Intraosseous Orthobiologic Treatment for Knee, Hip, Shoulder, and Ankle Arthritis

For many patients living with knee, hip, shoulder, and ankle arthritis, the pain is not only coming from the cartilage inside the joint. In many cases, a major source of pain and progression may also come from the bone just beneath the joint surface, known as the subchondral bone. This is especially important in the knee, where changes inside the bone are often associated with more severe arthritis pain and a higher likelihood of eventually needing joint replacement.

Intraosseous orthobiologic treatment is an advanced, image-guided procedure designed to treat these deeper bone-related pain generators. Rather than placing bone marrow concentrate or platelet-rich plasma only into the joint space and surrounding structures, intraosseous treatment allows a physician to precisely place your body’s own healing agents into targeted areas of bone beneath the damaged joint surface.

Why the Bone Beneath the Joint Matters

Arthritis is often described as “wear and tear” of cartilage, but that explanation is incomplete. The joint is a complex system made up of cartilage, bone, ligaments, tendons, joint lining, and surrounding soft tissues. When arthritis progresses, the bone beneath the cartilage can become irritated, overloaded, inflamed, or structurally weakened.

On MRI, these areas may appear as bone marrow lesions, sometimes called bone marrow edema. These findings can be associated with pain, swelling, reduced function, and progression of arthritis. In the knee, bone marrow lesions are especially important because they may indicate that the joint is under significant stress and may be moving closer to the point where joint replacement is considered.

By treating the subchondral bone directly, intraosseous procedures are intended to address an important part of the arthritis process that traditional regenerative injections cannot fully reach.

Promising Solution for Knee Arthritis and Knee Replacement Candidates

Knee arthritis is one of the most common reasons patients are told they may eventually need a total knee replacement. While knee replacement can be appropriate for some patients, many people want to delay or avoid surgery when possible, especially if they are active, younger than the typical joint replacement patient, or concerned about recovery time, implant lifespan, or surgical risks.

This is where intraosseous knee treatment has generated significant interest.

Research published by Dr. Philippe Hernigou has shown promising long-term results using subchondral bone marrow concentrate in patients with knee osteoarthritis. In that study, treatment directed into the bone beneath the joint surface showed the potential to reduce pain and help some patients postpone or avoid knee replacement.

Based on the growing understanding of the role that subchondral bone plays in knee arthritis, Regenexx has introduced intraosseous treatment as the highest standard of care for appropriate knee arthritis patients.

How the Procedure Works

Before any treatment plan is established, the doctor will perform a detailed evaluation, which will include a physical exam, imaging review (MRI and/or X-rays), and an assessment of your symptoms, function, and goals. Not every patient is a candidate.

When bone marrow concentrate is used, it is collected from the back of the pelvis. This sample is processed to concentrate and extract the cells and healing factors (which include your own stem cells) naturally found in your bone marrow. The physician then uses advanced imaging guidance to place the concentrated cells into precise areas of the joint and, when appropriate, into the subchondral bone.

For knee arthritis, this includes injections into the joint and intraosseous injections into targeted areas of the femur and tibia. For hip and shoulder arthritis, similar principles may apply when imaging and symptoms suggest that the underlying bone is part of the pain pattern.

Knee, Hip, Shoulder, and Ankle Applications

Although the knee is currently the area of greatest emphasis and is supported by the most research, intraosseous orthobiologic procedures may also be considered for select hip, shoulder, and ankle patients. In the hip, arthritis and bone-related changes can contribute to deep groin pain, stiffness, and loss of mobility. In the shoulder, joint degeneration or bone stress may contribute to pain with motion, lifting, reaching, or sleeping. Ankle arthritis creates obvious painful challenges for nearly all activities that involve time spent on our feet.

The goal is not simply to “inject the joint,” but to identify the specific structures contributing to pain and treat them with precision. This is part of what makes the Regenexx approach different from many conventional injection clinics. Regenexx procedures are performed by specially trained physicians using advanced image guidance and detailed protocols designed around orthopedic diagnosis, anatomy, and function, with the goal of producing the best possible outcomes.

Evaluating Whether You’re a Candidate

As with any medical procedure, outcomes will vary. The best way to determine whether this treatment is appropriate is to undergo a detailed evaluation to review imaging, examine the joint condition, and discuss realistic expectations.

If you have been told you are a candidate for knee replacement, or if you have hip or shoulder arthritis and want to explore advanced non-surgical options, an evaluation can help determine whether regenerative treatment options may be right for you.