Nancy Killmer of Bethel Park underwent an IOBP procedure more than two years ago.

A bucket list item turned into a huge pain a few years ago for Nancy Killmer.

“I’ve always wanted to run a 5K,” said Killmer, of Bethel Park. “I’ve never run, so I started running to prepare for a 5K. One day I was walking and my knee just gave out on me. I was in immediate pain.”

Killmer wound up seeing an orthopaedic specialist and learned she had little cartilage left in her knee.

“I was shocked but it was my own fault,” said the active 57-year-old. “You never know what’s going on in your body until you try to do something. There’s probably a progression and running wasn’t helping it.”

At first, she tried physical therapy to relieve the pain, but that didn’t work.

Then she consulted Dr. Sam Akhavan, orthopaedic surgeon and Director of Orthopaedic Research with Allegheny Health Network. He presented her with a new solution she had never heard of: using bone marrow stem cells to heal her knee.

“He proposed two courses of action,” Killmer said. “One was a partial knee replacement and one was to do the stem cell surgery. We weighed the pros and cons. The reason I went with the stem cell surgery is that down the road if I have problems, I can do it again without having invasive surgery.”

Promote healing,

delay surgery

The whole idea behind this relatively new procedure called intraosseus bioplasty (IOBP) is to promote healing of the joint and to delay surgery.

IOBP is used to treat acute or chronic knee injuries such as osteoarthritis or early-stage osteonecrosis and osteoarthritis, which affects more than 21 million Americans. It’s a treatment that uses concentrated biological materials from bone marrow to promote healing and repair within the knee joint.

“With knee pain, one of the things that can happen is the bone marrow that actually supports the joint either gets overloaded or as a result of injury gets something called bone marrow edema, which essentially means there’s fluid and inflammation right under the cartilage,” Akhavan said.

In the past, that meant either knee replacement surgery or another option to stabilize the knee.

“In the past, what we’ve done is surgically drilled into that area and injected calcium phosphate to stabilize that area,” Akhavan said. “It’s a good option for some patients. In younger patients, it’s not a great option because if that fails, there’s really no other option but to do a knee replacement.”

So why not drill then inject something that could heal the joint?

That’s how IOBP works by replacing the calcium phosphate with a mixture of stem cells taken from the patient’s hip and a bone graph.

“We basically mix the two of them together to create kind of like a slurry,” Akhavan said. “We inject that into the area and it promotes healing of the bone marrow edema rather than just stabilizing it or filling in that area.”

Who it helps

Not everyone is a candidate for IOBP, but Akhavan said a good candidate would be a patient with early stage osteoarthritis who has knee pain and a bone marrow edema on an MRI.

What causes the edema?

“There’s a variety of causes,” Akhavan said. “You can get edema as a bone bruise, the bone dying off from vascular necrosis or as a result of osteoarthritis.”

The benefit of the IOBP procedure is it can relieve pain, promote healing and delay or eliminate the need for knee replacement surgery.

There’s also another huge upside.

“Unlike the procedure with the calcium phosphate, this procedure can actually be repeated,” Akhavan said. “So if somebody does well from this, they can come back in three, four or five years or whatever then pick up and we can do it again.”

The procedure itself takes only about 30 minutes in an outpatient surgical setting. The downside is that recovery requires absolutely no weight bearing on the knee for three to four weeks.

“To allow them to kind of set a structural property,” Akhavan said of the healing time. “It’s just basically bone graft and stem cells, so we want to put them in a position where they can actually heal themselves.”

For Killmer, that three-week period was the toughest part.

“I was on crutches and I couldn’t even put my foot down,” Killmer said. “He said if you put your foot down and break a potato chip that’s too much. I was able to manage doing it.”

After three weeks, Killmer began physical therapy. That was two and half years ago and she’s thrilled with the results.

“It was a lot of hard work,” she said. “But once I didn’t have any more pain, it was just like a miracle. I was released to resume basically normal activity and exercise except for running.”

This summer, she’s walking and swimming and is still pain-free.

“Anybody that starts talking to me about knee stuff, you need to look into this procedure,” Killmer said. “Because it’s like a Space Age thing, really, to use a stem cell from another area and putting it into a place where it kind of regenerates itself. I mean, it’s unbelievable.”


Kristin Emery is a meteorologist at KDKA-TV in Pittsburgh, an O-R columnist, and writer for Total Health magazine and other publications. Kristin is a Washington native and a graduate of Washington High School and West Virginia University.

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