Debunking the Myth: “Bone on Bone” Classification of Knee Osteoarthritis

One of the things I hear regularly from our knee pain patients, is that they are “bone on bone and there is nothing I can do but get surgery.”

These are people looking for a nonsurgical approach and have been told by a specialist in orthopedics they are bone on bone and that’s it, surgery is their only option.Less than one-quarter of these patients actually reviews their own x-rays and has taken the specialists at their word. Time and time again we take x-rays of the same knee and it turns out it IS a “bone on bone” case, BUT… it’s only bone on bone on one side of the joint, usually the medial side, and there is still a lot of space on the lateral side. Rather than surgery, there are other solutions that can be offered such as off-loading braces that would open the knee joint and steal some space from the other side of the joint to see if it can decrease the inflammation and reduce pain.

Instead, they are offered surgery, a cortisone shot or told they cannot have a cortisone shot and must do surgery.It is amazing to me how many people will blindly go down this path without asking questions or seeking out more truths. The patient’s perception of bone on bone is that the entire joint is smashed on top of itself and there is nothing left of the tissue that once made up the meniscus or the articular cartilage;9 times out of 10 that is not true!

I have conducted x-rays for over 1000 knees in the past several years, and I have seen one case where the joint has no tissue or cartilage…only ONE case.Truth is; a lot of these patients could go 5-10 more years using an over loader brace and a hyaluronic acid injection on an annual to 6-month basis. Additionally, Regenerative Medicine and PRP could be used to heal the tissue. It may not make the joint look 20 years old again, but it can relieve pain and improve function, and it does so without changing the joint by removing bone and adding hardware or drying it out causing further degeneration.

Let’s take the bone on bone quiz:

Look at each of the photos below and make note of your Yes or No answers for each:

  • 1. Is the knee considered bone on bone?
  • 2. Can it be treated non-surgically to reduce overall pain and frequency of pain?
  • How did you do?

    ALL but one can be treated successfully with an off-loading brace, hyaluronic acid injection and Regenerative Medicine or PRP. Only the last picture, Grade 4, is a true bone on bone situation in that nothing will help except surgery, but remember, even surgery is not guaranteed to work. Based on research, following surgery 25% of people suffer less pain, but still have some pain, 25% of people suffer worse pain, 25% experience the same pain as before the surgery and only 25% experience no pain. Keep in mind, this research reflects results from the first two years after surgery and the hardware utilized does eventually wear out.

    BE AWAREif your diagnosis is that you are bone on bone and that surgery is the only option, be sure you have the opportunity to look at your x-ray, what you see might surprise you and will hopefully inspire you to get a second opinion.

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