Frequently Asked Questions

Conventional orthopedics primarily manages pain through medications (NSAIDs, cortisone, opioids) or structural correction through surgery. These approaches address the symptom of the structural problem, but often do not address the biological environment that can allow the structural damage to heal.

Regenerative orthopedic medicine works differently. It uses the body's own signals to stimulate the repair processes the body uses naturally, through the use of growth factors, platelets, stem cells, and more. The goal is not to mask pain but to restore tissue function by supporting healing. Dr. Bhandari's approach also addresses the systemic factors of nutrition, hormones, sleep, and inflammation, as these determine whether healing can proceed.

Absolutely. Dr. Bhandari puts a heavy emphasis on using updated research evidence in guiding his clinical practice. Regenerative orthopedics has an incredibly fast-growing base of research evidence that helps guide decisions on which treatments are best for what conditions, and how best to utilize them for specific cases. You can find select research articles Dr. Bhandari has shared on the Resources page.

Dr. Bhandari's decision of which treatment is right for you is based on a thorough evaluation that includes a complete history of your symptoms and prior treatments, a detailed physical examination, review of new and existing imaging (MRI, X-ray, ultrasound), and comprehensive laboratory analysis when indicated. Depending on what the assessment reveals, Dr. Bhandari may recommend PRP, adipose-derived stem cell therapy, perineural injection therapy, prolotherapy, shockwave therapy, or peptide therapy.

Both PRP and stem cell therapy are autologous orthobiologic injection therapies, but they work through different mechanisms and are suited to different clinical situations.

PRP (Platelet-Rich Plasma) is derived from your blood. It concentrates platelets, which carry growth factors that signal tissue repair, and delivers them directly to the damaged area. PRP is appropriate for a wide range of conditions: tendon injuries, early to moderate joint degeneration, ligament damage, and muscle tears.

Stem Cell Therapy (Biocellular Fat Graft) involves harvesting a small amount of adipose (fat) tissue from the patient, processing it to isolate a concentrated cellular fraction rich in MSCs (medicinal signaling cells) and growth factors, and delivering it precisely to the target tissue. It provides broader biological activity compared to PRP and is typically reserved for more advanced conditions: significant joint degeneration, larger tendon or ligament tears, or in patients of more advanced age.

Regenerative injection therapy and cortisone are fundamentally different in their intent and mechanism.

Cortisone (corticosteroid) injections are anti-inflammatory. They suppress the inflammatory response to provide short-term pain relief. The problem is that inflammation is part of the healing process. Repeated cortisone injections have been shown to weaken connective tissue and can accelerate joint degeneration over time. They manage symptoms without addressing the underlying problem.

Regenerative injections do the opposite. PRP, autologous stem cells, or prolotherapy injections, when delivered to areas of damaged tissue like ligaments or tendons, cause a controlled, localized inflammatory response. This deliberately triggers the body's natural healing cascade, drawing in growth factors and other supportive cells that help synthesize new tissue. The result is stronger, healthier tissue with a less inflammatory tissue environment.

Regenerative injections like PRP and autologous stem cell therapy are generally considered very safe, when performed by a trained physician. As with any medical intervention, there are inherent risks, and with injection procedures the risks include bleeding, infection, or temporary pain at the site of injection. However, serious complications are rare. With autologous (from your own body) cellular therapies, the risks associated with donor or lab-grown cells are not present.

Pain tolerance varies by patient and by treatment type, however most patients tolerate PRP and stem cell injection treatments very well.

The injection therapies do involve mild to moderate discomfort during the procedure, though typically brief, and well-managed by most patients.

Injections performed under live ultrasound guidance provide the accuracy to limit injection time and needle passes, further reducing discomfort.

PRP and adipose-derived stem cell therapies often provide long-term pain relief for many common orthopedic and sports medicine conditions. Depending on age, nutritional status and lifestyle behaviors, activity level, and the severity of the condition being addressed, benefits can last anywhere from 12 months to 3+ years, and many patients have experienced even longer lasting relief. It is important to note however that all patients respond differently to these therapies. With stem cell therapy specifically, there is research evidence to show benefits can last even 5-7 years following treatment.

Most patients will begin to notice improvements in their pain and function within 4-8 weeks, while some will notice pain relief as early as 2-3 weeks. Since regenerative therapies work through biological processes that take time, they are not the same as cortisone, which may provide relief within days by suppressing inflammation. Instead, the body responds to these treatments through its natural healing processes, which take time to build new tissue and resolve chronic inflammation.

Improvements build over time, with peak benefits usually noted around 3-4 months post-procedure for most PRP treatments, and 4-6 months post-procedure for most stem cell treatments. This timeline can vary based on individual factors, the severity of the condition being addressed, and the specific treatment area. Dr. Bhandari strives to set realistic expectations at your consultation.

Most regenerative injection therapies are not covered by insurance. This is consistent with how these therapies are classified across most insurance plans in the United States: as emerging or investigational treatments, regardless of the research and clinical evidence supporting them.

Health savings accounts (HSA) can be used towards these treatments, as well as some flexible spending accounts (FSA).

The cost of a PRP or adipose-derived stem cell treatment can vary depending on several factors: your age and individual health history, the specific condition being treated, and the complexity or severity of your condition. Since each case is unique, as is the patient, the first step is a comprehensive assessment, which allows Dr. Bhandari to build a specific treatment plan for exactly what needs to be treated, and then provide a more clear answer on the costs associated with treatment.

The goal is to provide the best possible treatment for what your goals are, so there is never a “plug-and-play” protocol used. Dr. Bhandari will discuss pricing transparently at the time of your consultation.

Dr. Bhandari practices out of SageMED in Bellevue, Washington, and serves the Greater Seattle metropolitan area. He regularly sees patients from throughout Washington State, including Spokane, Yakima, Olympia, and Bellingham. He also sees patients traveling from other states, and Canada.

For patients traveling from outside the area, Dr. Bhandari's clinic staff can assist with scheduling consultations and treatments efficiently.

For patients located outside the Bellevue area, an initial telehealth consultation may be available for appropriate cases. This allows Dr. Bhandari to review history, imaging, and prior treatment records and assess whether an in-person evaluation and treatment is likely to be worthwhile for your specific situation.

Please contact the clinic to discuss whether a remote initial consultation is appropriate for your case. Note that all telehealth consultations do require a follow up in-person consultation for a thorough physical examination prior to a procedure.

The first step is booking a consultation through the online scheduling system or by calling the clinic directly.

To make the most of your initial consultation, please bring:

• Any relevant imaging (MRI, X-ray, ultrasound), either physical films or CD, or access to a patient portal with digital images
• A list of all current medications and supplements
• A summary of prior treatments for your condition and your subjective response to each
• Any prior lab work from the past 6 months

The initial consultation is your opportunity to have a thorough, unhurried conversation with Dr. Bhandari about your history, your goals, and what options are realistically available to you.