Frequently Asked Questions

We have treated a number of patients with auto-immune conditions such as rheumatoid arthritis that predominantly effects joints, however, the numbers are small, some have responded, and some have not but it is difficult to draw general conclusions about autoimmune conditions. It is important to discuss this with our consultants who would be best able to guide you in the suitability of any treatment.

Platelet-rich plasma (PRP) injections uses a patient’s own blood cells to accelerate healing in a specific area. PRP consists of two elements: plasma, or the liquid portion of blood, and platelets, a type of blood cell that plays an important role in healing throughout the body. Platelets are well-known for their clotting abilities, but they also contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing in the treated area. To create platelet-rich plasma, clinicians take a blood sample from you and place it into a device called a centrifuge, separating out the other components of the blood from the platelets and concentrating them within the plasma. After creating the PRP, it is injected into the target area, such as an injured knee or a tendon. In some cases, the clinician may use ultrasound to guide the injection. 

The idea is to increase the concentration of specific bioproteins or hormones, called growth factors, in a specific area to accelerate the healing process. Studies show that the increased concentration of growth factors in platelet-rich plasma may stimulate or speed up the healing process, shortening healing time for injuries, decreasing pain and even encouraging hair growth. PRP is used to treat tendon, ligament, muscle and joint injuries, can be used for cosmetic purposes, it can be used for post surgical healing and in early/mild cases of Osteoarthritis. PRP injections are usually grouped into a set of 3 injections spaced 1-2 weeks apart.

Bone marrow is the soft, spongy substance that fills the tiny spaces inside of bones. It is where your blood is produced. These tiny spaces hold blood and stem cells, the primitive cells that are able to grow into various types of blood cells. A surgeon will harvested your bone marrow from the back of your pelvis (hip) using a needle and syringe. You will usually be sedated, and the area around the pelvis is numbed with a local anaesthetic. Bone marrow aspirate is the fluid taken from bone marrow. Depending on the number of joints to be injected, approximately 50-60 mL (3-4 tablespoons) of bone marrow is aspirated, and is then processed (in a centrifuge) into a concentrate known as Bone Marrow Aspirate Concentrate (BMAC). This concentrated solution which can then be injected into your damaged tissue to promote healing.

nSTRIDE and PRP injections are similar in that both are autologous treatments that utilise blood proteins to promote tissue healing. The key difference between the two is that nSTRIDE contains white blood cells (leukocytes) and anti-inflammatory proteins (cytokines), which are not present in PRP injections. Also, unlike PRP, which requires several injections to attain desirable results, nSTRIDE is a one-time injection providing results that typically last between 1 to 2 years. nSTRIDE is used mainly used in the treatment of early osteoarthritis of the knee. It is ideal for younger people with knee arthritis who want to avoid surgery, and anyone who does not like the idea of a knee replacement for early arthritis. PRP uses concentrated platelets only. These are components of your blood which are involved in clotting. PRP is used for other diagnoses, such as tendon problems, ligament issues, post surgical healing or even in cosmetic surgery. Your Clinician will guide you to the most appropriate treatment for your condition.

Following are the different levels of sedation used at The Regenerative Clinic: Minimal sedation: Where you feel drowsy and relaxed, with minimal effects on bodily sensations. Moderate sedation: Where you are semi-conscious, can breathe on your own and respond to stimulation. Deep sedation: You are nearly unconscious and only have purposeful response to repeated and painful stimulation. You may need assistance with breathing. General anesthesia: You are completely unconscious and do not respond to any level of pain. You will require breathing assistance. We carry out nearly all of our procedures with our patients mildly or moderately sedated, this means they are awake but very comfortable. Throughout the procedure an anesthetist will look after you to ensure you are happy. You can opt for local anaesthetic only and your consultant agrees. Some procedures may require you to be under general anaesthetic e.g. facial and spinal treatments. This will be discussed with you in advance and the best option agreed with yourself and your consultant.

This procedure has been available worldwide for approximately 10 years. In the UK, it was first started by The Regenerative Clinic in May 2017.

At the Regenerative Clinic, we have treated over 1,000 patients and over 1,700 joints. We are by far the largest and busiest group in the Europe and the UK using this technology. There have been approximately a further 100 individuals who have been treated in other centres across the UK, which of course, do these in much lower volume. Worldwide, MFAT has been used to treat over 30,000 patients with surgeons all reporting great results.

It’s a very small amount of fat, around 50ml, around the size of an espresso cup, for one joint. This is then reduced to approx 5ml which is injected into each joint. More fat will be taken if multiple joints are to be injected. Fat is usually harvested from your tummy area, but can take from flanks and upper thighs.

Many patients are not yet ready for replacement surgery (too young or too active), so this is a good alternative. The procedure is minimally invasive with a minimum recovery time. You do not have to go under general anaesthetic.

We offer both BMAC and MFAT treatments. There is also research to show that the quality of cells in bone marrow decreases significantly as you get older, especially in women. Age and gender has no effect on the quality of the cells present in fat tissue. Both methods of harvesting have been tried, tested and have proven to be very effective. The severity of osteoarthritis and other issues like ligament, tears, tendon issues can direct the consultant to the most appropriate treatment for you.

This technology is still undergoing assessment. There are some studies that clearly demonstrate its efficacy but in order for new and novel treatments to make their way on to the NHS or private medical insurance, there is invariably rather onerous processes that may take a number of years before it is approved. A good example of this is the use of platelet rich plasma which has been around for approximately 25 years, but it is only recently that it has found its way to the NHS and is being offered across the board now. There are still some insurance companies that do not approve platelet rich plasma despite overwhelming evidence for its efficacy.

Yes of course, we have a large team of orthopaedic consultants who specialise in different areas of the body. We can arrange for you to have some imaging done of the extra joint if you do not have any already and for you to meet with the relevant specialist.

Yes, if we are given enough notice we can occasionally arrange for you to have your consultation and procedure on the same day. What is often easier is to arrange for you to have your consultation and procedure on adjacent days. Ie consult one day and procedure the following day. Alternatively we offer telephone and video consultations and can arrange any necessary MRI/scans at a location more local or convenient for you. You would then have a final face to face consultation on the day of your procedure.

Our clinicians are orthopaedic surgeon consultants who are specialists in joint preservation and rejuvenation. They will be able to discuss traditional orthopaedic surgery and all of your regenerative options with you. If the consultant thinks you are not suitable they will suggest an alternative course of treatment best suited to your diagnosis.

We keep a registry of all of the patients that have been treated and we have found that between 65% and 75% of all patients treated have had a positive outcome with improvements in both pain scores as well as functional scores (depending on joint treated and diagnosis). The level of improvement for the treatment in our knee arthritis patients has been equivalent to the improvement seen in a total knee replacement in severe arthritic group. However, different joints have differing success rates, which also depends on your diagnosis/other factors (for example a meniscal tear in addition to knee arthritis). We have published a number of papers on our success rates, which you can find on our website, or can be provided on request.

There are a number of different patterns of response to this treatment. There are some individuals who have an immediate effect with a profound reduction in their symptoms. Others demonstrate an initial increase in their symptoms following the injection but then things settle down and they slowly improve. Interestingly, some patients having hip MFAT have a slower response with sometimes a 6 week period before the benefits start appearing. In some of our patients, they continue to improve after 3-6 months. This may be due to the fact that by reduction of the pain in the joint, the muscles then start regaining some of their strength and the control which is achieved by the strengthening of these muscles further stabilises the joint improving symptoms. 

A small number of patients did not see an improvement until almost 6 months after the procedure, but went on to have significant reduction of their pain. We strongly recommend a Physiotherapy program to aid recovery, strengthen your muscles and improve function. We will provide an initial plan which covers the first few weeks. Care should be taken to not “rush” back into full activity once pain levels start to reduce, your physiotherapist can guide you on appropriate return to pre-arthritis levels of activity.

Some of our patients treated have passed the 3 years mark and it appears that in those who respond, in the first year, this response may well be maintained for over 3 years. Some patients feel that a “booster” or “top-up” injection may be necessary at 2-3 years but the numbers for these are small. Currently, our research does not extend past the 3 year stage. As with all procedures, the Individual results may vary and depends on several factors like patient weight and activity level. Your consultant will counsel you about strategies for your post-procedural care. It is important to closely follow these instructions regarding post-procedure activity/physiotherapy and follow-up care.

There have been a number of studies undertaken to determine how safe MFAT is. All studies have pointed to micro-fragmented adipose tissue as a safe and beneficial adjuvant in surgical treatment. One study conculded that “The procedure is simple, sustainable, quick, minimally invasive, one-step, and safe”. We have not noted any adverse outcomes. In cases where the treatment has not worked, it has been the natural progression of the disease. This treatment does not interfere with any future interventions required. There is no evidence that it will interfere for example – with having a total knee replacement. (as concluded in the following paper: Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis by G. Cattaneo et al, published in 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977739/ ) 

The procedure is very safe and the risks are minimal. All procedures, including an injection, do come with risks. However, some patient experience mild bruising from the fat harvest site or a flare up from the injection site.

In our experience there are patients who do not respond and it is difficult to predict which patients will not benefit. However, it does seem that the patients across all grades of arthritis benefit in a similar way with many patients having reduction in pain and improvement in function. It is important to follow all the instructions your consultant and the physiotherapist give you. We have found that patients respond better if a long term physio program is followed. The Regenerative Clinic will provide a plan which covers the first few weeks, thereafter a tailored plan for yourself needs to be put in place. Please contact us if you need help with this.

The effect of steroids is thought to be detrimental and not advised. We have no direct experience of this because we advise patients to leave a time of at least 3 months between the steroid injection and the treatment in order to make sure that the joint returns to a normal state, therefore gaining full benefit.

The technology has been used successfully on patients with all stages of arthritis, that being said, each case is unique and that is what is so important about the consultation. Many patients with severe arthritis also have a secondary issue, for example a knee arthritis diagnosis may also include a meniscus tear. Our clinicians can offer conventional surgery but are also specialists in joint preservation and rejuvenation and will be able to assess your individual suitability for the procedure. This is why the clinical assessment is so important and it means the patient is receiving some of the top care in the country.

We don’t generally advocate injecting into joints that have had a joint replacement, but we have had a few cases where we have injected into a joint which has been replaced or partially replaced. We would certainly recommend a review by one of our specialists before any further treatment is advised.

If the treatment does not work, we can try other forms of injections including Platelet Rich Plasma (PRP), Bone Marrow Aspirate Concentration (BMAC), nSTRIDE, Interosseous PRP and conventional surgery. In some cases, the injection of these other substances can trigger a response. In cases where there is a deformity in the limb which is a cause for mechanical symptoms, this can be corrected with surgery and in cases of instability around the joints, particularly in the shoulder, the elbow and the ankle joint we can also offer reconstructive surgery to stabilise the joint and mitigate the symptoms.

Prior to the procedure it is important to continue with your normal activities and exercise. If these activities cause pain, it is important to reduce the activities to avoid pain but by exercising and continuing to be active, muscle tone and strength is maintained and balance will continue to improve. These are very important features in the post-operative rehabilitation as well. Once the pain in the joint is reduced, it then becomes very important to exercise in order to regain muscle tone, muscle strength and then rehabilitate balance. We will provide a Physiotherapy program to get you started for the first few weeks. It is highly recommended that you continue Physiotherapy after this point. A Physiotherapist can put a tailor-made plan in place for you. If you do not have a Physio, we will be able to assist you on this. You should refrain from any strenuous exercise for 2 weeks after your procedure. Give your body time to heal and as everybody heals at a different rate, you are best placed to know when to start the gentle exercises provided.

Everyone heals at a different rate but generally we find that will need to take it easy for the first few days. We find that the site of lipo-aspiration or bone marrow harvesting can be uncomfortable and will take a number of days to improve. Occasionally, the joint can become a little bit uncomfortable and swollen following the injection (known as a flare up), it is best to reduce activities to allow the joint to settle down. Most patients will experience a dull aching pain in the joint for 2-3 days, however the pain is not debilitating and can be managed with regular strength painkillers. If you have a labour intensive job, you may need to take some additional time off, however the majority of patients can be back at work within a 3-5 days. Patients who combine their injection with surgery will be required to take more time off work, and in this case we will advise how long you may require (depending on your job and type of surgery).

After your procedure, you receive post-op pack including: post-op care leaflet, discharge summary medication and extra dressings. The Physiotherapist will also send you the exercise plan and instructions to ice or rest the joint, etc. The post-op leaflet outlines dos and do nots before and after your procedure and provides an out of hours number to get in-touch with our staff. Our staff will contact you 24-48 hours (working days) after your procedure to check your progress and answer any questions you may have. You will then have a follow-up appointment with your consultant at 6 weeks so we can monitor your improvement. Thereafter our research team will contact you at 3, 6, 12, 24 and 36 months after your procedure to check your progress and book any follow up appointments you need. Outside of these normal contact points, you can call or email us any time you need advise or wish to talk to your consultant.

After the procedure, patients would be advised to wait for at least 12 months before they have an MRI to maximise the possibility of seeing benefits to the joint. You consultant will guide you on the optimum time and whether there is a requirement for a post procedure MRI.

Medical literature shows there is good evidence which suggests that after MFAT injections, a MRI scan shows the cartilage quality has improved. One study remarks that “The treatment induces host chondrocytes to make rejuvenating structural and biochemical changes in the cartilage.” It was also noted that it was not just the thickness but rather the quality of the regrown cartilage which was remarkable. (as cited on The Regenerative Clinic website: https://www.theregenerativeclinic.co.uk/news/cartilage-regrowth-proven-in-clinical-trial/ )

There is a direct relationship between good health pre-procedure and a succesful outcome post procedure. Therefore, where possible, we advise patients to exercise (or follow physio protocols as appropriate) pre and post procedure. Our clinicians will ask questions about your general health, previous medical conditions, medication and previous operations. Our Specialists will be able to give you specific advice on any aspect of your health or improvements necessary.

Patients would need to be assessed by one of our specialists to ascertain their suitability for further treatment. This could be repeat treatment or a complementary Regenerative treatment.

The data collected by the research team is kept securely in an encrypted, password-protected database known as a Registry. The data is then used to assess the efficacy of the treatments using statistical analysis and other analytical methods. Research papers will be published in scientific journals and these will be disseminated globally to demonstrate the growing evidence base for these treatments. Currently The Regenerative Clinic have published a number of papers on the safety and effectiveness of the MFAT procedure. Please see our website for links to these clincial papers. All the data published in these papers does not refer to any individual patient. Only summarised statistical data is published.

Every patient is different and given enough time to recover. Usually between 1 and 3 hours is enough time to fully recover. All patients should have a chaperone (family or friend) collect them after their procedure and remain with them on the journey home. We will let you know an approximate collection time for your companion/chaperone to collect you.

You will be expected to arrive 1 hour before your procedure. Your procedure should take 1 hour (but does depend on the number of joints being injected). You should expect to need 1-3 hours for recovery.

The Harley Street Specialist Hospital (HSSH) will send you an email with a link to the Pre-assessment form/questionnaire. The Pre-assessment form ask you questions about your medical history, current medical conditions, medication, allergies etc. This allows the surgical team who will look after you during your procedure to ensure your safety and dispense the correct advice and medication. It is very important that you complete this form as soon as possible to ensure the HSSH team has time to review your information and follow up if they have any questions.

Contact details and instructions are provided in a patient plan which will be given on the day. During working hours, please contact the office on 0330 2233332. If it is not urgent and it is out of hours, please email us. If you have an emergency and it is out of hours, we suggest you call your GP, 101 services or make your way to the nearest A&E department.

Our staff will contact you a few working days after your procedure to book in your first follow up appointment. This will take place approximately 6 weeks after your procedure. Following that our Research team will contact you at regular timepoints with questionnaires, the check your progress and offer an appointment.

Currently, this will depend on your vaccine status. If you are double vaccinated then a lateral flow test is required. If you are not double vaccinated, then you will require a PCR test. We cover the cost of the PCR. This advice changes to match government advice, our staff will discuss current requirements with you.

Please contact the sales team for accurate and up to date pricing. You may be able to take advantage of an offer – see our Facebook page for current offers.

Please contact the sales team for accurate and up to date pricing. You may be able to take advantage of an offer – see our Facebook page for current offers.

We usually recommend that you wait at least 48 hours for a short haul flight. We can advise for longer flights.