Why Bone Marrow Concentrate May Work Better Than PRP for Advanced Arthritis

By Deborah Westergaard, MD | Pain Experts | Dallas–Plano

PRP Alone Often Isn’t Enough for More Advanced Cases.

If you’ve been told you have “moderate to severe arthritis,” that usually means the joint is pretty worn down. Doctors often use something called the Kellgren-Lawrence (KL) scale to grade arthritis from 1 to 4:

Grade 1–2: Mild arthritis (cartilage is thinning but still working).

Grade 3–4: Moderate to severe arthritis (cartilage is mostly gone, bone is showing changes).

For KL grade 1–2, platelet-rich plasma (PRP) can be very helpful. PRP comes from your own blood and is rich in growth factors that calm inflammation and help tissue heal.

But when arthritis advances to KL grade 3–4, the problem goes deeper. It’s not just about cartilage loss, the bone underneath the cartilage (called the subchondral bone) begins to fail. That bone normally feeds nutrients to the cartilage, like a pipeline. As it scars and stiffens, the “pipeline” shuts down.

That’s why PRP alone often isn’t enough for more advanced cases.

The Solution: Bone Marrow Concentrate (BMC)

Bone marrow concentrate (BMC) is different from PRP because it’s not just platelets. It also contains stem cells and other important building blocks that can help repair the foundation of the joint.

Here’s how it works:

Cartilage has no blood supply. When we’re young, cartilage gets nutrients from two places: synovial fluid (the natural joint lubricant) and the bone underneath.

As we age, the bone pipeline clogs. The bone beneath the cartilage becomes scarred, weak, and less able to support cartilage.

BMC “re-seeds” the bone. We take marrow from the back of your hip (where it’s healthiest), concentrate it, and place it directly into the weakened bone under the joint surface. This refreshes the nutrient pipeline and stabilizes the joint.

Dr. Philippe Hernigou, a well-known orthopedic researcher, found in clinical trials that patients with advanced knee arthritis who received BMC into the bone often delayed knee replacement surgery by 10–15 years, compared to just 1–2 years with PRP

Risks and Limitations

Not a magic bullet: BMC works best when arthritis is in the moderate to severe range (KL 3–4). Results can vary depending on age, weight, and overall health.

Risks: Bone marrow harvest can cause temporary soreness (10–20% of patients). Infection risk is very low (<1%). These risks are far less than joint replacement surgery.

FDA note: Both PRP and BMC are considered “off-label” for arthritis. That means they are safe and widely used, but not formally approved by the FDA for this condition.

Let's Keep You Moving

At Pain Experts in Dallas and Plano, we combine advanced imaging, precise cell processing, and careful cell counts to make sure your treatment is done with excellence and quality. Our goal is resilience, helping you keep moving and living well, without jumping straight to joint replacement.

If you’ve been told your arthritis is “too far gone” for simple injections, schedule a consultation. Bone marrow concentrate may be the option that transforms your joint health and keeps you active for years to come.

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