What Can You Do for Bone on Bone Knee Pain Relief? (without Surgery)

What Is Bone on Bone Knee Arthritis?

When many people hear the the term bone on bone knee pain they think envision that there's no cartilage left in their knee.

In reality, that's usually not the case.

But because of that misconception, it's common for people to think that the only option for bone on bone knee pain relief is knee replacement surgery.

Furthermore, when you have bone on bone knee arthritis, it's likely that you'll be referred to see an orthopedic surgeon. And knee surgeons are biased to believe that the only (or best) treatment for bone on bone knee pain is a total knee replacement surgery.

So what does "bone on bone knee pain" really mean?

Bone one bone knee pain is a colloquial term for Grade 4 knee arthritis.

Knee arthritis is graded on a 0-4 scale known as the Kellgren-Lawrence Scale.

Kellgren-Lawrence Arthritis Grading Scale

• Grade 0 - no arthritis
• Grade 1- doubtful arthritis,
• Grade 2 - mild arthritis
• Grade 3 - moderate arthritis
• Grade 4 - severe arthritis

 

More specifically, Grade 4 knee arthritis means the presence of "large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone ends".

That means that there are large bone spurs, severe joint space loss (not necessarily the entire joint space), and hardening and deformity of the bone that's underneath the cartilage.

That can be in one compartment of the knee or it can be in multiple compartments of the knee.

The 3 compartments of the knee include:

1. Medial compartment (inside of the knee)
2. Lateral compartment (outside of knee)
3. Patellofemoral compartment (front of knee)

 

If you just have grade four knee arthritis in one compartment, you very well may be able to continue to function and do your everyday activities without needing surgery.

If you have severe arthritis in all three compartments, your odds of needing surgery increase.

Do You Need Surgery For Bone on Bone Knee Pain?

The truth is nobody ever needs knee replacement surgery.

It's an elective surgery, and you can live without it.

For example, if you have a heart attack, a cardiac bypass may not be optional if you want to continue living.

However, the choice of whether you have a knee replacement is ultimately up to you.

Sometimes patients with bone on bone knee arthritis are told by their orthopedic surgeons that "you need a knee replacement."

However, if you can find ways to continue to do the things that you need and want to do without being limited by your knee pain, then no one can tell you that you need a total knee replacement.

For some people, that is the best option.  For others it's not.

The decision is ultimately yours as to what option you're most comfortable with.

What Can You Do For Bone on Bone Knee Pain Relief Without Surgery?

There are alternatives to having a knee replacement if you choose not to have surgery for bone on bone knee pain.

Exercise Therapy for Knee Arthritis

First of all, one of the most widely studied and most effective treatments for knee arthritis is exercise.

Exercise therapy for knee arthritis, from mild to severe grades, has consistently been shown in research to improve function and improve pain.

However, a less know role of exercise is that it can even affect the structure of knee cartilage according to a 2022 Systematic Review in Healthcare.

What type of exercise should you do for bone on bone knee pain?

There's no one particular exercise that's going to fix bone on bone knee pain. However, many kinds of exercise can relieve it.

Most of the research is centered around weight-bearing aerobic activity such as walking.

But that's a catch-22 for many people who have bone on bone knee pain because walking is usually one of the activities that bothers people the most.

Water Walking

Walking in the water is a great way to unload your knee if you have access to a pool because the buoyancy of the water helps unload your joints and makes you functionally lighter.

Weight Loss For Bone on Bone Knee Pain Relief

To that end, weight loss is another very effective alternative for bone-on-bone knee pain.

The less weight you're carrying in your abdomen, the less pressure there is on your knee joint.

That weight gets magnified over your knee joint up to 4 times, according to a study in Arthritis & Rheumatology.

Devices for Bone on Bone Knee Pain Relief

There are some devices that will allow you to walk more comfortably with bone on bone knee pain as well.

Using a cane, a rollator walker, or a knee unloader brace also helps take pressure off the knee so you're not bearing as much weight down across the arthritic joint surfaces.

Many people are hesitant to use a cane, a rollator walker, or a knee brace because they think it'll make them look old.

However, if you're going to be having a knee replacement - having a part of your body cut out - who cares what other people think?

If using a rollator walker or a cane will allow you to get around more comfortably and do the things that bring value to your life, it's okay to use one.

Truth be told, if you're limping around because you're in pain, you're probably going to look old anyway.

Your friends and family will be much happier if you're able to go out and do things with them.

Nobody besides you is probably going to care about the fact that you're using a cane or a rollator walker.

Strengthening Exercises For Bone on Bone Knee Pain Relief

Strengthening exercises can also be helpful if you have bone on bone knee arthritis.

Weakness in your hip muscles or in your glute muscles can contribute to more side-to-side motions. This puts extra stress on the medial compartment and lateral compartment.

Therefore, it's important to help strengthen your glutes, particularly the muscles that help you stay balanced on one leg when you're walking.

Strengthening your gluteus medius helps with side-to-side balance, while strengthening your gluteus maximus helps reduce compression forces behind your kneecap.

What About Other Treatments For Bone on Bone Knee Pain?

Cortisone injections can be helpful in the short term if you're, say, going on vacation and you need temporary bouts of pain relief.

However, they can damage the knee joint if you have them too often. Therefore, it's best to have them only on a very occasional basis.

Is PRP or platelet-rich plasma good for bone on bone knee pain?

Platelet-rich plasma (PRP) is an upcoming treatment in the field of regenerative medicine.

There are studies showing promising results.  However, according to a 2022 meta-analysis, they found that PRP did show small, not clinically important benefits over other types of injections in terms of pain and function. Furthermore, it was not superior to exercise therapy for pain and function, nor was it superior any treatment for improvements in cartilage thickness.

Conclusion

If you have bone on bone knee pain, ultimately, the choice of whether you need or want to have knee replacement is up to you.

Neither your doctor, surgeon, nor physical therapist can make that decision for you.

It's your choice.

But there are a few things I want you to take home from this video:

1. Just because you have bone-on-bone knee arthritis doesn't necessarily mean that there's no cartilage at all left in your knee.
2. There are conservative treatment options available, but those options aren't going to be the same for every person.

So, I would encourage you to explore your conservative treatment options.

You can always go and have the knee replacement later, but once you have it, you can't undo it.

Furthermore, there are about 20% of people who have knee replacements who aren't satisfied with their results.

Need Need Help For Bone On Bone Knee Pain Relief?

If you're in the St. Louis area and you'd like to explore your options to avoid knee replacement surgery, we'd be happy to help you out here at More 4 Life.

Just tap the button below to request an appointment with one of our specialist physical therapists.

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