BACKGROUND: Recently, regenerative medicine based on cell-based therapies has emerged as a therapeutic possibility for the management of osteoarthritis (OA). Stromal vascular fraction (SVF) is a cellular mixture obtained from lipoaspirate processed through either mechanical or enzymatic separation. SVF has been applied in several countries to treat OA patients without robust supporting evidence or comprehensive evaluation. METHODS: This review purposes to summarize clinical evidence regarding SVF as a therapeutic for OA and to introduce the author's perspective. Eleven studies were found suitable for this review; out of these, seven were randomized clinical trials and four were cohort studies. RESULTS: A review of controlled studies suggests that SVF may offer better symptomatic relief than placebo or hyaluronic acid in the long term, and the effect of SVF is comparable to that of bone marrow aspirate concentrates. CONCLUSION: Prospective studies with improved control over the cell isolation method, dosage, and patient selection are necessary to provide convincing evidence of the benefits of SVF in treating OA.