The Science and Evidence

Bone Marrow Injections Outperform Knee Replacements After 15 Years, Study Finds. How to Avoid Knee Replacement Even with “Bone on Bone” arthritis.

Mark Ayzenberg, MD, FAAOS

If you’re struggling with knee arthritis, you may think surgery is the only answer—especially when the pain starts interfering with your everyday life. But what if there was a less invasive option that could relieve your symptoms and help you delay—or even avoid—a knee replacement altogether? Read on to see the outcomes patients had 15 years out from having BMAC for one knee and knee replacement on the other knee.

That’s exactly what a growing number of patients are discovering with Bone Marrow Aspirate Concentrate (BMAC) injections.

What Is BMAC?

BMAC is a regenerative treatment that uses your own bone marrow—rich in healing cells and growth factors—to reduce pain and support tissue repair in the joint. When precisely injected into the subchondral bone (the layer just beneath your cartilage), BMAC has been shown to not only reduce symptoms, but also change the course of arthritis progression.

A Unique Study Comparing BMAC to Knee Replacement

In a remarkable 15-year study, French orthopedic surgeon Dr. Philippe Hernigou followed 140 patients with severe arthritis in both knees. Each patient had one knee replaced (total knee arthroplasty, or TKA) and received a BMAC injection into the other knee—all during the same procedure.

Here’s what they discovered over time:

Only 18% of BMAC-treated knees eventually needed a knee replacement—but that happened on average 10 years later.
Interestingly, a similar percentage of the replaced knees failed and required revision surgery—meaning they had to undergo a second knee replacement due to wear, loosening, or persistent pain.
In other words, BMAC held up just as well as surgery in terms of long-term durability, while avoiding the invasiveness of a joint replacement.

But maybe the most surprising result?

69% of patients said they preferred their BMAC-treated knee over the one that had been surgically replaced.

That’s not something you hear every day.

Why This Matters

While knee replacement can be life-changing for many people, it’s not a guaranteed fix. In fact, studies show that up to 1 in 3 patients are unhappy with their replaced knees—due to lingering pain, stiffness, or unnatural joint movement. It’s a major surgery, and recovery can take months.

By contrast, BMAC is minimally invasive, uses your body’s own biology, and may offer relief that lasts over a decade—with fewer risks and no implants to fail.

Is BMAC right for you and how can you avoid knee replacement surgery?

If you’ve been told you need a knee replacement but want to explore alternatives first, BMAC may be worth considering. When done properly, BMAC doesn’t just mask pain—it addresses the source.

Want to find out if you’re a candidate for BMAC? Schedule a consultation with Iron Mountain Orthopaedic Institute to learn more!