PRP or Stem Cells for Knee Arthritis. What the Trials and the British Orthopaedic Association Say
Almost nothing sold as a stem cell injection contains many stem cells, and the British Orthopaedic Association calls the term misleading. In the only randomised trial comparing them directly, bone marrow concentrate andPRP were equivalent at 12 months. Cell therapies in London cost from £2,800 to £4,995 per joint against £780to £950 for PRP, on thinner evidence.
Key points
The British Orthopaedic Association’s 2022 information document states that point-of-care cell therapiescontain fewer than 0.001 to 0.005 percent mesenchymal stromal cells, that bone marrow concentrate hasfewer than 1 in 1,000 cells considered MSCs and almost none that are true stem cells, and that there is noevidence any of them form new tissue.
A 2020 randomised trial in the Orthopaedic Journal of Sports Medicine randomised 90 patients withgrade 1 to 3 knee osteoarthritis to a single injection of bone marrow concentrate or PRP and found bothimproved WOMAC and IKDC scores from 1 month, sustained to 12 months, with no difference betweenthem at any point.
A 2023 meta-analysis in Arthroscopy of 27 Level I studies, covering 1,042 PRP patients, 226 bone marrowconcentrate patients and 1,128 hyaluronic acid patients, found both PRP and bone marrow concentrategave better WOMAC, pain and IKDC scores than hyaluronic acid.
The BOA notes that a study of 896 US stem cell clinics found 95 percent of their websites contained atleast one statement of misinformation, and that a UK clinic was criticised by the Advertising StandardsAuthority for implying permanent pain relief.
If you have been quoted for a stem cell treatment and want a second view, message us on WhatsApp or email team@thewellnesslondon.com and a doctor will tell you what the evidence supports for your knee.
What is actually in a stem cell injection
The products sold as stem cell treatments for joints fall into 3 groups, and none is what the name implies.Bone marrow aspirate concentrate, usually shortened to BMAC, is bone marrow drawn from the pelvis, spun toconcentrate the cells, and injected the same day. Microfragmented fat, sold under names such as Lipogems, isliposuctioned fat broken into small fragments and injected. Stromal vascular fraction is fat processed furtherto separate its cells. All 3 are point-of-care products, meaning they go from the patient back into the patient inone visit.
The British Orthopaedic Association’s information document, adopted by its Council in February 2022 andwritten with Versus Arthritis, is direct about what these contain. Point-of-care preparations hold fewer than0.001 to 0.005 percent mesenchymal stromal cells. In bone marrow concentrate fewer than 1 in 1,000 cells areconsidered MSCs and almost none are true stem cells. In microfragmented fat fewer than 1 in 100 cells areMSCs. The BOA’s view is that using the term stem cells may be misleading and liable to confuse people intosupposing the treatment has advantages proven in other areas of medicine, and that there is no medicalevidence any of these products result in structural improvement or new cartilage. Cultured stem cells, grownin a laboratory over weeks, are a different product with different regulation, and are not what a same-day clinicinjects.
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What the head to head trial found
Only one randomised trial has compared bone marrow concentrate directly with PRP. Published in theOrthopaedic Journal of Sports Medicine in 2020, it randomised 90 patients aged 18 to 80 with grade 1 to 3knee osteoarthritis to a single injection of either product. To keep patients blind, the PRP group also had asham bone marrow aspiration from the pelvis and the bone marrow group also had a sham blood draw. Bothgroups improved significantly on WOMAC and IKDC scores from 1 month, and the improvement held to 12months. There was no difference between bone marrow concentrate and PRP at any point.
A 2021 trial of 175 patients randomised to bone marrow concentrate, PRP or hyaluronic acid reported thatbone marrow concentrate could be better up to 12 months, and said in the same sentence that the differencefrom PRP was not statistically significant. A 2017 single-blind trial in the American Journal of Sports Medicineinjected bone marrow concentrate into one knee and saline into the other in patients with bilateral arthritis andfound both knees improved with no difference between them. The 2023 Arthroscopy meta-analysis pooled 27Level I studies and found PRP and bone marrow concentrate both beat hyaluronic acid, with 1,042 PRPpatients against 226 bone marrow patients, which is a measure of how much thinner the cell therapy evidenceis. The BOA’s summary is that there have been very few trials of concentrated bone marrow and they reportconflicting results.
Send your knee imaging on WhatsApp and a doctor will tell you whether your grade of disease matches thepatients in these trials.
What the cell therapies do well
Fairness requires saying where the cell therapies have a case. Bone marrow concentrate carries more cellsand more protein than PRP, and laboratory work suggests it releases a broader range of anti-inflammatorysignals. A 4-year series of 37 knees with grade 3 to 4 disease in Scientific Reports reported sustainedimprovement, which is longer follow up than most PRP series in advanced disease. Cultured mesenchymalstromal cells, which are almost pure MSCs grown over weeks, have small trials reporting symptomimprovement and some early signals on cartilage quality, though the BOA notes most report only 1-yearoutcomes.
For a patient with grade 3 to 4 disease who has had a good response to PRP that faded, who is not yetsurgical, and who understands they are paying for a product with a handful of trials rather than dozens, bonemarrow concentrate is a defensible next step, and a surgeon-led clinic that offers it with a harvest underproper anaesthesia and imaging is the right setting. What is not defensible is offering it first, calling it stemcells, or promising regeneration.
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How they are regulated in the UK
Point-of-care cell therapies sit in a regulatory space the BOA describes as under review by the MHRA.Products that are minimally manipulated and returned to the same patient in one procedure are treateddifferently from cultured cells, which are advanced therapy medicinal products requiring a licence. Anythinginvolving stored or processed human tissue falls under the Human Tissue Authority. PRP for a medical purposeis treated by the MHRA as an unlicensed medicine that doctors may prepare for their own named patients, andNICE has guidance for its use in the knee. The BOA notes PRP is the one orthobiologic available on the NHS incertain circumstances.
For the patient the practical difference is that every UK-registered doctor is bound by GMC guidance onconsent, which in this context means telling you whether a treatment is new or experimental, what theevidence is, and any conflict of interest the doctor or clinic has. A clinic selling a same-day product as stemcells, without saying how few stem cells it contains or that the BOA considers the term misleading, is failingthat test whatever its price.
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Six questions before paying for a stem cell injection
Take these to whichever clinic you see, including ours.
What exactly is in the product, and what proportion of the cells are mesenchymal stromal cells. The BOAfigure is fewer than 1 in 1,000 for bone marrow concentrate.
Which randomised trial shows this product outperforming PRP for my grade of arthritis. The only directtrial found them equivalent.
Is the clinic claiming the treatment regenerates cartilage, and if so on what evidence, since the BOA saysthere is none.
Who performs the harvest, under what anaesthesia and imaging, and what are the harvest-sitecomplications.
What is the itemised price, and what does the same clinic charge for PRP.
Has the clinic ever told anyone the cheaper treatment was the right one.
Our doctors put it this way. If a clinic calls it stem cells, ask how many. If it says regeneration, ask for thescan. If it costs 4 times what PRP costs, ask which trial says it works 4 times better. The honest answer toall three is the same, and it is why we offer PRP first.
Message us on WhatsApp with your grade of arthritis, any quote you have been given, and any imaging, and adoctor will give you a straight answer.
What PRP does not do either
PRP is not the answer to every criticism of cell therapies. It does not regrow cartilage, and the BOA applies thesame finding to it, that there is no evidence PRP restores cartilage or slows progression. It failed againstplacebo in the 288-patient JAMA trial and helped 90 late-stage patients in the 2026 trial, and NICE calls itsevidence limited in quality. Its advantage over the cell therapies is not that it works better. It is that it works aswell in the only direct comparison, has dozens of trials rather than a handful, requires a blood draw rather thana bone marrow harvest, and costs a fraction of the price. PRP is not routinely commissioned by the NHS andprivate medical insurance rarely covers it.
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What each treatment costs in London
Cell therapies sit at the top of the market. Microfragmented fat injections are listed in London from £4,995 forthe first joint and £1,000 for each joint after. Bone marrow concentrate and related cell products are listedfrom £2,800 to £3,000 for a single injection, and UK prices are generally reported at £2,000 to £5,000 persession. The same London clinics list PRP from £950 for a single injection. Specialist central London clinicscommonly charge from around £780 to £900 or more per image guided PRP injection including assessment.
The reframing is the one the trial makes for you. In the only randomised comparison, bone marrow concentrateand PRP were equivalent at 12 months. A treatment that performs the same at 3 to 6 times the price, with aharvest from the pelvis instead of a blood draw, is not a better option. It is the same result bought expensively,and the money saved buys a second course of PRP, imaging, and a surgical opinion if the first course does nothold.
Care at The London PRP Clinic by The Wellness is doctor-led and priced below flagship central London rates,with your exact figure confirmed at the free suitability review once a doctor has seen your imaging.
Ask about the cost for your knee on WhatsApp and we will explain what the review covers.
The free suitability review
Every enquiry here starts with a free, doctor-led suitability review rather than a booking. A GMC-registereddoctor assesses you and gives one of two answers. Either you are approved for treatment, with a clear planand realistic expectations drawn from the trials rather than the marketing, or you are not approved, with anhonest explanation of what would serve you better, which may in some advanced cases be a cell therapy at asurgeon-led clinic or a surgical opinion, and we will say so.
We decline a meaningful share of the people who enquire. That is deliberate. A clinic that approves everyone isoptimising for bookings, not outcomes.
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Why people choose The London PRP Clinic by The Wellness
An 87 percent patient success rate across treatments.
More than 187 five star reviews.
Every treatment performed by a GMC-registered doctor.
100 supervised treatments completed by every clinician before they treat a patient here unsupervised.
A 32 percent average density increase reported in our hair restoration programme.
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Frequently asked questions
Are stem cell injections better than PRP for knee arthritis
Not in the evidence. The only randomised trial comparing bone marrow concentrate with PRP found themequivalent at 12 months in 90 patients. A 2023 meta-analysis found both beat hyaluronic acid, with 5 times asmany PRP patients studied. Cell therapies cost 3 to 6 times more for the same result.
Do stem cell knee injections actually contain stem cells
Very few. The British Orthopaedic Association states point-of-care products contain fewer than 0.001 to 0.005percent mesenchymal stromal cells, that fewer than 1 in 1,000 cells in bone marrow concentrate are MSCs,and that the term stem cells may be misleading.
Can stem cells regrow knee cartilage
No available treatment has been shown to. The British Orthopaedic Association, NICE, OARSI and theAmerican College of Rheumatology all find no evidence that orthobiologic injections, including cell therapiesand PRP, create new cartilage or slow osteoarthritis. Any clinic claiming regeneration should be asked for theimaging.
What is BMAC and how does it compare to PRP
Bone marrow aspirate concentrate is marrow drawn from the pelvis, spun and injected the same day. It carriesmore cells than PRP but very few stem cells. In the one head to head trial it matched PRP at 12 months. Itrequires a bone marrow harvest and costs from £2,800 to £3,000 in London against £780 to £950 for PRP.
Is Lipogems better than PRP
There are no high quality trials of microfragmented fat products against PRP or placebo, according to theBritish Orthopaedic Association, only lower quality studies reporting symptom improvement. It is listed inLondon from £4,995 per joint. PRP has dozens of randomised trials and costs a fraction of that.
Are stem cell injections regulated in the UK
Same-day cell products sit in a space the British Orthopaedic Association describes as under MHRA review,cultured cells need a licence, and human tissue handling falls under the Human Tissue Authority. All UKdoctors must tell you whether a treatment is new or experimental and any conflict of interest under GMCconsent guidance.
message us on WhatsApp or email team@thewellnesslondon.com
References
British Orthopaedic Association, 2022. Injectable orthobiologic treatments for osteoarthritis, informationdocument adopted by BOA Council in February 2022. https://www.boa.ac.uk/static/ebc80dba-725d-4089-8f0786bf6e427fc7/BOA-Information-Document-Injectable-Orthobiologic-Treatments-for-Osteoarthritis.pdf
Orthopaedic Journal of Sports Medicine, 2020. Anz et al. Bone marrow aspirate concentrate is equivalentto platelet-rich plasma for the treatment of knee osteoarthritis at 1 year, a prospective randomised trial of90 patients. https://pmc.ncbi.nlm.nih.gov/articles/PMC7029538/
Arthroscopy, 2023. Patients with knee osteoarthritis who receive platelet-rich plasma or bone marrowaspirate concentrate injections have better outcomes than patients who receive hyaluronic acid, asystematic review and meta-analysis of 27 Level I studies. https://pubmed.ncbi.nlm.nih.gov/36913992/
Medicina, 2021. Dulic et al. Bone marrow aspirate concentrate versus platelet rich plasma or hyaluronicacid for the treatment of knee osteoarthritis, a randomised trial of 175 patients.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623697/
Scientific Reports, 2024. Pabinger et al. Intra-articular injection of bone marrow aspirate concentrate inKellgren Lawrence grade 3 and 4 knee osteoarthritis, 4 year results of 37 knees.https://www.nature.com/articles/s41598-024-51410-2
JAMA, 2021. Bennell et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain andmedial tibial cartilage volume in patients with knee osteoarthritis, the RESTORE randomised clinical trial.https://pubmed.ncbi.nlm.nih.gov/34812863/
Journal of Orthopaedic Surgery and Research, 2026. Intra-articular platelet-rich plasma demonstratessuperior clinical and serum biomarker outcomes compared with corticosteroids and NSAIDs in late-stageknee osteoarthritis, a randomised controlled trial. https://link.springer.com/article/10.1186/s13018-026-07013-w
NICE, 2019. Platelet-rich plasma injections for knee osteoarthritis, interventional procedures guidanceIPG637. https://www.nice.org.uk/guidance/ipg637/chapter/1-Recommendations
Published London clinic price lists for bone marrow concentrate, microfragmented fat and PRP injections,accessed September 2026, and UK BMAC price range reported at https://pabau.com/blog/bmac-injection/
Central London clinic price lists for image guided PRP and steroid injections, accessed September 2026.
This article is for general information and does not replace a medical assessment. Speak to one of our doctorsbefore deciding on any injection for your knee.
Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The London PRP Clinic byThe Wellness. Last updated September 2026.
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