The short answer
PRP, BMAC and Lipogems (microfragmented adipose tissue) all use your own tissue to treat arthritis and tendon injuries without surgery. PRP concentrates platelets from your blood, BMAC concentrates cells and growth factors from your bone marrow, and Lipogems washes and injects your own fat to cushion and support the joint. Dr. Marc Gruner, DO, a Mayo Clinic–trained sports medicine physician, offers all three in Bethesda, MD, for patients across the Washington, DC area.
Written by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship
Orthobiologic Lipogems for Knee Arthritis — Dr. Marc Gruner
Many patients with joint pain arrive in what is often called the treatment gap. Physical therapy, corticosteroid injections and viscosupplementation no longer give lasting relief, but they are not ready for major surgery. Orthobiologics were built for that gap: they use your own blood, bone marrow or fat, in an office procedure, with minimal downtime.
The three options are not interchangeable. Each starts from a different tissue and does a different job, which is why the choice depends on the joint, the diagnosis and how advanced the problem is.
How PRP, BMAC and Lipogems compare
All three use your own tissue, so there is no donor material.
| PRP | BMAC | Lipogems (microfragmented fat) | |
|---|---|---|---|
| Comes from | A blood draw | Bone marrow, usually from the pelvis, under local anesthesia | Fat from the belly or flanks, under local anesthesia |
| How it is prepared | Spun in a centrifuge for about 15 minutes, concentrating platelets up to eight times normal levels | Concentrated to gather the marrow's reparative cells and growth factors | Washed with saline only in the FDA-cleared Lipogems closed system |
| What it provides | Growth factors that trigger the body's repair response | Reparative cells and growth factors | Structural cushioning plus a supportive cellular environment |
| Typically used for | Knee, hip and shoulder arthritis; tennis and golfer's elbow; rotator cuff, patellar and Achilles tendinopathy; plantar fasciopathy | Select osteoarthritis and certain tendon and ligament injuries | Knee, hip and shoulder arthritis and rotator cuff problems, for patients in the treatment gap |
| Time in the office | About an hour | Outpatient procedure | Usually under an hour, including harvest |
How Dr. Gruner chooses between them
The decision starts with a diagnosis: an exam, imaging, and usually an in-office diagnostic ultrasound. PRP is often the first orthobiologic for tendon problems and mild-to-moderate arthritis. Lipogems is aimed at joints that need cushioning and support as well as a healing signal. BMAC is considered for select patients, often when other measures have not given lasting relief. Sometimes treatments are combined.
Some patients are not good candidates for any of them. Advanced, bone-on-bone arthritis is generally better served by other options, and a history of certain blood diseases, such as lymphoma or leukemia, rules out BMAC. Dr. Gruner is candid about this at the first visit.
Before and after treatment
Orthobiologics rely on a healing inflammatory response, so anti-inflammatory medications (NSAIDs, aspirin) and blood thinners are usually stopped for about two weeks before and four weeks after PRP. Improvement is gradual: many patients notice benefit within 4–6 weeks, and results can last a year or longer for the right candidate. A physical therapy program alongside treatment gives the best chance of a lasting result.
PRP is often considered elective and may not be covered by insurance. The office reviews costs with you before any procedure.
Frequently asked questions
- Where can I get Lipogems in the Washington, DC area?
- Dr. Marc Gruner, DO, a Mayo Clinic–trained sports and regenerative medicine physician, performs microfragmented adipose therapy with the FDA-cleared Lipogems system at OrthoBethesda in Bethesda, MD, serving patients from across Maryland, Washington, DC and Northern Virginia.
- Is Lipogems better than PRP for knee arthritis?
- Neither is better for everyone. PRP concentrates growth factors from your blood and is often used first for mild-to-moderate arthritis. Lipogems adds structural cushioning from your own fat and is aimed at patients whose conservative care has stopped working but who are not ready for surgery. Dr. Gruner recommends the one that fits your joint, sometimes in combination.
- What is the difference between BMAC and Lipogems?
- Both use your own tissue. BMAC concentrates cells and growth factors from bone marrow drawn from the pelvis; Lipogems washes fat from the belly or flanks. BMAC is considered for select joint and tendon problems; Lipogems is used mainly to cushion and support arthritic joints.
- Who is not a candidate for orthobiologic injections?
- Advanced, bone-on-bone arthritis is generally better served by other options, and a history of certain blood diseases rules out BMAC. A diagnostic exam and imaging determine whether an orthobiologic is appropriate.
This article is for general education and is not a substitute for individualized medical advice. Please consult a qualified clinician about your specific condition.