When medical professionals refer to bone-on-bone knee pain, they are usually describing osteoarthritis. This condition affects a huge number of people in the U.S. and is a leading cause of pain and disability.
Fortunately, treatment options are available, and there are lifestyle changes you can make to reduce your chances of developing symptoms or ease symptoms you already have. In this article, we’ll explore what bone-on-bone knee pain is, what causes it, and common symptoms. We’ll also discuss how it’s diagnosed and treated, including surgical and non-surgical options.
What is bone-on-bone knee pain?
Your knees have protective cartilage (menisci) that separates the bones of your knee joint, stopping them from coming into direct contact with each other. Bone-on-bone pain describes the pain you get when your knee’s protective cartilage gets worn away.
Without the cartilage, the joint surfaces of your knee can scrape against each other, causing pain, inflammation, and other symptoms. There can be several reasons for this — let’s look at some of these in more detail.
Causes of bone-on-bone knee pain
In medical terms, 'bone-on-bone knee pain' usually means knee osteoarthritis (OA). OA affects millions of people worldwide and is more common in older adults.
Joint inflammation and cartilage breakdown are typical characteristics of OA. It is a degenerative condition, meaning it tends to get worse over time. As cartilage continues to break down and inflammation worsens, you may experience pain, weakness, and difficulty walking or moving your knee as normal.
Other types of arthritis that may cause cartilage breakdown and bone-on-bone knee pain include:
- Rheumatoid arthritis. This is an autoimmune condition in which your immune system attacks your knee joint cartilage. Over time, this can cause bone-on-bone knee pain.
- Post-traumatic arthritis. This is common in people who have broken a bone in their knee. Injuries can damage the knee cartilage, causing instability, pain, swelling, and further cartilage damage over time.
- Psoriatic arthritis. This type of arthritis is related to the skin condition psoriasis. It is estimated that 20–30% of people with psoriasis will develop psoriatic arthritis over time, which damages cartilage in the knee.
Symptoms and diagnosis
Here, we’ll focus on osteoarthritis, the most common form of bone-on-bone knee pain. Let's explore its common symptoms and how it’s diagnosed.
Symptoms
Symptoms of knee osteoarthritis may include pain (the most common symptom of OA), swelling, and stiffness. You may find it hard to bend or straighten your knee, and you may struggle to walk normally during flare-ups or as it progresses.
You may also experience grinding sensations or clicking sounds in your knee joint. These are called crepitus and, in people with arthritis, are often due to bones rubbing against each other where the cartilage has worn away.
Diagnosis
To diagnose your symptoms, your doctor or physical therapist will require a full medical history. This includes your symptoms, other medical conditions, and any medications you take.
They will also perform a set of physical tests to assess the strength of your knee, its range of movement, any pain, how you walk, and any visible changes to your knee. If your doctor thinks you may have knee OA, they may order an X-ray or a magnetic resonance imaging (MRI) scan.
X-rays are often more convenient but may not show early signs of joint damage. MRIs take longer and are more expensive, but can provide more detail.
Visible signs on knee joint imaging can indicate OA. These include the presence of bony spurs (called osteophytes) along the edges of your knee joint or a narrower knee joint space than normal.
If your doctor suspects something other than OA may be causing your knee pain, they may order blood tests or take a sample of your joint fluid to rule out other conditions, such as gout or an infection.
Treatment options
There are many potential treatment options for bone-on-bone knee pain. These vary depending on the type of arthritis you have, the stage it’s at, and other factors.
Non-invasive treatments
Non-invasive treatments are usually the first port of call when you’re diagnosed with osteoarthritis. Here are some of the top evidence-based treatments for knee OA.
Physical therapy
Most people with knee OA will benefit from a referral to physical therapy at some point over the course of their treatment. One of the main roles of physical therapists is to help with tailored exercise programs — exercise is strongly recommended by research as a treatment and prevention for knee OA.
Physical therapists can also help with self-management strategies for pain, such as hot and cold therapy, as well as providing pain-relieving techniques like kinesiotaping.
Healthy weight management
If you’re overweight, dropping a few pounds may help your knee pain as well as improve your overall health. Less weight means less pressure on your knee joint, which may reduce pain and inflammation.
Assistive devices
Physical therapists often prescribe walking aids, such as crutches or a cane. These can help with pain and mobility during a flare-up and keep you active for as long as possible if your OA progresses.
Knee braces can reduce pain, improve stability, and help with getting around. Your doctor may prescribe a specific type of knee brace that takes pressure off the part of your knee affected by arthritis.
Pain medication
Painkillers can help with keeping your knee pain manageable and allow you to stay active. These include non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injections into the knee.
Alternative therapies
Research supports the use of several alternative therapies for bone-on-bone knee pain. These include acupuncture, tai chi, supplements for bone health, and more.
Surgical options
If non-invasive treatments are not sufficient, your doctor may recommend knee surgery. This involves an initial consultation with an orthopedic knee surgeon, who will discuss the pros and cons of surgery to help you make an informed decision.
Surgical options include arthroscopy and partial or total knee replacement. An arthroscopy involves inserting a tiny camera into your knee joint, which can be used for diagnostic purposes and minor surgery.
While the camera is inside your knee, your surgeon may remove damaged cartilage or bone spurs. However, it is usually not a long-term solution.
For a partial knee replacement, only the affected joint surfaces are replaced, and the unaffected parts of the joint are left untouched. For example, if you have inner knee pain but the rest of your knee is unaffected, you may just have the inner part of your knee joint replaced. A partial replacement often has quicker recovery times than a total knee replacement.
However, you may need a total knee replacement in the future if the other parts of the joint become affected. A total knee replacement involves replacing the entire knee joint and is often the chosen treatment for severe cases of knee arthritis.
The final word
Bone-on-bone knee pain can be debilitating, but help is available. If you’re experiencing symptoms of arthritis, seek advice from your doctor or physical therapist. They can provide a diagnosis and lifestyle advice and recommend the best treatment options for you.
FAQ
Do you need a knee replacement if you have bone-on-bone knee pain?
Not everyone with bone-on-bone knee arthritis needs a knee replacement. Less invasive methods are usually tried first, but if these are unsuccessful and you continue to struggle with pain and limited movement, you may be a candidate for a knee replacement.
How bad is bone-on-bone knee pain?
If your knee cartilage is sufficiently worn that your bones are rubbing together, you may have significant pain. You might struggle with sleeping, walking, and completing basic tasks due to your pain and reduced mobility. However, the level of pain associated with bone-on-bone arthritis varies greatly, and surprisingly, some people have no pain at all.
Is walking actually good for bone-on-bone knee pain?
For people with bone-on-bone knee pain, walking is important to maintain strength and flexibility in your knee, as well as general aerobic fitness. However, it’s important not to overdo it. Walking too far or too fast when you have arthritis can cause your symptoms to flare up, so listen to your body.
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Bone-on-bone knee pain is often caused by osteoarthritis. This condition causes cartilage to wear away over time until, eventually, the bones of your knee joint can rub together.
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Other types of arthritis that may cause bone-on-bone knee pain include rheumatoid arthritis, post-traumatic arthritis, and psoriatic arthritis.
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Non-invasive treatments for arthritis pain include physical therapy, exercise to strengthen your knees, walking aids, knee braces, weight management, and pain medication.
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For severe cases of arthritis that don’t respond to non-invasive treatment methods, your healthcare team may recommend an arthroscopy or knee replacement surgery.
7 resources
- JCI Insight. Dysregulated integrin αVβ3 and CD47 signaling promotes joint inflammation, cartilage breakdown, and progression of osteoarthritis.
- International Journal of Surgery. Lingering risk: a meta-analysis of outcomes following primary total knee arthroplasty for patients with post-traumatic arthritis.
- F1000 Research. Psoriatic arthritis.
- Best Practice & Research Clinical Rheumatology. Pain in osteoarthritis from a symptom to a disease.
- JAMA. Diagnosis and treatment of hip and knee osteoarthritis.
- Arthritis & Rheumatology. 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee.
- Knee Surgery, Sports Traumatology, Arthroscopy. Patients return to work sooner after unicompartmental knee arthroplasty than after total knee arthroplasty.
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