Fat Tissue Injection Shows Promise for Severe Knee Arthritis
Jay Panchal, Gerard Malanga, Mitchell Sheinkop · American Journal of Orthopedics · 2018
17 Patients Avoid Knee Replacement with Single Injection
This study followed 17 patients who had severe knee osteoarthritis. All were candidates for total knee replacement surgery but wanted to try a different approach first. Researchers injected their knees with Lipogems®—processed fat tissue taken from the patients' own bodies. The fat tissue contains special healing cells that may help damaged joints recover.
All 26 knees treated (some patients had both knees done) had advanced arthritis. This was confirmed by X-rays showing significant joint damage, rated as Kellgren-Lawrence grade 3 or 4 (the most severe levels). Every patient had already tried standard treatments like medications, physical therapy, and other injections without adequate relief.
Pain Scores Drop Significantly Within Six Weeks
Patients reported meaningful pain reduction that began early and continued throughout the study. Using a standard pain rating scale, researchers tracked improvements at six weeks, six months, and twelve months after treatment.
The results showed:
Substantial pain relief starting at the six-week mark
Continued improvement through the six-month follow-up
Benefits maintained at one year after the procedure
These improvements were statistically significant, meaning they were unlikely to occur by chance alone.
Knee Function and Daily Activities Improve at All Check-Ins
Beyond pain relief, researchers measured how well patients could use their knees and perform everyday tasks. They used two validated assessment tools: the Knee Society Score (which rates knee function on a 100-point scale) and the Lower Extremity Activity Scale.
Both measures showed meaningful improvement at every follow-up visit. Patients reported better ability to walk, climb stairs, and complete daily activities. This functional improvement matched what patients typically experience after traditional knee replacement surgery.
Minimally Invasive Procedure Uses Patient's Own Fat Tissue
The Lipogems® procedure works differently from knee replacement surgery. Doctors first collect fat tissue from the patient's body using gentle suction. This tissue is then processed in a closed system that breaks it into tiny clusters—about 500 microns in size—while preserving the natural healing environment around blood vessels.
The processed tissue contains:
Pericytes (cells that support blood vessel health and healing)
Mesenchymal stem cells (regenerative cells that can help repair damaged tissue)
Doctors then inject this material directly into the knee joint using ultrasound guidance. Patients avoid weight-bearing for 48 hours afterward and resume normal activities gradually.
No Serious Side Effects Reported During Year-Long Follow-Up
Safety was a key focus of this research. Throughout the entire study period, no serious adverse events occurred. This stands in contrast to total knee replacement, which carries risks including blood clots, infection, nerve damage, and the need for future revision surgery.
The study also noted that up to 20 percent of knee replacement patients continue experiencing pain after surgery. For younger patients especially, there are concerns about implants wearing out and requiring additional operations later in life.
Study Suggests Alternative for Patients Wanting to Delay Surgery
This research demonstrates that micro-fragmented fat tissue injection may offer a viable option for patients with severe knee arthritis who wish to avoid or postpone joint replacement. The procedure is minimally invasive, uses the patient's own tissue (eliminating rejection risk), and showed meaningful benefits lasting at least one year.
However, this was a relatively small study without a comparison group receiving a placebo treatment. Larger, controlled trials would help confirm these findings and identify which patients respond best to this approach.
For patients facing the decision between continued conservative care and knee replacement surgery, this treatment may represent a middle ground worth discussing with their physician.
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Source: Panchal et al., American Journal of Orthopedics, 2018.
Original Publication
Safety and Efficacy of Percutaneous Injection of Lipogems Micro-Fractured Adipose Tissue for Osteoarthritic Knees
Jay Panchal, Gerard Malanga, Mitchell Sheinkop · American Journal of Orthopedics · 2018
Knee osteoarthritis (OA) is a chronic disease affecting all demographics but is most prevalent in obese and elderly individuals, representing the fourth leading cause of disability worldwide. Current conservative treatments address symptoms without treating underlying causes, and total knee arthroplasty (TKA) is standard for advanced arthritis after conservative failure. However, patients often hesitate due to surgical complications, with up to 20% experiencing persistent post-operative pain. This IRB-approved study evaluated the safety and efficacy of autologous, micro-fractured, minimally manipulated adipose tissue injection for severe refractory knee OA. Seventeen subjects with 26 symptomatic knees (Kellgren-Lawrence grade 3 or 4) who were TKA candidates underwent the Lipogems procedure, which harvests adipose-derived stem cells while maintaining the perivascular niche containing pericytes. The procedure involves lipoaspiration, tissue processing, and intra-articular injection. Patients were evaluated using the numerical pain rating scale, Knee Society Score with functional component, and lower extremity activity scale at 6 weeks, 6 months, and 12 months post-injection. Results demonstrated significant improvements in pain and function lasting at least 12 months. This intervention may represent a viable nonsurgical treatment option to avoid knee joint replacement in patients with severe knee OA, offering an alternative with reduced morbidity compared to TKA.