What are Intraosseous Injections?
Intraosseous injections provide a new way to target advanced osteoarthritis. It’s s a promising new approach to interventional orthopedics offering a quick recovery and limited downtime. Often times when a joint is too damaged with degenerative disease, just injecting intraarticularly is not enough to improve function. Therefore targeting a key player in the pathophysiology of osteoarthritis, subchondral bone is injected in addition to the intraarticular environment.
How do you determine proper candidates for intraosseous injections?
MRI shows bone marrow edema lesions (BML) either affecting the medial, lateral or patella femoral joint compartment. These lesions mimic a fracture histologically and more strongly correlate to pain than cartilage thickness or synovial effusion. Studies show those with BML are up to 9x more likely to require arthroplasty.
Do you use it in your clinic and/or surgery center?
The procedure is often performed in an outpatient surgery center under light sedation under sterile conditions. A C-arm/fluoroscopy machine is utilized to ensure proper needle placement in correlation with MRI bone edema.
What indications is it used for?
In mild to moderate arthritis PRP may be sufficient to provide pain relief and return of function in active individuals. However, when the osteoarthritis is severe with Grade IV, PRP is often not strong enough. While Bone Marrow Concentrate may hold promise for more advanced arthritis, a new understanding of how arthritis and cartilage damage occurs, sheds light on a new key target; subchondral bone.
What regions are intraosseous injections used for?
Common areas include advanced knee, hip & shoulder arthritis
If using it, what results have been seen?
We have seen excellent results in our patients for over 2 years now. Many experience rapid relief, likely resulting from a decompressive effect of the needle penetrating bone releasing pressure buildup associated with osteoarthritis. Knees so far are the most common region treated in our group and show the best results with the fastest recovery, although patients have had notable relief in other regions. We also follow up or MRI’s and see improved bone edema on MRI.
Why are you excited that TOBI will be featuring intraosseous injections at TOBI this year?
I’m thrilled to share this valuable treatment option with the medical community. As physicians we need to offer a spectrum of options and determine which biologic therapy is indicated based on each individual case taking account physical activity goals, lifestyle, age and structural pathology etc. More often we are seeing patients with advanced arthritis but are too young for arthroplasty which is associated with poor outcomes under 60 years of age.
What’s exciting about this therapy?
Not only are we learning more about each autologous cell option & when and how to use them (white blood cells or red blood cells +/- in PRP or BMC preparation & varying aspiration techniques) but how to deliver the cells. Intrassoeous injections integrates the latest understanding of subchondral bone’s role in osteoarthritis.
Any research references?
Mikel Sanchez has published most of the clinical data and will be sharing results comparing Intraarticular PRP in mild to moderate and severe osteoarthritis with intraosseous PRP for severe osteoarthritis.
Who are the field leaders to learn this treatment from?
Several of our colleagues around the world are implementing intraosseous injections all with favorable feedback thus far. Most of them will be on faculty at TOBI in the intraosseous hands-on cadaver lab.