Intraosseous Orthobiologic Treatment for Knee, Hip, Shoulder, and Ankle Arthritis
For many patients living with knee or hip arthritis, pain does not come only from cartilage deterioration inside the joint. An important source of pain and disease progression may also be the bone immediately beneath the joint surface, known as subchondral bone. Changes within this bone can be associated with more severe symptoms, reduced function, and an increased likelihood of eventually needing joint replacement.
The same underlying principle may apply to select cases of shoulder arthritis, although the knee and hip are the primary focus of this treatment approach.
Intraosseous orthobiologic treatment is an advanced, image-guided procedure designed to address these deeper, bone-related pain generators. Instead of placing bone marrow concentrate or platelet-rich plasma only into the joint and surrounding tissues, intraosseous treatment allows a physician to precisely deliver a patient’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 this explanation is incomplete. A joint is a complex system that includes cartilage, bone, ligaments, tendons, the joint lining, and surrounding soft tissues. As arthritis progresses, the bone beneath the cartilage can become irritated, overloaded, inflamed, or structurally weakened.
On MRI, affected areas may appear as bone marrow lesions, sometimes called bone marrow edema. These findings can be associated with pain, swelling, stiffness, reduced function, and arthritis progression.
In the knee, bone marrow lesions can indicate that portions of the femur or tibia are experiencing significant stress. In the hip, changes within the femoral head or acetabulum may contribute to deep groin pain, stiffness, and loss of mobility. In both joints, identifying subchondral bone involvement can provide a more complete understanding of the patient’s symptoms and help guide treatment.
By treating the subchondral bone directly, intraosseous procedures are intended to address an important component of arthritis that conventional injections into the joint space cannot fully reach.
Intraosseous bone marrow concentrate delays total hip arthroplasty in osteoarthritis: A fifteen year matched cohort study with dose–response analysis
Promising Solution for Knee, Hip and Shoulder Arthritis and Joint Replacement Candidates
Knee and hip arthritis are among the most common reasons patients are advised to consider joint replacement. Replacement surgery may be appropriate for some patients, but many people want to delay or avoid it when possible—particularly those who are active, younger than the typical joint-replacement patient, or concerned about recovery time, implant lifespan, and surgical risks.
Intraosseous treatment has generated interest as a potential nonsurgical option for appropriately selected patients whose imaging shows that the bone beneath the joint surface is contributing to their condition.
Research published by Dr. Philippe Hernigou has reported promising long-term results from the use of subchondral bone marrow concentrate in patients with knee osteoarthritis. Treatment directed into the bone beneath the joint surface showed the potential to reduce pain and help some patients postpone or avoid knee replacement.
The clinical rationale for treating hip arthritis is similar: if imaging identifies meaningful changes within the subchondral bone, treating both the joint and the affected bone may provide a more comprehensive approach than an injection into the hip joint alone. Because every hip is different, candidacy depends on the extent and location of the arthritis, the condition of the surrounding structures, and the patient’s symptoms and functional goals.
Based on the growing understanding of the role subchondral bone plays in arthritis, Regenexx considers intraosseous treatment an advanced option for appropriate knee and hip patients, particularly when MRI findings demonstrate bone involvement.
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 and hip are currently the area of greatest emphasis and supported by the most research, intraosseous orthobiologic procedures may also be considered for select shoulder, and ankle patients. 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.