmark knee studies demonstrated encouraging long-term outcomes in carefully selected patients with advanced knee osteoarthritis who underwent image-guided intraosseous bone marrow concentrate procedures.

More recently, his work has expanded into the hip, continuing to explore the role of orthobiologics in preserving joint function in selected patients.

Earlier this month, at the IOF/TOBI MAX Conference in Denver, he presented emerging work involving the shoulder and ankle, further expanding our understanding of how subchondral bone may contribute to joint disease.

As with all scientific advances, these findings require continued investigation, peer review, and replication. But they represent an exciting direction in musculoskeletal medicine.

My Own Journey

This research isn't simply interesting to me as a physician.

It is personal.

Years after my original hip surgery, I eventually required a hip replacement because of progressive arthritis.

Again, I remain incredibly grateful for that procedure.

It restored my mobility and allowed me to continue doing what I love.

But I often wonder...

If today's image-guided orthobiologic procedures had existed years earlier—and if the evidence we now have had been available then—might I have delayed my hip replacement?

No one can answer that question.

Medicine doesn't allow us to replay history.

But it is a reasonable question to ask.

More recently, I also underwent an image-guided intraosseous procedure on my own arthritic shoulder.

Before treatment, the pain frequently woke me at night and interfered with sleep.

Today, I am sleeping comfortably again, and my shoulder pain has improved substantially.

That is my personal experience.

It should not be interpreted as a guarantee of results. Every patient is different, and outcomes depend on many factors, including diagnosis, disease severity, anatomy, rehabilitation, and overall health.

Why This Matters to My Patients

Perhaps what excites me most isn't that I personally may benefit from these advances.

It's that I have the privilege of offering evidence-informed options to patients today.

Every week I meet people who simply want to keep doing the things they love.

Playing golf.

Traveling.

Working.

Playing with grandchildren.

Remaining independent.

Joint replacement remains an outstanding treatment for many patients.

But if carefully selected individuals may have an opportunity to preserve their own joint longer, delay surgery, or maintain function with less downtime, then I believe they deserve to understand those options.

Not because surgery is bad.

But because informed patients make better decisions.

What Makes Regen Experts Dallas & Plano Different?

At Regen Experts Dallas & Plano, my focus is not simply treating pain.

My focus is understanding why a joint hurts.

Every patient receives a comprehensive structural evaluation using advanced imaging to identify the tissues contributing to symptoms. Rather than viewing osteoarthritis as cartilage loss alone, I evaluate the joint as an integrated system including cartilage, ligaments, tendons, muscles, capsule, and subchondral bone.

As a Regenexx affiliate physician, I incorporate evidence-informed orthobiologic techniques, standardized image-guided procedural principles, and ongoing physician education developed through the Regenexx network. Regenexx has helped advance the field through physician training, clinical research, outcomes registries, and collaboration with leaders in regenerative orthopedics.

Insurance coverage for orthobiologic procedures continues to evolve. Some image-guided Regenexx procedures are covered through participating employer-sponsored and health plans, while coverage varies depending on the patient's specific insurance benefits and the procedure being performed. My team helps patients understand their available options before treatment.

Artificial Intelligence Is Accelerating Medical Progress

One of the most exciting developments in modern medicine isn't a new injection.

It's artificial intelligence.

AI allows physicians to analyze research from around the world faster than ever before, identify meaningful trends, collaborate internationally, and bring new knowledge into clinical practice more efficiently.

It doesn't replace scientific rigor.

It amplifies our ability to learn from it.

I believe this will accelerate responsible innovation and ultimately benefit patients across the globe.

My Hope for the Future

I don't believe every patient can avoid joint replacement.

Nor should they.

Joint replacement remains one of medicine's greatest success stories.

But I do believe that medicine should continue asking better questions.

If ongoing research allows some carefully selected patients to preserve their own joints longer...

Delay surgery...

Maintain mobility...

And continue living active lives...

Then that is progress worth pursuing.

I feel incredibly fortunate to practice medicine during a time when science, technology, physician collaboration, and artificial intelligence are converging to expand what's possible.

As both a physician and a patient, that gives me great optimism for the future.

Frequently Asked Questions

Does insurance determine whether a treatment is effective?

No. Insurance coverage reflects many considerations, including regulatory review, coding, reimbursement policies, and the available evidence. Coverage status alone does not determine whether a treatment is appropriate for a particular patient.

Does Regen Experts Dallas & Plano accept insurance?

Yes. We participate with many insurance plans for evaluations and covered services. Certain Regenexx image-guided procedures may also be covered through participating employer-sponsored and health plans, while other orthobiologic procedures remain self-pay depending on the patient's individual benefits and treatment plan.

Does this research mean everyone should avoid joint replacement?

No. Joint replacement remains an excellent option for many people. The goal is to ensure patients understand all evidence-informed options before making a decision.

Who is Professor Philippe Hernigou?

Professor Philippe Hernigou, MD, PhD, is an internationally recognized orthopedic surgeon and researcher whose pioneering work on bone marrow concentrate and subchondral bone has significantly influenced the field of regenerative orthopedics.

Are orthobiologic procedures guaranteed to work?

No. Individual outcomes vary. Factors such as diagnosis, disease severity, anatomy, age, activity level, rehabilitation, and overall health all influence results.

About Dr. Deborah Westergaard

Dr. Deborah Westergaard is a board-certified physician in Pain Medicine and Anesthesiology with nearly three decades of experience in image-guided musculoskeletal procedures. She completed her fellowship training under internationally recognized mentors Drs. Gabor Racz, Prithvi Raj, and Miles Day and is dedicated to helping patients better understand the structural causes of pain.

As the founder of Regen Experts Dallas & Plano and a Regenexx affiliate physician, Dr. Westergaard emphasizes comprehensive evaluation, precision image guidance, and evidence-informed orthobiologic procedures designed to support mobility, joint preservation, and long-term function. Her philosophy is simple: empower patients with knowledge, provide individualized treatment recommendations, and help them make informed decisions that align with their goals and lifestyle.

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FTC Compliance Notice: This article is intended for educational purposes only and should not be interpreted as medical advice or as a guarantee of clinical outcomes. Individual results vary. Treatment recommendations are based on a comprehensive evaluation, and not every patient is a candidate for orthobiologic procedures or for delaying or avoiding surgery.

#BackpainDallas #BackpainPlano #Orthobiologics #RegenExperts #RegenexxAffiliate #JointPreservation #RegenerativeMedicineDallas #AvoidBackSurgeryDallas

References

Hernigou P, Centeno CJ, Murphy MB, et al. Intraosseous bone marrow concentrate delays total hip arthroplasty in osteoarthritis: A fifteen year matched cohort study with dose–response analysis. Int Orthop. 2026. doi:10.1007/s00264-026-06908-x. (Online first / June 2026).

Hernigou P, Delambre J, Quiennec S, Poignard A. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up. Int Orthop. 2021;45(2):365-373. doi:10.1007/s00264-020-04571-4. PMID:32322943. https://pubmed.ncbi.nlm.nih.gov/32322943/ (DOI link: https://doi.org/10.1007/s00264-020-04571-4)

Hernigou P, Bouthors C, Bastard C, et al. Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study. Int Orthop. 2021;45(2):391-399. doi:10.1007/s00264-020-04687-7. PMID:32617651. https://pubmed.ncbi.nlm.nih.gov/32617651/

Hernigou P, Homma Y, Hernigou J, Flouzat Lachaniette CH, Rouard H, Verrier S. Mesenchymal Stem Cell Therapy for Bone Repair of Human Hip Osteonecrosis with Bilateral Match-Control Evaluation: Impact of Tissue Source, Cell Count, Disease Stage, and Volume Size on 908 Hips. Cells. 2024;13(9):776. doi:10.3390/cells13090776. PMID:38727312. Open access full text: https://www.mdpi.com/2073-4409/13/9/776

Hernigou P. Intraosseous bone marrow concentrate for ankle and shoulder osteoarthritis. Presented at: IOF/TOBI MAX 2026 Conference; June 2026; Denver, CO. (Conference presentation; related foundational rotator cuff augmentation work: Hernigou P et al. Int Orthop. 2014 — see also summaries in secondary literature such as Regenexx reviews.)