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What is stem cell therapy in orthopaedics
In orthopaedics, “stem cells” usually means the patient’s own cells from fat tissue or bone marrow. They are harvested during the same procedure, processed and injected into a joint, tendon or intervertebral disc.
These cells include mesenchymal stromal cells. Current evidence suggests they act mainly through signalling substances: they reduce inflammation and support tissue repair. How much the tissue recovers cannot be predicted in advance.
Embryonic and donor cells are not used in these procedures. Intravenous “stem cell infusions” for dozens of diseases have nothing to do with orthopaedic treatment.
At a glance
- Cell source: your own fat (MFAT, SVF) or bone marrow (BMAC)
- Procedure time: 1.5–3 hours, outpatient
- Anaesthesia: local, sometimes sedation
- Onset: usually after 4–12 weeks
- Assessment: after 3–6 months
- Cost: BMAC from €7,500, MFAT from €9,500 per area
MFAT, SVF, BMAC and culture-expanded cells
| Method | Source and processing | EU status | When it is discussed |
|---|---|---|---|
| MFAT (microfragmented fat) | Mini-liposuction, mechanical processing without enzymes | Allowed as minimally manipulated own tissue | Knee and hip osteoarthritis stages II–III, cartilage defects |
| SVF (stromal vascular fraction) | Cells isolated from fat with enzymes | Enzymatic processing can make the product an advanced therapy medicinal product (ATMP) | Limited, under the rules of the specific clinic |
| BMAC (bone marrow concentrate) | Aspiration from the iliac crest, centrifugation | Allowed as minimally manipulated own tissue | Osteoarthritis, femoral head necrosis, combined with surgery |
| Culture-expanded MSCs | Cells grown in a laboratory for several weeks | Advanced therapy medicinal product (ATMP), mainly clinical trials | Hardly used outside trials in the EU |
More on fat tissue at MFAT / Lipogems; comparison with PRP at stem cells or PRP.
Which conditions cell-based methods are used for
| Condition | What is known | Comment |
|---|---|---|
| Knee osteoarthritis stages II–III | Many patients report less pain, but high-quality studies are few | The most frequently discussed indication |
| Hip osteoarthritis | Limited evidence | Under X-ray or ultrasound guidance |
| Early femoral head necrosis | BMAC is used together with core decompression | The orthopaedic surgeon decides |
| Cartilage defects in younger patients | Used as an addition to surgical techniques | High-resolution MRI needed |
| Disc degeneration | Early studies, little evidence | Intradiscal injection only for strict indications |
In stage IV osteoarthritis with joint destruction and deformity, cell-based methods usually bring no meaningful effect — then joint replacement is discussed.
What studies show
A systematic review in the British Journal of Sports Medicine (2017) concluded that the quality of studies on cell injections for knee osteoarthritis is low and no firm conclusions on effectiveness can yet be drawn. In a placebo-controlled trial with BMAC in one knee and saline in the other, both knees improved without a significant difference.
So the honest position is: cell-based therapy is an option for selected patients when exercise, weight loss and simple injections no longer help and surgery is to be postponed. A result or “new cartilage” cannot be guaranteed. A “success rate” depends on how the clinic measures it — ask exactly how results were assessed.
How to tell an honest clinic from advertising
Normal
A decision based on MRI and examination, your own cells, injection under ultrasound or X-ray, an honest discussion of the chance of benefit and alternatives, a written plan and price.
Warning signs
Promises of a cure or “growing new cartilage”, guaranteed results, intravenous infusions for dozens of diseases, donor or embryonic cells, treatment without imaging.
What to ask the clinic
Which product is injected and how it is obtained, which approvals exist, how results are assessed, what happens if there is no effect and what risks the harvest carries.
We work with clinics in Germany, where cell-based procedures are subject to European and German medicines law. See also myths about stem cells.
How the procedure works
Selection by MRI
A clinic physician reviews your images and tests; the preliminary opinion follows within 1–3 business days of receiving the MRI.
Tissue harvest
Under local anaesthesia, a small amount of fat (usually from the abdomen) or bone marrow (from the iliac crest) is taken.
Processing
The tissue is processed in a sterile closed system during the same procedure.
Injection
The product is injected into the joint or injured area under ultrasound or X-ray guidance.
Home the same day
After a short observation you can leave. A trip to Munich usually takes 3–5 days, including a follow-up visit.
Recovery after the procedure
- Bruising and tenderness at the fat or bone-marrow harvest site may last 3–7 days; compression garments are sometimes worn.
- The joint may be swollen and sore for a few days; cold, rest and paracetamol help.
- Anti-inflammatory drugs are usually avoided for 2–4 weeks — the physician gives exact instructions.
- Load is increased gradually following an exercise plan; running and jumping usually not before 6–12 weeks.
- The result is assessed after 3–6 months by pain, function and, if needed, MRI.
Who cell-based methods are not suitable for and risks
Contraindications
Active infection, active or recent cancer, clotting disorders, pregnancy, severe general illness that makes tissue harvest risky.
Possible risks
Bruising, pain and swelling at the harvest site, rarely haematoma or infection. Joint swelling for a few days after the injection. The effect may be absent.
When surgery is needed
Stage IV osteoarthritis with deformity, a mechanically locked joint, a complete tendon rupture — cell-based methods do not replace surgery here.
How much does stem cell therapy cost in Germany
| Procedure | Guide price | Included |
|---|---|---|
| BMAC, one area | from €7,500 | Bone-marrow harvest, processing, guided injection |
| MFAT, one area | from €9,500 | Mini-liposuction, processing, guided injection |
| Two areas | from €11,000 | Individual protocol |
| Spine (intradiscal) | from €15,000 | Injection under X-ray or CT guidance |
Statutory insurers do not pay for these procedures and private insurers rarely do. Prices are lower in countries with less strict regulation, but what matters is which product is injected and who is responsible for it. The clinic states the exact cost after reviewing your MRI; see also cost of cell therapy in Germany.
Prices are approximate. Each clinic sets its own conditions and price: we send your request to several clinics and forward their offers so you can compare.
Scientific evidence
A review and a placebo-controlled trial of cell injections for knee osteoarthritis:
Frequently asked questions about stem cells
Find out whether cell therapy is right for you
Send your MRI and describe your diagnosis. The coordinator replies within 24 hours; a clinic physician gives a preliminary opinion in 1–3 business days.
Send MRI