
Bone/Intraosseous
Injections
INTRA-OSSEOUS OR (IO) INJECTIONS INVOLVE INJECTING PLATELETS RICH IN GROWTH FACTORS OR BONE MARROW CONCENTRATE INTO A BONE TO TREAT SEVERE FORMS OF OSTEOARTHRITIS OR SUBCHONDRAL BONE OEDEMA.
The most advanced, minimally invasive treatment at OrthoRegen® is Intra-osseous injections. This treatment is reserved for patients with severe osteoarthritis and MRI findings of subchondral oedema. It is also a treatment used for patients with Osteochondral Defects or OCD lesions. Subchondral oedema is a significant pain generator in severe osteoarthritis. It is indicative of small cracks or micro-fractures within the bone and is a sign that the bone beneath the cartilage is weak. Subchondral oedema shown on MRI correlates with more pain than cartilage loss or the presence of a joint effusion. This finding is also a sign that the osteoarthritis is actively progressing.
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We use autologous high dose Platelet Rich Plasma (SC-PRP) with our Concentrated Growth Factors (C-GF), or Bone Marrow Concentrate (BMAC) to inject precisely in the subchondral bone where the damage is taking place.
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Dr Paul Schiavo was among the first in Australia to use intraosseous injections for the management of severe osteoarthritis. He has had the pleasure and honour of meeting the undisputed father of intra-osseous injections, Dr Phillipe Hernigou (France) at international conferences and been honoured to receive advanced training in this technique by world leaders in the USA.
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Intraosseous Orthobiologic Injections: A Breakthrough in Osteoarthritis Treatment
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One of the most compelling advances in regenerative medicine for osteoarthritis has emerged from the work of renowned French orthopedic surgeon, Dr. Philippe Hernigou, a pioneer in the use of bone marrow concentrate (BMAC) for joint disease. Over a 15-year longitudinal study, Dr. Hernigou and his team followed over 140 patients with knee osteoarthritis who received intraosseous (subchondral bone) injections of BMAC—a rich source of stem cells and growth factors—into the femur and tibia near the knee joint.
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The results were remarkable:
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Over 85% of patients avoided total knee replacement (TKR) for more than a decade.
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Patients showed significant improvements in pain, function, and mobility, often exceeding the results seen in patients who underwent TKR.
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MRI and radiographic follow-ups demonstrated regeneration of subchondral bone quality, a crucial factor in maintaining long-term joint health.
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Interestingly, patients with less joint space narrowing but significant subchondral bone edema responded the best—emphasizing the role of the bone beneath the cartilage in osteoarthritis.
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Why Subchondral Bone Injections Work
Traditionally, osteoarthritis has been viewed primarily as a cartilage disease, but growing evidence - including Hernigou’s research - shows that the subchondral bone (the bone just below the cartilage) plays a critical role in the initiation and progression of OA. Damage to this bone leads to inflammation, pain, and mechanical breakdown of the joint, which perpetuates cartilage loss.
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Intraosseous injections deliver orthobiologics directly to the damaged bone, not just into the joint space. This allows the mesenchymal stem cells (MSCs), cytokines, and growth factors in BMAC or platelet-rich plasma (PRP) to:
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Reduce inflammation and bone marrow lesions (BMLs)
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Stimulate repair of subchondral microfractures
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Promote a healthier bone-cartilage interface
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Improve shock absorption and load distribution across the joint
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Advantages Over Total Knee Replacement
While total knee replacement can be effective, it is invasive, costly, and comes with a risk of complications, including infection, prosthesis wear, and the need for revision surgery. Hernigou’s long-term data suggest that biologic restoration of joint function through intraosseous injection can delay or entirely prevent the need for surgery, while preserving natural joint anatomy and biomechanics.
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Dr. Philippe Hernigou’s groundbreaking work provides strong evidence that intraosseous injection of BMAC into the subchondral bone can significantly improve outcomes for patients with knee osteoarthritis, often outperforming surgical alternatives like TKR.
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At OrthoRegen, we use this cutting-edge approach to target the root cause of osteoarthritis - not just the symptoms - offering patients a minimally invasive, regenerative option with real long-term benefits.
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​​DOES THE PROCEDURE HURT?
Intra-ossoues injections are performed under local anaesthetic and Nitric Oxide in the OrthoRegen® treatment rooms. Most patients are surprised at how little the procedure hurts. On occasion, it can be performed under twilight sedation in an outpatient surgical centre.
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HOW IS THE RECOVERY?
For most patients, 48-72 hours of increased discomfort can be expected. It is common to actually experience some relief in pain from your condition as the treatment can reduce the pressure inside the bone providing temporary relief. Healing of the subchondral oedema will take weeks to months following the treatment.
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WHAT PATIENTS ARE CANDIDATES FOR IO INJECTIONS?
Patients suffering from severe osteoarthritis with or without subchondral oedema lesions on their MRI are candidates for this procedure. Patients have usually failed conservative measures and are interested in avoiding surgery or are not surgical candidates.
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RESEARCH
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Current Concepts in Intraosseous Platelet-Rich Plasma Injections for Knee Osteoarthritis
Diego Delgadoa, Ane Garatea, Hunter Vincent, Ane Miren Bilbao, Rikin Patel, Nicolás Fiz, SteveSampson, Mikel Sánchez
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Mikel Sanchez et al
Intraosseous Infiltration of Platelet Rich Plasma for Severe Hip Osteoarthritis
Nicolas Fiz et al
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Phillipe Hernigou et al
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