Stem Cell Treatment: Adipose-derived SVF and Bone Marrow BMAC

A stem cell is a cell that can divide and multiply and, under appropriate conditions, develop into different tissue cells. The adult body contains cells involved in repair in many tissues, particularly bone marrow and fat. In orthopaedics, 'stem cell treatment' does not mean pure stem cells expanded in a laboratory. The product used is a cell-rich mixture obtained from the patient's own tissue during the same session, which includes stem cells.

There are two common ways to obtain this mixture. One processes fat taken from the abdomen or hip into SVF (stromal vascular fraction); the other concentrates bone marrow taken from the pelvis by centrifugation, producing BMAC (bone marrow aspirate concentrate, also called BMC in some sources). Alongside stem cells, both products contain growth factors, molecules regulating inflammation and supporting cells.

The aim is to support the biological environment within the joint and reduce pain. It must be clear from the outset that there is no reliable evidence of worn cartilage being regenerated; this remains under investigation. Presenting the treatment as a replacement for joint replacement surgery is incorrect.

SVF is the fraction containing vascular and connective tissue cells within fat tissue. The procedure begins by obtaining fat from the lower abdomen or side of the hip through a small cannula under local anaesthesia. During the same session, the tissue is processed in a specialised system to separate it from fat cells; the resulting cell-rich fluid is injected into the joint.

Fat tissue is relatively rich in cells and easy to access, which is the practical advantage of this method. However, it includes liposuction and is therefore more invasive than the bone marrow approach. Bruising, tenderness and fullness at the collection site for several days are expected.

How the product is processed is decisive. Treatments fall into three categories: products separated solely by mechanical methods (washing, centrifugation and filtration); products separated enzymatically, by digesting tissue with an enzyme such as collagenase, which includes most conventional SVF preparation; and products in which cells are expanded (cultured) in a laboratory.

These three categories are not equivalent legally or scientifically. Since enzyme use can take tissue processing beyond the limits of 'minimal manipulation', enzymatically prepared products are assessed under a different authorisation framework from mechanically separated products. Products in which cells are expanded in a laboratory may be used in Türkiye only at centres authorised by the Ministry of Health and for specific indications. You have the right to ask during consultation which of these three categories the proposed treatment belongs to.

BMAC is obtained by centrifuging bone marrow taken with a special needle from the upper back part of the pelvic bone (iliac crest). The procedure uses local anaesthesia and is usually completed in one session. The concentrate is applied to the target joint or into bone.

Bone marrow is a natural source of the skeletal tissue's own repair cells, so it is particularly considered for conditions involving bone healing. One much-discussed orthopaedic application is early avascular necrosis of the femoral head: BMAC may be considered alongside surgery intended to reduce pressure inside the bone (core decompression). The condition itself is explained in detail on its dedicated page.

The bone marrow collection site may hurt and remain tender for several days. This is unrelated to bone marrow donation or stem-cell transplantation for cancer; the patient's own tissue is used in the same body during the same session.

• Avascular Necrosis of the Femoral Head

Cell-containing procedures are not standard treatment for a disease; they are considered after standard approaches in selected patients with expectations clearly discussed. In orthopaedics, they are most often discussed for:

• Early to moderate joint osteoarthritis: where joint space is largely preserved → knee osteoarthritis, hip osteoarthritis
• Avascular necrosis of the femoral head: in early stages, alongside core decompression surgery → avascular necrosis of the femoral head
• Delayed bone healing: for post-fracture union problems as part of a surgical plan → fracture treatment
• Persistent tendon problems: selected cases unresponsive to other methods → regenerative and non-surgical treatments

The honest answer is that the evidence is still under investigation. Some published studies report improvements in pain and function scores in patients with early to moderate osteoarthritis. However, most involve small numbers of patients, short follow-up periods and, in some cases, no comparison group. More importantly, the products used differ: cell numbers, processing methods and doses are not standardised. This makes it difficult to combine results and draw a general conclusion.

What can currently be said is that cell-containing treatments may be considered for appropriately selected patients; results cannot be predicted or promised. There is no reliable evidence that they rebuild cartilage, remove the need for surgery or stop the disease. We advise caution with promotional claims of this kind.

This page deliberately contains no success percentages, promised timescales or claims of comparative superiority. Promising healthcare outcomes is scientifically inappropriate and contrary to advertising regulations. Individual expectations are discussed at examination using your diagnosis and imaging findings.

In Türkiye, stem cell procedures are subject to Ministry of Health regulations. Applications involving cells expanded or cultured in a laboratory, or obtained from another person, may only be performed in authorised centres, for specified indications and with the relevant committee approvals. Offering such procedures as routine outpatient services is not compliant with the regulations.

The processing method therefore matters. The three categories described above, mechanical separation, enzymatic (collagenase) separation and laboratory expansion (culture), fall under different authorisation frameworks. Products taken from the patient's own tissue and subjected only to mechanical processing in the same session (centrifugation, filtration, washing) are not classified in the same way as products processed using enzymes. Which procedure may be performed, under what conditions and at which centre depends on current regulations and the centre's authorisation.

At AC CLINIC, this subject is approached through an assessment consultation, without promising a procedure in advance. Your diagnosis, disease stage and previous treatments are reviewed. The consultation explains which category of procedure may be discussed for you, which must be performed at an authorised centre and how any necessary referral would work.

Before agreeing to treatment, you are entitled to ask where and how the product is obtained, whether cells are expanded, where the procedure is performed and under what authorisation, its expected benefits and risks, and the plan if it does not help. Do not consent to a procedure without clear answers.

Treatments are performed as outpatient or day-case procedures; admission is usually unnecessary. During the first days, the treated joint may feel full and temporarily more painful, while the tissue-harvest site (abdomen, hip or pelvis) may be tender and bruised. Cold applications and simple pain relief are sufficient for most patients; follow your doctor's timing advice regarding anti-inflammatory medicines.

Heavy loading, running and strenuous sport are postponed for a time, depending on the treated area and any accompanying operation. The procedure is not a complete programme by itself: without exercise, weight control and activity modification, expected benefits are short-lived.

Pain level, walking distance and joint range are assessed at intervals, with repeat imaging when necessary. If the expected benefit does not occur, reassessing the diagnosis and treatment plan is preferable to repeatedly continuing the same treatment.

Because the product is prepared from the patient's own tissue, the risks of rejection and disease transmission are very low. However, the process includes a surgical step: bleeding, bruising, prolonged pain and, rarely, infection can occur where tissue is taken. As with any injection, there is also a risk of infection in the treated joint.

Increasing redness, warmth, progressively worsening pain, discharge or fever at the treatment site requires prompt assessment. The clinic is not a 7/24 emergency department; if such signs occur at night or over the weekend, call 112 or attend the nearest hospital emergency department.