Medically Reviewed by: Dr. Steven Sampson, DO & Dr. Danielle Aufiero, MD | The Orthohealing Center
Specialty: Regenerative Orthopedics & Sports Medicine

What are Intraosseous (IO) injections?

✨ In Simple Terms

Most joint injections go into the joint space. But many painful joint conditions actually start in the bone beneath the cartilage.

Intraosseous (IO) injections are different. They place healing cells from your own body directly into the bone under the joint surface—helping address pain at its source.

An intraosseous (IO) injection is an advanced, minimally invasive medical procedure that delivers orthobiologics—such as Platelet-Rich Plasma (PRP) or Bone Marrow Concentrate (BMC)—directly into the subchondral bone, just beneath the cartilage surface of a joint.

While traditional joint injections deliver medicine into the empty joint space (intra-articular), IO injections specifically target the deep bone damage, bone marrow lesions, and poor blood supply that drive severe arthritis progression. By addressing the damaged bone directly, IO therapy stimulates the body's natural healing process, alters dysfunctional cell signaling, and provides a regenerative alternative for patients facing total joint replacement.

What are the benefits of IO Injections?

This technique offers a less invasive, more natural approach to nourish and heal degenerative joints than do traditional medical interventions. With previously limited treatment options available, it also provides hope to severe arthritis sufferers. IO injections appeal to those who want to avoid the increased risk, downtime, and recovery time associated with surgery. As with all the Orthohealing Center's procedures, this modality is safely delivered on an outpatient basis; conversely, traditional knee and hip replacements require hospital stays. Furthermore, due to the finite nature of joint replacements, there are few alternatives available should the surgical approach fail; as an added benefit, IO injections do not exhaust any treatment options.

Feature Intraosseous (IO) Injections Traditional Joint Injections (Cortisone/HA) Total Joint Replacement Surgery
Target Area Deep subchondral bone & bone marrow Empty joint space (capsule) Entire joint removal
Primary Goal Heal bone lesions & delay/prevent surgery Temporary symptom management Mechanical joint replacement
Invasiveness Minimally invasive (Outpatient) Minimally invasive (Outpatient) Highly invasive (Hospital stay)
Recovery Time 2-3 days of mild discomfort 1-2 days 3-6 months (requires physical therapy)
Preserves Future Options? Yes Yes No (Finite lifespan of hardware)

What conditions does IO therapy treat?

IO is considered for severe arthritis, to address the associated pain, limited function, and small cracks in the bones beneath the cartilage. These microfractures are indicated in MRI imaging by bright white regions (edema). Additionally, the presence of bone-swelling on MRI signifies the progressive advancement of arthritis. We commonly use IO injections to treat:

  • Severe Osteoarthritis (OA): Particularly in the knees, hips, and shoulders.
  • Bone Marrow Lesions (BML) / Bone Edema: Swelling and microfractures inside the bone.
  • Persistent Bone Bruises: Deep injuries resulting from acute or chronic trauma.
  • Subchondral Insufficiency Fractures: Hairline cracks in the bone beneath the cartilage.
  • Early-Stage Avascular Necrosis (AVN): Bone tissue death due to a lack of blood supply.

Why choose the Orthohealing Center for IO procedures?

Our esteemed physicians were among the first in the world to treat patients with Intraosseous (IO) injections. They have conducted extensive research on the approach and have also authored a textbook on the subject. Additionally, the Orthohealing Center's team has shared and advanced their IO techniques at the Walter Reed National Military Medical Center, and at medical conferences and symposiums around the globe.

Furthermore, our doctors use advanced x-ray guidance for the precise delivery of each injection to maximize patient comfort and treatment outcomes.

Are IO injections painful?

No, the procedure is generally well-tolerated and painless during administration. Although IO injections can be performed in-office with local anesthetic and nitrous oxide, they are generally administered with twilight sedation at an outpatient surgery center to optimize patient comfort during the procedure.

Recovery after IO injections

Recovery times vary based on the area treated, patient compliance, and severity of the damage. Most individuals only experience discomfort for two to three days post-procedure. Many experience pain relief immediately after IO therapy, as injecting directly into the bone can reduce the accumulated pressure. When this innovative approach is applied on knees, for example, there is no need for crutches; patients can bear weight as tolerated.

Are IO injections suitable for everyone?

This approach is typically appropriate for those:

  • with severe osteoarthritis with or without bone marrow edema lesions
  • with localized pain corresponding with their MRI
  • who would like to avoid joint replacement surgery
  • for whom more traditional methods of treatment have failed
  • who are not candidates for surgery

Factors for consideration include age, activity level, weight, and the underlying medical issue. A formal consultation and MRI review are required.

What other therapies address bone damage?

As an alternative or adjunct to IO injections, Focal Shockwave may be used to reduce bone edema and strengthen bone.

Will this treatment stimulate the regrowth of cartilage?

While IO injections excel at healing the underlying bone, they do not typically regrow full cartilage. Although we commonly see improvement of bone edema on MRI post-IO injection procedure, surgery is typically required for cartilage regeneration of focal lesions.

Take the Next Step

Don't let severe joint pain limit your life. Contact The Orthohealing Center in Los Angeles at (310) 453-5404 to request a consultation and find out if Intraosseous Injections are right for you.

Request a Consultation

Important IO articles

Intraosseous therapy is backed by a growing body of peer-reviewed clinical data. The following foundational research and published papers were authored by or feature contributions from the expert physicians at The Orthohealing Center, demonstrating our commitment to advancing regenerative medicine: