PRP and BMC Delay the Need for Knee Replacement

By /

delaying a knee replacement

One of the hopes of orthobiologics is that they can help younger patients push a knee replacement out to an older age. Why is that critical? Let’s dive in.

Knee Replacement and Age

A knee replacement is the amputation of the knee joint and insertion of a prosthesis. That’s as big a surgery as it sounds. However, an even bigger surgery is the second knee replacement. Why?

First knee replacement surgeries are 60-90 minute procedures. However, the second knee replacement is a 3-4 hour marathon. The difference is that it’s harder to safely remove the original prosthesis and then insert a second one.

Because of this, most surgeons want a “one and done”. Given that a knee replacement prosthesis lasts about 10-20 years (less if you’re active and more if you’re not), the best age for a knee replacement is the mid to late 60s.

The Knee Replacement Doughnut Hole

So what happens when a patient in their 40s or 50s shows up to get a knee replacement? If the surgeon is really honest and has the patient’s best interest at heart, they will generally tell the patient that they’re too young and send them packing. I call this the “Knee Replacement Doughnut Hole”.

Can Orthobiologics Fill the Doughnut Hole?

Orthobiologics are injectates like PRP and stem cells. To learn more, see my video below:

A recent study may answer that question (1). Here PRP injections were used in more than 600 patients. PRP is made from the patient’s concentrated blood platelets. These platelets release healing growth factors. These injections in knee arthritis patients delayed the need for a knee replacement by a median time of more than 5 years!

Our experience also shows, that in patients with more severe osteoarthritis, bone marrow concentrate (BMC or a same-day bone marrow stem cell procedure) can delay the need for a knee replacement. So while PRP helps patients with mild arthritis fill that doughnut hole, for more severe bone on bone patients, BMC can help more severe patients.

Can Orthobiologics Prevent the Need for a Knee Replacement?

While PRP helped patients delay the need for a knee replacement, can orthobiologics get rid of the need altogether? We have patients that are 10+ years plus out from a BMC procedure and who have never had a knee replacement. More importantly, a recently published study out of France shows that 4 in 5 patients who got advanced BMC injections were able to avoid a knee replacement at 15 years post-injection (2).

The upshot? You really don’t ever want to get two knee replacements. Hence, a great use for orthobiologics is filling that doughnut hole for young knee arthritis patients in their 40s and 50s. Based on the published data, many patients may be able to push the need for that big surgery to a more appropriate age. In addition, using BMC, many patients could be able to avoid the need for a knee replacement long-term.



(1) Sánchez M, Jorquera C, Sánchez P, Beitia M, García-Cano B, Guadilla J, Delgado D. Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis. Int Orthop. 2020 Jul 3. doi: 10.1007/s00264-020-04669-9. Epub ahead of print. PMID: 32621139.

(2) Hernigou P, Delambre J, Quiennec S, Poignard A. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up. Int Orthop. 2020 Apr 23. doi: 10.1007/s00264-020-04571-4. Epub ahead of print. PMID: 32322943.

Get health and wellness information from a trusted source.

By submitting the form, you are agreeing that you read and consent to our Privacy Policy. We may also contact you via email, phone, and other electronic means to communicate information about our products and services. We do not sell, or share your information to third party vendors.

Category: Uncategorized

Leave a Reply

Your email address will not be published. Required fields are marked *

3 thoughts on “PRP and BMC Delay the Need for Knee Replacement

  1. Linda Custodio

    I’d like to challenge your assertion that the best age for a knee replacement is mid to late 60’s. I’m an active martial artist, age 73, who’s been working with a Regenexx doctor in Oregon since age 69 to postpone knee replacement through BMC and PRP. I come from a long lived family, and if I had gotten the knee replacement that my local physician wanted in 2016, I’d already be well on my way to the second! In 2015 I was told I have bone on bone osteoarthritis.
    Perhaps it would be more realistic to base the optimal timing for knee replacement on life expectancy? I’m hoping for at least another 2+ decades, as much of that as possible working out in and teaching tae kwon do. I’ve stopped running and focus on walking 2-3 miles per day (more weekends since I work full time M-F) and pre covid I trained in or taught martial arts 3-5 times per week.
    Please don’t get too caught up on age rather than life expectancy or activity levels.
    Otherwise love your blog and extremely grateful that I found Regenexx and the terrific docs at Columbia Pain Management!

    1. Chris Centeno, MD Post author

      Linda, great that you have a long life expectancy in your genes! Great to hear that you’ve been successful in putting off the replacement, as your right, with a life expectancy into the 90s, the best age would be much later.

  2. Dane

    I read that PRP study and noticed a few interesting things. They were using pretty weak PRP, only about 1.5-2.5x over baseline. One of their conclusions was that PRP was less effective in older patients, but could it be because of their low platelet concentration? They also found that multiple injections and injection into the subchondral bone was more helpful for delaying knee replacement, which is good to know, but why would they compromise it with such weak PRP?

Is Regenexx Right For You?

Request a free Regenexx Info Packet


Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar


Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog


9035 Wadsworth Pkwy #1000
Westminster, CO 80021


Copyright © Regenexx 2020. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.