Percutaneous Hydrotomy

Percutaneous hydrotomy is a local injection technique that combines local hydration with the targeted delivery of selected therapeutic substances.

In practical terms, very fine needles are used to introduce sterile physiological saline into the skin or just beneath it in the area being treated. The saline forms a local reservoir known as the hydrotomy cushion.

The technique can be understood through three complementary principles: local hydration, targeted local delivery, and micronutrition and regenerative support.

It developed at the intersection of approaches including mesotherapy and subcutaneous infusion.

Our introductory article What Is Percutaneous Hydrotomy? explains the technique, how a session works and what it is used for.

Percutaneous hydrotomy is used in osteoarthritis, chronic joint and tendon problems, back pain and other persistent or recurrent musculoskeletal conditions.

The treatment is designed as a locoregional approach. It combines superficial local hydration with targeted delivery of selected therapeutic substances to the tissues around the area being treated.

The clinical objectives are practical and patient-centred: reducing pain, improving mobility and function, increasing tolerance of activity and supporting recovery of the affected tissues.

In degenerative conditions, the therapeutic objective can also extend beyond symptom relief towards supporting the repair, recovery and biological condition of the affected tissues themselves. Clinical and radiological observations of structural improvement have been described in some degenerative joint and spinal conditions, alongside improvements in pain, mobility and function. Research at the level of larger controlled studies continues to develop.

Percutaneous hydrotomy was developed by Dr Bernard Guez and has been used clinically for several decades.

Over that time, physicians, nurses and other trained practitioners using the technique have accumulated substantial clinical experience in osteoarthritis, chronic joint and tendon problems, spinal pain and other persistent musculoskeletal conditions.

Hydrotomy has also been documented through university work, clinical series, congress communications and practitioner experience, including work relating to knee osteoarthritis, chronic low-back pain and large-dilution mesoperfusion.

Within this clinical experience, improvements in pain, mobility and function have been reported consistently. Structural changes and imaging observations have also been described in some degenerative conditions, which continues to support clinical interest in the regenerative dimension of the technique.

At Centre Algos, patients also experience substantial improvements in pain, movement and everyday function following treatment.

Clinical experience with percutaneous hydrotomy includes substantial improvements in pain, mobility and function across a range of musculoskeletal conditions.

At Centre Algos, we see these improvements in practice, particularly in patients treated for osteoarthritis, persistent joint and tendon problems, and certain chronic back and disc-related conditions.

The improvements that matter most are often practical:

In degenerative joint conditions, including knee osteoarthritis, structural and cartilage-related improvements have also been described or observed clinically and on follow-up imaging; we set this out in our article on percutaneous hydrotomy for knee osteoarthritis.

In chronic back and disc-related conditions, clinical experience includes substantial improvements in pain, mobility and function. Disc rehydration and regenerative processes can form part of the therapeutic objective, and structural changes have also been observed and described clinically and radiologically. Our article Back Pain Without Surgery discusses this in more detail.

These structural observations matter clinically, because they indicate that improvement is not necessarily limited to temporary symptom relief.

Treatment response is assessed throughout the course of care. We consider pain, movement, function, tolerance of activity and return to everyday life, and where clinically relevant, existing or additional imaging also informs the overall assessment.

Percutaneous hydrotomy has been used clinically for several decades, with reported improvements in pain, mobility and function in musculoskeletal and degenerative conditions.

The evidence relating to percutaneous hydrotomy sits at several levels: hydrotomy-specific clinical and university work, prospective research into large-dilution mesotherapy and mesoperfusion, and a broader peer-reviewed literature on locoregional spinal and musculoskeletal mesotherapy.

These levels of evidence should be distinguished from one another, but together they provide more information than clinical experience alone.

Chronic low-back pain: the 2022 multicentre mesoperfusion study

One of the most clinically relevant studies was completed in 2022 by Dr Myriam Semani as part of the university diploma in mesotherapy at Pitié-Salpêtrière / Paris VI.

This prospective multicentre study examined large-dilution mesotherapy delivered by mesoperfusion in 47 patients with chronic low-back pain, with or without associated sciatica. Symptoms had been present for an average of around 29 months.

Many participants had already been treated: 92 percent had received physiotherapy, 40 percent had received infiltrations, and some had previously undergone surgery.

Average pain scores were 7.8/10 at baseline, 3.6/10 at day 30, 2.1/10 at day 60 and 1.1/10 among the participants for whom day 90 data were available.

The study reported an improvement in individual pain scores in 96 percent of the patients included. This should not be interpreted as a universal 96 percent success rate. Functional disability also improved substantially: the median Quebec functional score fell from 50 at baseline to 14 at final assessment, and analgesic use decreased over the follow-up period.

The study was prospective and multicentre, but it did not include a randomized control group. Later follow-up data became progressively incomplete, so the day 90 value applies only to the subgroup of participants with data at that point.

The study used a closely related large-dilution mesoperfusion approach involving physiological saline and superficial locoregional administration. Its design makes it particularly relevant to the hydration and large-dilution principles used in percutaneous hydrotomy.

Even with these limitations, the size of the improvement in pain and function is clinically meaningful and supports further research into large-dilution mesoperfusion and hydrotomy-related approaches.

Broader spinal mesotherapy research

A 2024 study examined spinal mesotherapy in 130 patients with chronic low-back pain. The treated groups showed significant improvements in pain and disability that were maintained over follow-up, and no adverse effects were reported in the study.

A 2025 review then analysed nine studies including more than 800 patients with chronic back pain syndromes. Across the studies included, spinal mesotherapy showed a consistent positive effect on pain and function, and no serious adverse events were reported in the studies reviewed.

These studies did not all use the same technique, substances, dilution or protocol as percutaneous hydrotomy, so they should not be read as direct trials of every hydrotomy protocol. They remain scientifically relevant because they show that the broader family of locoregional mesotherapy techniques has a growing clinical evidence base.

Knee osteoarthritis

Hydrotomy-specific clinical and university work has also examined knee osteoarthritis, and the broader mesotherapy literature includes randomized controlled research in osteoarthritis and musculoskeletal pain. We set out treatment, reported results, structural observations and evidence in detail in our article on percutaneous hydrotomy for knee osteoarthritis: treatment, results and evidence.

How should this evidence be interpreted?

The data do not all come from identical treatment protocols. The Semani work is particularly relevant to the large-dilution mesoperfusion tradition, which is closely related to percutaneous hydrotomy, while the broader spinal and musculoskeletal mesotherapy literature supports the wider locoregional treatment family.

Taken together with decades of hydrotomy-specific clinical experience and reported clinical and structural observations, these studies provide a growing clinical evidence base for the technique and its broader locoregional treatment approach.

Larger controlled studies, particularly studies with standardized imaging endpoints, can further define the extent, frequency and durability of regenerative structural change.

Source: Myriam Semani. Intérêt des grandes dilutions en mésothérapie dans la prise en charge des lombalgies chroniques. Technique de mésoperfusion. DIU de Mésothérapie, Pitié-Salpêtrière / Paris VI, 2022.

Hydrotomy-specific clinical experience also includes structural and radiological observations in degenerative joint and spinal conditions.

For a deeper look at clinical results, safety, scientific research and regenerative observations, read our guide to Percutaneous Hydrotomy: Effectiveness, Safety and Scientific Evidence.

Percutaneous hydrotomy is used for a range of chronic, recurrent and degenerative problems affecting the joints, tendons, back and other parts of the musculoskeletal system.

It is used for problems such as:

Our pages on osteoarthritis, back pain and tendon problems describe these situations in more detail.

Back pain and disc problems: disc degeneration involves changes in the extracellular matrix, loss of hydration and alterations in the local tissue environment.

Within percutaneous hydrotomy practice, treatment can therefore aim to improve the hydration and biological conditions of the local tissue environment and to support disc rehydration and regenerative processes.

Clinical experience includes substantial improvements in pain, mobility and function, and structural changes have also been observed and described clinically and radiologically.

These observations are encouraging and clinically relevant. Larger controlled imaging studies can clarify how frequently structural change occurs and quantify it more precisely. Our article Back Pain Without Surgery discusses the options in detail.

At Centre Algos, we first look at the problem as a whole: where the pain or limitation is, how it developed, how long it has been present, what examinations have already been performed and which treatments have already been tried.

We then determine with the patient how percutaneous hydrotomy and other relevant treatments fit into the individual treatment plan.

You can also learn more about why knee osteoarthritis becomes painful in our dedicated Knowledge Centre article.

Percutaneous hydrotomy differs from a conventional infiltration both in how the treatment is administered and in its therapeutic concept.

With percutaneous hydrotomy, very fine needles are used superficially, in the skin or just beneath it around the area being treated. The saline forms the local hydrotomy cushion and, depending on the treatment plan, carries selected therapeutic substances in substantial dilution.

A conventional infiltration generally involves administering a more concentrated medication, such as a corticosteroid, into or around a specific structure primarily for the pharmacological effect of that medication.

The approaches therefore use different techniques and have different therapeutic objectives.

Hydrotomy does not mean inserting a large needle directly into a joint. Its superficial intradermal and subcutaneous technique, the local hydration and hydrotomy cushion, the substantial dilution and the targeted delivery form a distinctive and broader therapeutic concept.

During a percutaneous hydrotomy session, very fine needles are used to make superficial injections into the skin or just beneath it in the area being treated.

Sterile physiological saline is introduced through these injections, creating the local hydrotomy cushion. Depending on the treatment plan, selected therapeutic substances are also administered through this local approach.

The needles themselves remain superficial rather than being inserted deeply into a muscle, disc or joint.

The precise technique depends on the area being treated, the condition and the therapeutic objective. Different methods are used, including direct injections and mesoperfusion, in which the solution is administered progressively through multiple superficial points.

The treatment is performed using sterile products and single-use equipment under strict hygienic and aseptic conditions.

Percutaneous hydrotomy is generally well tolerated, although the superficial injections can cause temporary discomfort.

The sensation varies depending on the area being treated, the technique used, the amount of solution administered and the patient's individual sensitivity.

Very fine needles are used, and the procedure is adapted to make treatment as comfortable as possible.

The treated area can also feel temporarily sensitive after a session.

There is no fixed number of percutaneous hydrotomy sessions that is right for every patient.

The number and frequency of treatments depend on the problem being treated, how long it has been present, its severity, previous treatments and the patient's individual response.

Some problems are treated as a course rather than a single session. Progress is assessed during treatment so that the plan can be continued or adapted according to how the patient responds. Session fees are listed on our prices page.

The treatment plan is therefore built around the individual patient rather than a fixed schedule.

Percutaneous hydrotomy is generally well tolerated, including by many people who are initially a little apprehensive about needles.

The technique uses very fine, superficial needles placed in the skin or just beneath it. They are not inserted deeply into a joint, muscle or spinal disc.

At Centre Algos, treatment is performed under strict hygienic and aseptic conditions using sterile products and single-use equipment. Particular attention is paid to the substances used, their dilution and compatibility, and the injection technique.

Before treatment, we review relevant medical history, current medications, allergies and possible contraindications.

Temporary local reactions can occur, such as sensitivity at an injection point or a small bruise. More significant complications are uncommon when appropriate precautions and aseptic technique are followed.

At Centre Algos, percutaneous hydrotomy is integrated into an individual treatment plan based on the patient's symptoms, diagnosis, function, previous treatments and therapeutic goals.

We review the clinical picture as a whole, including existing examinations and imaging, previous treatment response and relevant medical factors.

We then define the treatment strategy together with the patient, including the areas to treat, the hydrotomy protocol, the substances used and the number and rhythm of sessions.

Percutaneous hydrotomy can be used as a focused treatment or combined with other approaches where this supports the patient's broader recovery and functional goals.

If you are living with osteoarthritis, persistent joint or tendon pain, chronic back pain or another recurrent musculoskeletal problem, a consultation at Centre Algos allows us to review your symptoms, previous investigations and treatments and determine how percutaneous hydrotomy can fit into your treatment plan.

We then discuss the treatment approach with you and build the plan together.