BMAC for Hip Arthritis: What Patients Should Know About the Research, Benefits, and Risks

Hip arthritis can make everyday activities such as walking, climbing stairs, exercising, and getting out of a chair increasingly uncomfortable. When symptoms persist, many patients want to explore treatment options that may help reduce pain, improve mobility, and maintain an active lifestyle without immediately pursuing surgery.

Bone marrow aspirate concentrate (BMAC) is a biologic treatment being investigated for hip osteoarthritis. It uses material collected from a patient’s own bone marrow, which is processed to concentrate selected cellular and biological components before being administered to the treatment area.

Clinical studies have reported improvements in pain and physical function following certain bone marrow-based treatments for hip osteoarthritis. In addition, a 2026 long-term cohort study reported an association between a specific bone marrow concentrate procedure and a lower rate of conversion to total hip replacement over 15 years.

These findings add to the growing body of research into biologic approaches to joint care. However, the evidence is still developing, and different procedures, preparation methods, and injection techniques should not be considered interchangeable.

At Sampson Regen, understanding the research, setting realistic expectations, and evaluating each patient’s individual needs are important parts of discussing potential treatment options. Here is what patients should know about BMAC, the current evidence, and how it may fit into a broader hip arthritis treatment plan.

1. What Is BMAC?

BMAC stands for bone marrow aspirate concentrate. The procedure typically begins with collecting liquid bone marrow from the iliac crest, a portion of the pelvis. The collected marrow is then processed, commonly using a centrifuge, to concentrate selected cellular and biological components.

Bone marrow concentrate contains a mixture of cells and signaling components, including a relatively small population of mesenchymal stromal cells. Researchers are studying these components for their potential roles in inflammatory signaling, tissue health, and the body’s response to injury.

BMAC is not a purified or laboratory-expanded stem cell product. Its composition can vary depending on the patient’s biology, the collection technique, and the processing method.

It is also important to distinguish between bone marrow aspirate (BMA), which refers to the collected marrow, and bone marrow aspirate concentrate (BMAC), which has been processed to concentrate selected components. Studies involving these preparations may provide related insights, but their results cannot automatically be applied to every bone marrow-based treatment.

At Sampson Regen, treatment planning includes evaluating the patient’s condition and discussing the proposed procedure, including the use of imaging guidance during injections. Patients should ask their clinician which preparation and treatment technique is being recommended and how it relates to the available clinical evidence.

2. What Are the Potential Benefits of BMAC for Hip Arthritis?

The primary goal of BMAC treatment for hip osteoarthritis is to help reduce pain and improve function. Researchers are investigating whether the biological components in bone marrow concentrate may influence the environment within an arthritic joint and help improve symptoms.

Potential outcomes being studied include:

• Reduced hip pain and discomfort.
• Improved mobility and physical function.
• Greater ability to participate in everyday activities.
• Improvements in patient-reported quality of life.
• The possibility of delaying additional interventions in selected patients, an area that requires further study.

The extent of benefit, if any, can vary from person to person. The severity of arthritis, the specific procedure performed, individual health factors, and other aspects of treatment may all influence outcomes.

An important distinction: Improvement in pain or function does not necessarily mean that damaged cartilage has regenerated or that osteoarthritis has been reversed.

3. What Does the Research Tell Us So Far?

Research into bone marrow-based treatments for hip osteoarthritis has evolved, with studies examining both symptom improvement and longer-term outcomes.

A 2026 study examines hip replacement rates over 15 years

A study published in International Orthopaedics in July 2026 examined whether intraosseous bone marrow concentrate (BMC) treatment was associated with a delay in total hip arthroplasty, commonly known as hip replacement.

The single-center matched cohort study included 434 hips: 217 treated hips and 217 control hips. Researchers followed patients for up to 15 years, comparing those who received intraosseous bone marrow concentrate with matched patients who received conservative care.

Unlike a conventional injection into the joint space, the procedure involved injecting bone marrow concentrate directly into the femoral head, the ball-shaped portion of the hip joint, under fluoroscopic guidance.

The researchers reported the following findings at 15 years:

• 16.1% of the treated group had progressed to total hip arthroplasty, compared with 40.1% of the control group.
• Outcomes favored the treated group in analyses of hip-replacement-free survival.
• The researchers also reported a relationship between the measured cell-dose marker and outcomes.
• No adverse events were reported in the treated group in this study.

The authors concluded that intraosseous bone marrow concentrate was associated with a substantial delay in progression to hip replacement in their study population.

These findings are noteworthy because long-term outcomes are an important consideration when evaluating potential joint-preserving treatments.

However, the study has limitations that patients should understand. It was a matched cohort study, not a randomized controlled trial, and it was conducted at a single center. Differences between treatment groups that were not fully accounted for may have influenced the results. The findings therefore establish an association, not definitive proof that the procedure caused the lower hip replacement rate.

The study also evaluated a specific intraosseous technique. Its results should not be assumed to apply to standard intra-articular BMAC injections or every bone marrow concentrate protocol.

Further independent research will be important in determining how broadly these findings can be applied.

Study: Hernigou P, et al. “Intraosseous bone marrow concentrate delays total hip arthroplasty in osteoarthritis: A fifteen year matched cohort study with dose-response analysis.” International Orthopaedics. 2026. Read the study on PubMed.

A 2024 systematic review examines pain and function

A systematic review published in 2024 evaluated the clinical evidence for BMAC in hip osteoarthritis. The review included five studies involving 182 patients.

Across the included studies, researchers reported improvements in pain, physical function, and quality of life following bone marrow concentrate injections. No adverse events were reported in the studies included in the review.

The authors also emphasized the need for larger, better-designed studies with longer follow-up to establish treatment effectiveness and safety more definitively.

One limitation was the small number of studies and patients available for analysis. Treatment protocols varied, and much of the evidence came from studies without control groups. These factors make it difficult to determine how much of the reported improvement was attributable to treatment itself.

Study: Chandrashekar S, et al. “Safety and Efficacy of Bone-Marrow Aspirate Concentrate in Hip Osteoarthritis: A Systematic Review of Current Clinical Evidence.” Indian Journal of Orthopaedics. 2024. Read the review on PubMed.

A 2022 study examines bone marrow aspirate injections

A separate retrospective study followed 31 patients who received bone marrow aspirate injections for hip osteoarthritis. Researchers reported improvements in pain and hip function at follow-up, including at six and 12 months.

The study adds to the evidence that bone marrow-based procedures may have potential for symptom management. However, it evaluated bone marrow aspirate rather than necessarily the same concentrated preparation used in BMAC procedures. Its retrospective design and lack of a control group also limit the conclusions that can be drawn.

Study: “Bone marrow aspirate injection for osteoarthritis of the hip: A pilot study.” Interventional Pain Medicine. Read the study on PubMed.

What do these findings mean for patients?

Taken together, the available research provides encouraging signals that certain bone marrow-based treatments may improve symptoms in some patients with hip osteoarthritis. The 2026 cohort study also raises an important question about whether a specific intraosseous procedure may delay the need for hip replacement in selected patients.

Nevertheless, these findings do not establish that all BMAC procedures are equally effective, that every patient will experience improvement, or that treatment can reliably prevent surgery.

More rigorous research is needed to clarify which patients may benefit most, which techniques are most appropriate, how durable the results are, and how these approaches compare with established treatments.

4. Can BMAC Regenerate Hip Cartilage?

One of the most common questions patients ask is whether BMAC can regrow damaged cartilage or reverse hip arthritis.

Bone marrow contains biological components being investigated for their potential effects on inflammation and tissue health. However, the ability of a BMAC injection to regenerate damaged cartilage in an arthritic human hip has not been established.

The 2026 study’s findings concerning hip replacement rates are also not the same as proof of cartilage regeneration. A treatment may be associated with symptom improvement or delayed surgery without demonstrating that cartilage has been restored.

The American Association of Hip and Knee Surgeons has addressed the limitations of biologic treatments for advanced hip and knee arthritis in its position statement.

For patients, the practical takeaway is to distinguish between three separate outcomes:

• Symptom improvement: Less pain or better function.
• Joint preservation: Potentially delaying the need for joint replacement.
• Cartilage regeneration: Demonstrating restoration of damaged cartilage.

These are different clinical outcomes and require different types of evidence. Patients should ask their clinician which outcome a proposed treatment is intended to address and what research supports that expectation.

5. Who Might Consider a BMAC Consultation?

A consultation may be appropriate for someone experiencing persistent hip pain who wants to understand the available nonsurgical and surgical options.

Whether BMAC is worth considering depends on several factors:

• Diagnosis: Is the pain coming from osteoarthritis inside the hip joint, or could it involve a tendon, bursitis, the lower back, or another condition?
• Severity of arthritis: Imaging findings and the degree of joint damage help guide treatment decisions.
• Previous treatments: Exercise, physical therapy, activity modification, medications, and other interventions may influence the next steps.
• Personal goals: A patient’s priorities may include walking more comfortably, returning to specific activities, or improving everyday function.
• Overall health: Medical history, medications, and other individual factors may affect the suitability of a procedure.

The 2026 study raises the possibility that disease stage and other treatment-related factors may influence long-term outcomes. However, its findings should not be interpreted as a definitive rule for determining which individual patients will benefit.

BMAC is not appropriate for everyone and should not automatically replace established treatment options. A thorough evaluation helps determine whether it belongs in an individual’s treatment discussion.

6. What Happens During a BMAC Procedure?

Although protocols vary, an autologous BMAC procedure generally involves several steps.

Step 1: Evaluation and treatment planning

The clinician reviews symptoms, medical history, physical examination findings, and imaging to confirm the diagnosis and discuss appropriate options.

Step 2: Bone marrow collection

Bone marrow is collected from the pelvis, typically using a needle and appropriate anesthesia.

Step 3: Processing

The collected marrow is processed to produce a concentrate containing selected cellular and biological components.

Step 4: Image-guided administration

The preparation is administered to the intended treatment area. For a deep joint such as the hip, ultrasound or fluoroscopy may be used to guide needle placement.

The exact injection location matters. A conventional intra-articular injection delivers material into the joint space, while the intraosseous technique evaluated in the 2026 study delivers concentrate into the femoral head. These are distinct procedures.

Imaging guidance helps the clinician position the needle at the intended location, but it does not guarantee a particular clinical outcome.

Step 5: Recovery and follow-up

Patients receive instructions regarding activity, rehabilitation, medications, and follow-up. Recovery recommendations depend on the procedure performed and the patient’s circumstances.

Before treatment, ask what to expect during recovery, when to resume normal activities, and how progress will be evaluated.

7. What Are the Risks and Considerations?

BMAC uses material collected from the patient’s own body, but the procedure still carries risks.

Potential complications include pain at the bone marrow collection or injection site, bruising, bleeding, an inflammatory reaction, and infection. The risks may vary with the technique used and the patient’s medical history.

Patients should also consider the following:

• Variable preparation methods: BMAC products can differ in cellular composition and processing.
• Uncertainty about outcomes: Research is ongoing, and improvement cannot be guaranteed.
• Financial considerations: These procedures may involve substantial out-of-pocket expenses and are often not covered by insurance.
• Evidence limitations: Positive findings from one technique or study cannot automatically be applied to another.

The absence of reported adverse events in a particular study does not establish that a procedure is risk-free. Patients should receive a clear explanation of the risks, potential benefits, costs, and alternatives before deciding whether to proceed.

8. How Does BMAC Compare With Other Hip Arthritis Treatments?

Hip osteoarthritis care is individualized. The most appropriate approach depends on symptom severity, imaging findings, overall health, activity goals, and response to previous treatment.

Options may include:

• Exercise and physical therapy: Help maintain mobility, strength, and function.
• Activity modification: Adjusting certain activities may reduce discomfort while preserving movement.
• Medications: Clinician-directed pain relievers or anti-inflammatory medications may help manage symptoms.
• Corticosteroid injections: May provide temporary symptom relief for selected patients.
• Platelet-rich plasma (PRP): A different biologic preparation that should not be considered interchangeable with BMAC.
• Hip replacement evaluation: When pain and functional limitations remain substantial despite nonsurgical care, surgery may be appropriate.

A discussion of BMAC should consider these alternatives rather than assume that one treatment is right for everyone.

The 2026 long-term study adds a potentially important area for further investigation, but it does not establish that BMAC is superior to other treatments or that patients should postpone an otherwise appropriate hip replacement. Treatment decisions should be based on the individual patient’s condition, goals, and informed preferences.

Frequently Asked Questions About BMAC for Hip Arthritis

Is BMAC a stem cell treatment?

BMAC contains a mixture of bone marrow components, including a small number of mesenchymal stromal cells. It is not a purified or laboratory-expanded stem cell product. Its composition depends on the collection and processing methods used.

Can BMAC help with hip arthritis pain?

Early clinical studies have reported improvements in pain and function following bone marrow-based treatments for hip osteoarthritis. However, the evidence remains limited, and individual results vary. More rigorous studies are needed to establish how consistently patients benefit.

Can BMAC delay hip replacement?

A 2026 matched cohort study reported a lower rate of total hip arthroplasty over 15 years among patients who received a specific intraosseous bone marrow concentrate procedure compared with matched patients receiving conservative care.

This is a promising finding, but the study was observational rather than randomized. It does not prove that the procedure caused the difference or that standard intra-articular BMAC injections will produce the same results.

Can BMAC regrow hip cartilage?

Cartilage regeneration in an arthritic human hip has not been established as an outcome of BMAC treatment. Symptom improvement or a potential delay in surgery should not be interpreted as proof that cartilage has been restored.

How long do the benefits last?

There is no single reliable timeframe that applies to every patient or every technique. Some studies have reported improvements over months, while the 2026 study examined the longer-term outcome of conversion to hip replacement following a specific procedure. More research is needed to clarify the duration of symptom relief and the long-term effectiveness of different approaches.

Is BMAC the same as bone marrow aspirate (BMA)?

No. BMA refers to the collected bone marrow, while BMAC refers to marrow processed to concentrate selected components. Intraosseous BMC treatment, as evaluated in the 2026 study, is also distinct from a conventional injection into the hip joint. These differences matter when interpreting research findings.

Will insurance cover BMAC?

Coverage varies, and these procedures often require out-of-pocket payment. Patients should request an itemized estimate covering the consultation, collection, processing, injection, imaging, and follow-up.

What should I ask my doctor before deciding?

Consider asking:

• What is causing my hip pain, and how advanced is the arthritis?
• Which specific bone marrow preparation and injection technique are you recommending?
• Is the treatment intra-articular or intraosseous?
• What does the research show for this specific procedure?
• What improvement would be a realistic goal in my situation?
• What are the risks, costs, and alternatives?
• How will we assess my response to treatment?
• When should I consider an orthopedic surgical consultation instead?

Explore Your Hip Treatment Options at Sampson Regen

If hip pain is affecting your daily activities, understanding the available options is an important first step.

At Sampson Regen, an evaluation can help you review your diagnosis, discuss individualized treatment approaches, and determine which options may be appropriate for your needs and goals.

Call 310-453-5404 to learn more or schedule a consultation. Bringing prior imaging and a list of treatments you have tried can help make the discussion more productive.

This article is for educational purposes only and does not replace individualized medical advice. BMAC and other bone marrow-based treatments remain areas of ongoing research. Published findings may not apply to every preparation or procedure, and outcomes vary. Treatment decisions should be made in consultation with a qualified clinician after reviewing the potential benefits, risks, costs, and alternatives.

References

1. Hernigou P, Centeno CJ, Berger DR, Dodson E, Murphy MB. Intraosseous bone marrow concentrate delays total hip arthroplasty in osteoarthritis: A fifteen year matched cohort study with dose-response analysis. International Orthopaedics. 2026;50(7):1617–1626. PubMed.
2. Chandrashekar S, et al. Safety and Efficacy of Bone-Marrow Aspirate Concentrate in Hip Osteoarthritis: A Systematic Review of Current Clinical Evidence. Indian Journal of Orthopaedics. 2024. PubMed.
3. Tsitsilianos N, et al. Bone marrow aspirate injection for osteoarthritis of the hip: A pilot study. Interventional Pain Medicine. 2022. PubMed.
4. American Association of Hip and Knee Surgeons. Biologics for Advanced Hip and Knee Arthritis. Position statement.
5. American Academy of Orthopaedic Surgeons. Osteoarthritis of the Hip. Patient education.
6. Sampson Regen. Bone Marrow Cell Therapy. Sampson Regen.