The BIOS Orthopedic Institute
Alberto J. Panero, D.O.
Regenerative Orthopedics Specialist & Sports Medicine Specialist located in Sacramento, CA
While the cartilage at articular surface of the joint has always been the primary focus of arthritis treatments, recent studies continue to highlight the importance of treating the bone underneath. This area, referred as the “subchondral bone”, bone underneath the cartilage can become inflamed and diseased. This bone inflammation is called subchondral edema, and because it increases the pressure inside of the bone, it can be quite painful. Furthermore, it sets a negative inflammatory cycle with the cartilage below it, leading to further breakdown of the joint.
With the advent of orthobiologics and interventional orthopedics, we can now treat the subchondral bone by performing intraosseous injections of PRP or BMC. Sometimes we have to use a bioactive scaffold like demineralized bone matrix (DBM) to help the bone heal.
There are now multiple studies that show that by treating the subchondral bone along with the cartilage can slow down the progression of arthritis, and prevent the need for joint replacement.
Our protocol at B.I.O.S is to do a series of treatments. For instance, in the case of knee arthritis that has subchondral edema or bony changes, we perform a series of 3 injections including PRP or BMC into the joint. At one of the visit, we will also perform an intra-osseous injection in to the site of bony pathology under x-ray guidance.
This injection can be painful while its happening, but quickly resolves after the injection is over. We protect the area by modifying your weight bearing for 5-7 days afterwards, and typically recommend using a compartment unloader brace for 4-6 weeks after the injection to help with healing.