Intraosseous PRP injects platelet rich plasma into the bone beneath the cartilage as well as the joint, because damaged subchondral bone drives osteoarthritis. A 2025 double-blind trial of 86 patients with severe knee osteoarthritis found adding bone injections to joint injections gave greater improvement at 3, 6 and 12 months.The evidence is promising, small and partly industry-linked.
Key points
A 2025 double-blind multicentre randomised trial in the Journal of Clinical Medicine gave 86 patients with Kellgren Lawrence grade 3 to 4 knee osteoarthritis either intraosseous PRP or intraosseous saline, both followed by 3 intra-articular PRP injections, and found the bone injection group had significantly greater improvement in nearly all KOOS and WOMAC domains at 3, 6 and 12 months with no serious adverse events.
A June 2026 review in EFORT Open Reviews synthesised randomised, observational and laboratory evidence to May 2025 and concluded intraosseous PRP, particularly combined with intra-articular PRP,improves pain, function and joint structure in moderate to severe knee and hip osteoarthritis, while callingfor standardised long term trials.
The technique was first described in 2014, and a 79-patient office-based series of grade 3 to 4 knees treated under local anaesthetic reported improvement in KOOS scores after 3 weekly sessions of 1 joint and 2 bone injections.
Standard intra-articular PRP failed against placebo in a 288-patient JAMA trial and helped 90 late stage patients in a 2026 trial, so intraosseous PRP is being tested in the group where standard PRP is leastreliable.
If you have advanced knee or hip arthritis and have read about bone injections, message us on WhatsApp or email team@thewellnesslondon.com and a doctor will tell you honestly where the evidence stands for your joint.
Why anyone would inject bone rather than joint
Osteoarthritis was long thought of as a cartilage disease. Cartilage wears, bone rubs, the joint hurts. Thepicture that has emerged over the last 15 years is that the bone beneath the cartilage, the subchondral bone,is not a passive floor but an active participant. It becomes stiffer and more porous, develops areas of oedemavisible on MRI as bone marrow lesions, and grows new blood vessels and nerves into the base of the cartilage.Bone marrow lesions are one of the strongest imaging predictors of pain in osteoarthritis and of how fast the joint will deteriorate.
A joint injection bathes the cartilage surface and the synovial lining but does not reach that bone. Intraosseousinjection places PRP directly into the tibial plateau and femoral condyle, or into the femoral head andacetabulum at the hip, through a needle passed into the bone under imaging guidance. The idea is to treat the whole osteochondral unit rather than one layer of it. The technique was first described in 2014 by a group in Spain, and for a decade the evidence was case series. That changed in 2025.
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What the 2025 trial found and what it did not
The trial that moved intraosseous PRP from theory towards evidence was published in the Journal of ClinicalMedicine in November 2025. It was a prospective, double-blind, multicentre randomised trial of 86 patients with Kellgren Lawrence grade 3 to 4 knee osteoarthritis, which is the severe group where standard PRP is leastreliable. Everyone received 3 intra-articular injections of PRP. Half also received intraosseous PRP into the bone, and half received intraosseous saline. Because both groups had needles placed into the bone, the trialisolated the effect of what was injected rather than the effect of the procedure.
At 3, 6 and 12 months, the group that had PRP in the bone showed significantly greater improvement in nearlyall domains of the KOOS and WOMAC scales, covering pain, symptoms, function and quality of life. No serious adverse events were recorded in either group. The authors concluded that treating the subchondral bone directly has a significant and clinically relevant effect in severe disease.
The limits are worth stating as plainly as the result. It is one trial of 86 patients, so the estimate of benefit isimprecise. The PRP used was a specific proprietary preparation, and several authors are affiliated with thecompany that makes it, which is disclosed in the paper. Follow up was 1 year. And the comparison shows bone PRP beats bone saline when both have joint PRP, not that the combined procedure beats a joint injection alone by a known margin.
Send your knee or hip MRI report on WhatsApp and a doctor will tell you whether the bone changes on yourscan are the ones this treatment targets.
What the wider evidence says
The June 2026 review in EFORT Open Reviews, from the orthopaedic group at Instituto Cugat in Barcelona, isthe most complete summary. It gathered randomised, observational and laboratory evidence published to May2025 and concluded that intraosseous PRP, particularly combined with intra-articular PRP, improves pain,function and imaging measures of joint structure in moderate to severe osteoarthritis of the knee and hip. Itskeywords included bone marrow lesions and joint preservation, which is the clinical target. The authors wereequally clear that standardised long term trials are still needed before the technique becomes routine.
Smaller studies point the same way. A 2022 single-blind randomised trial in Injury compared a single joint injection with and without bone injections. A 2018 study in Clinical Rheumatology compared hyaluronic acid,joint PRP, and combined joint and bone PRP. A 2021 study in International Orthopaedics followed intraosseous PRP for bone marrow lesions of the knee for a year. A 2022 systematic review in the Indian Journal of Orthopaedics could pool only a limited meta-analysis, which is the honest measure of how young this literature is. The 79-patient office series of grade 3 to 4 knees, treated under local anaesthetic with 1 joint and 2 bone injections weekly for 3 weeks, reported improved KOOS scores, and it was also authored by the group linked to the proprietary product.
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What the procedure involves and who it might suit
Intraosseous PRP is more than a joint injection. Under ultrasound or X-ray guidance, and after local anaesthetic infiltrated down to the bone, a needle is passed through the cortex into the cancellous bone of thetibial plateau and the femoral condyle, and PRP is injected into each. It is then combined with a standard joint injection, and the published protocols repeat the joint injection weekly for 3 sessions. The office-based series used a local anaesthetic technique without sedation, though some centres offer sedation. Bone injection isuncomfortable in a way a joint injection is not, and the leg is usually sore for several days afterwards.
The candidate the evidence describes is specific. Grade 3 to 4 knee or hip osteoarthritis, bone marrow lesionson MRI, symptoms despite standard treatment, and either not yet a surgical candidate or wanting to defersurgery for a defined reason. It is not a treatment for early arthritis, where a joint injection alone has the evidence, and it is not a treatment for the patient without bone changes on imaging, since there is nothing inthe bone to treat. A clinic offering it without an MRI has skipped the step that decides whether it is indicated.
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Five questions to ask before agreeing to a bone injection
These apply whichever clinic you see, including ours.
Does my MRI show bone marrow lesions or subchondral changes, and can the doctor show me where the injection would go.
What grade is my arthritis, and does it match the grade 3 to 4 patients in the 2025 trial.
Which PRP preparation will be used in the bone, and how does it compare with the proprietary product inthe trial.
What anaesthetic is used, who performs the bone puncture, and what imaging guides it.
What is the plan if the joint improves but the bone injection does not, and what is the surgical pathway if neither does.
If the answer to the first question is that a scan is not needed, the clinic is selling a procedure rather than treating a finding.
Our doctors put it this way. Intraosseous PRP is the first PRP technique in a decade with a real idea behind it and a real trial to back it. It is also 86 patients and 1 year, and anyone presenting it as proven is a year ortwo ahead of the evidence.
Message us on WhatsApp with your grade of arthritis, your MRI findings if known, and what you have alreadytried, and a doctor will give you a straight answer.
What intraosseous PRP does not do
Intraosseous PRP does not regrow cartilage in any proven way, and it does not replace joint replacement in aknee or hip that has reached the point of surgery. It has 1 double-blind trial of 86 patients with 1 year of follow up, industry involvement in most of the published work, and no head to head trial against a joint injection alone or against surgery. It is more uncomfortable and more invasive than a joint injection, with the small risks that follow from passing a needle into bone. It is not commissioned by the NHS, is not covered by private medical insurance, and is offered by very few clinics in the UK, which is a reason for caution rather than a mark ofexclusivity.
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What intraosseous PRP costs, and why the figure needs confirming
Specialist central London clinics commonly charge from around £780 to £900 or more per image guided joint PRP injection including assessment, with a course of 2 to 3 taking a plan past £2,000. Intraosseous treatment adds bone punctures, local anaesthetic to the bone, longer imaging and a 3 session protocol to that, and there is no established market price in London for a doctor to anchor against. Any clinic quoting a single flat figure without describing what is included should be asked to itemise it.
The reframing is the one that applies to every advanced arthritis decision. The relevant comparison is not the cost of the injections but the cost of a year, whether that year is spent waiting for surgery in pain, deferring it with a treatment that has some evidence, or paying for one that has none. Intraosseous PRP sits in the middlecategory, and should be priced and explained as such.
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 reviewed your MRI anddecided whether the bone is a target worth treating.
Ask about the cost for your joint 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, reviews your MRI, and gives one of two answers. Either you are approved for treatment,with a clear plan, a stated protocol and realistic expectations drawn from the 2025 trial rather than from marketing, or you are not approved, with an honest explanation of what would serve you better, whether that isa standard joint injection, a different treatment, or a surgical opinion.
We decline a meaningful share of the people who enquire. For intraosseous PRP that share is high, because the evidence describes a narrow group and we hold to it.
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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
What is intraosseous PRP
An injection of platelet rich plasma into the subchondral bone beneath the cartilage, usually the tibial plateauand femoral condyle at the knee, combined with a standard joint injection. It targets the bone changes and bone marrow lesions that drive pain and progression in osteoarthritis, and was first described in 2014.
Does intraosseous PRP work
A 2025 double-blind trial of 86 patients with grade 3 to 4 knee osteoarthritis found adding PRP bone injections to joint injections gave greater improvement in pain, function and quality of life at 3, 6 and 12 months than adding saline. A 2026 review agreed for knee and hip. It is one trial, and longer trials are needed.
Is intraosseous PRP painful
More than a joint injection. The needle passes through the bone surface under local anaesthetic, and the leg is usually sore for several days afterwards. Published series used a local anaesthetic technique in an officesetting without sedation, and reported no serious adverse events.
Who is intraosseous PRP for
Grade 3 to 4 knee or hip osteoarthritis with bone marrow lesions or subchondral changes on MRI, symptomsdespite standard treatment, and a reason to defer surgery. It is not for early arthritis, where a joint injection alone has the evidence, or for a joint without bone changes on imaging.
How many intraosseous PRP injections are needed
The published protocols use 3 weekly sessions, each with a joint injection and, in the office series, 2 bone injections. The 2025 trial gave the bone injection once alongside 3 joint injections. There is no evidence for repeat courses yet, and a clinic proposing one should be asked what supports it.
Is intraosseous PRP available on the NHS
No. It is not commissioned by the NHS, private medical insurance does not cover it, and very few UK clinics offer it. Almost all patients who have it do so as a self-pay treatment after a specialist assessment with MRI.
References
Journal of Clinical Medicine, 2025. Sánchez Santiuste et al. Plasma rich in growth factors versus saline intraosseous infiltrations combined with intra-articular PRGF in severe knee osteoarthritis, a prospectivedouble-blind multicentric randomised controlled trial with 1-year follow-up.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12653810/
EFORT Open Reviews, 2026. García Bordes et al. Intraosseous platelet-rich plasma for osteoarthritis, acomprehensive review. https://pubmed.ncbi.nlm.nih.gov/42227238/
Office-based intraosseous infiltrations of PRGF as an effective treatment for knee osteoarthritis, aretrospective observational clinical study of 79 patients.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342655/
BioMed Research International, 2016. Sánchez et al. Combination of intra-articular and intraosseous injections of platelet rich plasma for severe knee osteoarthritis, a pilot study.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947638/
Indian Journal of Orthopaedics, 2022. Intraosseous infiltration of platelet-rich plasma for knee osteoarthritis, a systematic review of literature and limited meta-analysis.https://link.springer.com/article/10.1007/s43465-022-00737-x
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 bio marker 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
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 doctors before deciding whether intraosseous PRP is right for your joint.
