When arthritis pain comes from the bone itself — not just the joint surface — an intraosseous injection delivers concentrated healing biologics directly into the bone marrow lesion driving it.
Quick answer
Intraosseous injection is a non-surgical procedure that delivers concentrated orthobiologics directly into the bone beneath damaged cartilage. Under precise fluoroscopic (X-ray) imaging guidance, the injection takes about 60-90 minutes including recovery, uses local anesthesia with oral sedation, and is most effective for: bone marrow lesions in advanced knee, hip, or shoulder osteoarthritis. It is frequently combined with an intra-articular BMAC or PRP injection in the same visit, particularly for patients hoping to delay or avoid joint replacement surgery.
Time in office
60 to 90 minutes
Anesthesia
Local + oral sedation
Typical course
Usually 1 session per site
Downtime
3 to 7 days
First results
6 to 12 weeks
Guidance
Fluoroscopy (X-ray), always
Incision
None — needle/trocar only
Tissue source
Autologous bone marrow / blood
Definition
It is the direct delivery of concentrated bone marrow aspirate concentrate and/or PRP into the bone itself — not just the joint — to treat the bone marrow lesions driving osteoarthritis pain from within.
Standard PRP or stem cell injections are placed inside the joint capsule. But in moderate-to-advanced osteoarthritis, much of the pain and structural damage originates in the subchondral bone itself — areas called bone marrow lesions, visible on MRI as bone swelling and microdamage just beneath the cartilage. An intra-articular injection alone does not reach this tissue.
Under live fluoroscopic (X-ray) guidance, a specialized needle or trocar is advanced through the bone cortex directly into the lesion, and concentrated bone marrow aspirate concentrate and/or high-dose PRP is delivered into the bone marrow itself. The same visit typically also includes an intra-articular injection, so both the bone and the joint surface are addressed together.
Indications
Any joint where MRI shows a bone marrow lesion or advanced cartilage loss contributing to pain, particularly when intra-articular treatment alone has not been enough.
Step by step
01
MRI is reviewed to confirm the location, size and severity of the bone marrow lesion, and the joint is assessed to plan the fluoroscopic access route.
02
Bone marrow is aspirated from the pelvis (iliac crest) and concentrated in the office, or blood is drawn and processed into high-concentration PRP, depending on the treatment plan.
03
The skin, soft tissue and bone surface are numbed. Many patients also receive a sublingual anti-anxiety and comfort medication for the procedure.
04
Under live X-ray guidance, a specialized needle or trocar is advanced through the bone cortex to the exact site of the bone marrow lesion.
05
Concentrated bone marrow aspirate concentrate and/or PRP is injected directly into the lesion, and the joint itself is typically injected in the same visit.
06
You're monitored briefly before discharge. Most patients take it easy for several days, with response assessed over the following weeks to months.
Candidacy
Comparison
Frequently asked
The skin, soft tissue and bone surface are numbed before the needle enters the bone, and most patients also receive an oral anti-anxiety and comfort medication. Some pressure or a dull ache is common as the needle passes into bone; most patients describe it as tolerable, with soreness settling over the following days.
A standard PRP or BMAC injection is placed inside the joint capsule. An intraosseous injection goes a step further, delivering concentrated biologics directly into the bone beneath the cartilage — into the bone marrow lesion itself — tissue an intra-articular injection alone cannot reach.
A bone marrow lesion is an area of swelling, microdamage and altered blood flow inside the bone just under the cartilage, visible on MRI. Research has linked bone marrow lesions closely to osteoarthritis pain and disease progression, which is why treating the bone directly — not just the joint — can be an important part of the strategy.
Published follow-up of a year or more after intraosseous PRP or BMAC has shown meaningful, sustained improvement in pain and function for many patients with bone marrow lesions, though results vary with the severity of arthritis and the individual patient.
For some patients with earlier or moderate disease, it can meaningfully delay or reduce the need for surgery. It is not appropriate for end-stage, bone-on-bone arthritis with severe deformity — those patients are usually better served by joint replacement, and an honest evaluation up front helps set the right expectations.
Because the needle must pass through bone, most patients are more comfortable with more than local anesthesia alone. Local and periosteal anesthesia is combined with a sublingual medication for anxiety and comfort; deeper sedation can be arranged for select patients.
This depends on the joint and how many bone marrow lesions are present. Some patients need injections into more than one location within the same joint — for example, both the femoral condyle and tibial plateau of the knee — during a single session.
Coverage varies by carrier and diagnosis. Orthobiologic procedures, including intraosseous injections, are generally performed as out-of-pocket, autologous same-day procedures. Our staff can review your specific situation in advance.
Sources
01
Lychagin A, Lipina M, Garkavi A, et al. Intraosseous injections of platelet rich plasma for knee bone marrow lesions treatment: one year follow-up. International Orthopaedics.
02
Centeno C, Cartier C, Stemper I, et al. The treatment of bone marrow lesions associated with advanced knee osteoarthritis: comparing intraosseous and intra-articular injections with bone marrow concentrate and platelet products.
03
Sánchez M, Fiz N, Guadilla J, et al. Intraosseous infiltration of platelet-rich plasma for severe knee osteoarthritis. Arthroscopy Techniques.
04
Wu TJ, Liao WC, Lee CW. Unexpected intramedullary canal fill during ultrasound-guided subchondral intraosseous PRP injection: a case report. Cureus.
05
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
This page is written for patient education and does not constitute medical advice or establish a physician-patient relationship. Treatment decisions require an in-person examination. Orthobiologic procedures are not FDA-approved drug therapies; they are performed as autologous same-day procedures under the practice of medicine. Dr. Tortland reports no financial interest in the products or devices described on this page.
If your knee, hip, or shoulder pain hasn't responded to standard PRP or joint injections, an MRI review can show whether a bone marrow lesion is present — and whether an intraosseous injection could help.