Bone marrow vs. adipose or fat tissue is a fairly contentious issue, and people on both sides get pretty worked up about it - in my opinion a lot of it is the time and energy they've put into developing their specific methods. At this point there is no good evidence to say that one is better than the other. Dr. Gelber favors adipose cells for the following reasons:
- Easier recovery for the patient - a week versus 2+ months of soreness.
- Adipose tissue has 100-500 times as many regenerative cells per unit of volume as bone marrow.
- You can collect much more adipose tissue than bone marrow - sometimes when Dr. Gelber performs a cosmetic liposculpture she collects a gallon or more; getting a few tablespoons is easy.
- Your body is using the bone marrow regenerative cells to make things it needs, while the adipose cells are as far as we know, not being called on to do anything.
- Since unprocessed bone marrow contains fewer regenerative cells than adipose tissue, most people culture the marrow for long periods of time to increase the cell counts. Dr. Gelber doesn't like the idea of culturing cells; genetically they may be yours - but grown in a petri dish, are they developing properly?
- Even proponents of bone marrow seem to feel that adipose preparations may offer better relief to those with a component of instability to the affected joint.
On a personal level, if I had bone on bone degeneration I would happily have bone marrow regenerative cell therapy - but given a choice I'd rather do adipose.
I hope that helps. You can ask the doctor when you see her but she'll say the same thing - adipose cells have such high yields and are so much easier on the patient it just makes sense to use them.
[This is a slightly edited version of an email I (Matthew) sent to a patient last week; I thought people would be interested in it so I am reposting it here.]