Intraosseous Bioplasty

Intraosseous Bioplasty is a minimally invasive treatment method targeting bone marrow lesions located just beneath the joint cartilage. These lesions typically arise from chronic overload and manifest as subchondral bone edema, stress fractures, or microscopic bone damage. In some cases, they may also indicate avascular necrosis (AVN), a condition caused by insufficient blood supply to the bone.

Traditionally, such lesions are treated with core decompression, in which a small channel is drilled into the bone to reduce pressure and stimulate healing. Intraosseous Bioplasty takes this approach a step further by introducing biologic materials—such as stem cells, PRP (Platelet-Rich Plasma), or bone matrix—into the decompressed area to promote biological regeneration and enhance tissue repair.

When performed in the early stages, especially in weight-bearing joints like the femoral head, this technique can reduce pain, help preserve the joint cartilage, and delay or even prevent the need for more invasive surgical procedures.

What Is Intraosseous Bioplasty?

Intraosseous Bioplasty is a biologically based, minimally invasive procedure designed to treat damage in the subchondral bone beneath the joint cartilage. It is most commonly used in cases of bone marrow edema, subchondral cysts, and early-stage avascular necrosis.

The treatment involves relieving pressure within the subchondral bone and initiating a healing response. Biologic materials—such as PRP, stem cells, or demineralized bone matrix—are then injected into the lesion site to support natural healing. This combination not only reduces pain but also helps prevent the progression of cartilage damage and joint degeneration.

When Is Intraosseous Bioplasty Indicated?

Intraosseous Bioplasty is particularly suitable for patients with:

• Bone marrow lesions

• Subchondral bone edema and stress fractures

• Subchondral cysts

• Early-stage avascular necrosis (AVN) of the hip

• Pain and loss of function in weight-bearing joints such as the hip, knee, and ankle

This technique helps preserve the integrity of the joint cartilage and may delay the need for more extensive procedures like total hip replacement.

How Is Intraosseous Bioplasty Performed?

Intraosseous Bioplasty is typically performed in an operating room under local or spinal anesthesia. The procedure has two main phases:

1. Bone Decompression

Guided by imaging (usually fluoroscopy or CT), a small channel is drilled into the affected area of the bone. This process is called core decompression and is intended to relieve intraosseous pressure and restore local blood flow. It is a critical step in slowing or halting the progression of bone marrow edema or early-stage AVN.

2. Biologic Material Application (Bioplasty)

After decompression, biologic materials with high regenerative potential are injected into the lesion site. The most commonly used materials include:

• Bone marrow aspirate concentrate (BMAC) containing stem cells

• Platelet-Rich Plasma (PRP)

• Demineralized bone matrix (DBM)

These biologics support the repair and remodeling of damaged bone and reinforce the subchondral structure, thereby reducing the risk of joint surface collapse.

The procedure usually takes 30 to 60 minutes, and most patients are discharged on the same day. Post-procedure care typically includes limited weight-bearing for several weeks, along with a structured rehabilitation program.

Who Is a Good Candidate for Intraosseous Bioplasty?

Intraosseous Bioplasty is particularly well-suited for patients seeking non-surgical or joint-preserving treatment options, especially when conventional methods have failed to provide sufficient relief. The following patient groups may be considered ideal candidates for this procedure:

1. Patients with Bone Marrow Edema

Individuals experiencing bone marrow edema in weight-bearing joints such as the knee, hip, or ankle often suffer from pain and reduced mobility. In such cases, biologic treatments can accelerate healing and improve joint function.

2. Early-Stage Avascular Necrosis (AVN)

Patients diagnosed with early-stage AVN of the femoral head (Ficat Stage I–II), before bone collapse has occurred, may benefit significantly from Intraosseous Bioplasty. This approach may reduce the risk of collapse and delay or avoid the need for major surgery like hip replacement.

3. Patients with Subchondral Cysts or Microfractures

If imaging (such as MRI) reveals small subchondral cysts, stress fractures, or microdamage beneath the cartilage, this treatment can help reinforce the bone structure and preserve overall joint health.

4. Patients with Intact Cartilage but Persistent Pain

Even when the joint cartilage appears largely intact, underlying subchondral bone damage can cause significant pain. In these cases, Intraosseous Bioplasty offers a biologic solution aimed at pain relief and joint stabilization.

5. Active Individuals Seeking a Non-Surgical Option

Athletes and physically active individuals who wish to avoid major surgery and return to activity more quickly may benefit from this joint-sparing technique.

Recovery Process After Intraosseous Bioplasty

The recovery process following Intraosseous Bioplasty depends on the joint involved and the type of biologic materials used. However, in most cases, patients can return to daily activities relatively quickly. The healing process generally includes the following phases:

1. Initial Days: Rest and Weight-Bearing Protection

Patients are usually advised to rest and limit weight-bearing for the first few days after the procedure. For treatments involving the hip or knee, walking aids such as crutches or a cane may be recommended to reduce load on the treated joint and allow proper healing.

2. Weeks 2–6: Gradual Activity and Physical Therapy

In this phase, patients gradually resume weight-bearing under the guidance of a tailored rehabilitation program. Physical therapy is crucial for restoring muscle strength, joint mobility, and balance. Most patients are able to walk with full weight-bearing by week 4 to 6.

3. After 3 Months: Return to Normal Activities

Within 8 to 12 weeks, most individuals can resume regular daily activities and low-impact sports such as walking, swimming, or cycling. High-impact activities may require medical clearance depending on healing progress.

4. Pain Reduction and Clinical Recovery

Many patients experience significant pain relief within the first few weeks. Full clinical recovery, including improved mobility and joint function, typically occurs within 3 to 6 months. Clinical studies support the effectiveness of this biologic approach in reducing pain and improving quality of life.

Differences Between Intraosseous Bioplasty and Core Decompression

Intraosseous Bioplasty and core decompression are two treatment techniques that serve the same fundamental goal—reducing intraosseous pressure, improving circulation, and relieving pain. However, they differ significantly in their method of application and regenerative potential:

1. Use of Biologic Support

• Core Decompression: A mechanical channel is drilled into the bone to reduce pressure and promote natural healing, without any biologic intervention.

• Intraosseous Bioplasty: In addition to decompression, biologic materials such as stem cells, PRP, or bone matrix are injected into the affected area. These materials actively promote bone repair and regeneration.

2. Healing Potential

Bioplasty provides enhanced and more rapid tissue healing through the use of biologic agents. This results in more effective pain control and better long-term outcomes.

3. Indications

Both methods are used to treat bone marrow lesions and early-stage avascular necrosis. However, bioplasty offers greater advantages in younger and more active patients where preserving the joint cartilage is critical.

4. Innovative Approach

Intraosseous Bioplasty is considered a modern, regenerative upgrade of core decompression. It integrates traditional orthopedic techniques with biotechnology, enhancing the success rate and clinical benefit.

Frequently Asked Questions (FAQ) About Intraosseous Bioplasty

1. What exactly does Intraosseous Bioplasty do?

It targets and repairs damaged bone beneath the cartilage to reduce pain and maintain joint health.

2. What conditions is it used for?

It is commonly used for bone marrow edema, subchondral cysts, and early-stage avascular necrosis (especially in the femoral head).

3. Is this considered a surgery?

No, it is a minimally invasive procedure that usually requires only a small incision and no stitches.

4. What biologic materials are used?

Commonly used materials include bone marrow aspirate concentrate (BMAC), PRP (platelet-rich plasma), and demineralized bone matrix (DBM).

5. How long does the procedure take?

The procedure typically takes 30 to 60 minutes.

6. Is hospitalization required?

Most patients are discharged the same day. It is often performed as an outpatient procedure.

7. Will I be able to walk afterward?

Weight-bearing is often limited for a few days. Most patients return to full weight-bearing in 4–6 weeks.

8. When can I return to sports?

Depending on individual healing, patients can usually return to low-impact sports within 2–3 months.

9. Will the pain go away completely?

Significant pain relief is expected. Full results usually become apparent within 3–6 months.

10. Can it prevent the need for joint replacement surgery?

When applied early, it may prevent bone collapse and delay or even eliminate the need for procedures like hip replacement.

Conclusion

Intraosseous Bioplasty is an effective biologic treatment option, particularly for bone marrow lesions and early-stage avascular necrosis beneath the joint cartilage. By combining the principles of core decompression with regenerative medicine, this innovative technique offers pain relief and accelerated healing while preserving joint integrity.

Its minimally invasive nature, shorter recovery time, and potential for customized treatment make it an especially appealing option for active individuals.

With proper patient selection and expert application, Intraosseous Bioplasty can serve as a non-surgical alternative for many individuals who might otherwise require major joint surgery.