'Bone on Bone' Knee Damage: What Does it Mean? (2023)

'Bone on Bone' Knee Damage: What Does it Mean? (1)

‘Bone on bone’ knee osteoarthritis

Knee cartilage starts to wear away as we get older. Symptoms of knee pain and swelling develop as the cushioning of the cartilage begins to fail. So what happens when you have no cartilage in knee, and what can you do about it? We discuss treatment options for ‘bone on bone’ knee cartilage damage in this blog.

Causes of no cartilage in knee

The most common cause of knee cartilage damage is osteoarthritis. Knee cartilage loss can be due to an injury to the knee, such as a ligament tear, patellar dislocation, or meniscal tear. In addition, loss of knee cartilage can be triggered by lifestyle factors such as weight gain, diabetes, and high cholesterol. Also, inflammatory arthritis conditions such as rheumatoid arthritis can lead to further knee cartilage damage. Overall, osteoarthritis of the knee is not as simple as ‘wear and tear’. Without proper diagnosis and treatment, osteoarthritis can quickly degenerate the joints even further until bone on bone knee damage is seen.

Symptoms of knee cartilage damage

Generally, symptoms of worsening loss of knee cartilage include pain with activity, swelling of the joint, and reduced knee joint function. Often, previously simple tasks such as walking, housework, and standing from sitting become more difficult due to pain, swelling, and restriction.


But all is not lost. A variety of treatments are used to treat cartilage loss in knee. Generally, treatments range from simple weight loss and exercise measures to more invasive treatments such as injections or surgery. Overall, we recommend simple treatments first for cartilage loss in knee.

Weight loss

In general, weight gain leads to worsening symptoms and progression of osteoarthritis. Firstly, increasing weight places more significant pressure on the knee joints leading to greater knee cartilage damage. It is well known that obese people develop osteoarthritis at an earlier age and have worse pain than healthy people. Secondly, increased fat cells in the body stimulate insulin production leading to chronic inflammation. This type of inflammation leads to more significant cartilage degradation and worsening cartilage loss in knee.

Overall, losing weight reduces pressure on the joints and reduces body inflammation improving symptoms. Studies suggest that a 10% reduction in weight leads to a 50% reduction in knee pain from cartilage loss – a vast improvement.

Exercise therapy

Exercise in the form of strength training and aerobic conditioning improves symptoms from loss of cartilage in knee. Symptom improvement occurs from lowering chronic inflammation in the body combined with weight loss and improvement of muscle strength. In addition, strengthening the muscles around the knee helps offload the knee and reduce pressure on the joint. Studies suggest that a combination of gym, pilates, yoga, and Tai Chi is the most effective for improving pain and function.

Generally, exercise works the best for the following:

  • younger patients, although older patients still benefit.
  • Knee arthritis. There are over 50 high-level studies showing exercise works in knee arthritis.
  • An exercise program that follows the American College of Sports Medicine guidelines. So, a combination of aerobic, resistance training, and balance exercises with the progression of strength training. Generally, the stronger you get, the better. Also, a supervised program with a personal trainer works best.

Can I run with knee arthritis?

There are no simple answers. An exercise program aims to improve symptoms and general exercise tolerance, including running. We always say to people that running should be your goal if you enjoy it. However, some people might need to reduce their running depending on pain. If you have true ‘bone on bone’ knee cartilage damage, you should find a lower impact form of exercise.

The good news in this study: running at your own pace does not worsen cartilage loss in knee on X-ray and may improve your pain.


An offloading brace can be effective when cartilage loss in knee s confined to one area of the knee only. These offloading braces push the knee away from the side of no cartilage, reducing pressure and inflammation in that part of the knee. Generally, braces are OK at reducing pain and improving function in the knee. However, some people find them uncomfortable.

NSAIDs for cartilage loss in knee

Over-the-counter medications such as ibuprofen reduce pain associated with no cartilage. However, the effect is negligible. Your doctor will be able to prescribe more effective medication to alleviate pain associated with bone on bone cartilage damage. But, you need to be aware of possible side effects such as gastritis, reduced kidney function, and increased blood pressure. One alternative to tablets is topical NSAID creams or ointments, which have shown to be effective in relieving the pain of hand and knee osteoarthritis.

Cortisone injection for no cartilage in knee

Cortisone is a powerful anti-inflammatory drug that reduces inflammation and pain.

In general, studies suggest short-term and mild improvement of knee pain for up to 8 weeks. However, recent studies show that cortisone is no different from placebo for knee arthritis at six months. Also, there is concern about repeated cortisone injections causing more knee cartilage damage. Overall, we use cortisone injections less for longstanding cartilage loss in the knee and reserve these injections only for a severely swollen knee.

Knee gel injection for cartilage loss in knee

A gel injection, also known as viscosupplementation, is the injection of a naturally-occurring substance called hyaluronic acid into the knee joint.

How these gel injections work is unknown, but we think they lubricate the joint or control inflammation by natural means. Some examples of commonly used gel injections include Gel-One, or Synvisc 1. Previously, repeated injections every week were required. There is a high molecular weight, a longer-acting gel that only needs to be injected once. Overall, these injections can last 6-12 months.

Recent studies suggest that the high molecular weight non-animal product hyaluronic acid such as Durolane works best for arthritis of the knee and hip. Also, if the first injection works, repeat injections are likely to work up to about five repeat injections.

Gel injections work better if the knee is quiet with no knee fluid. So, your doctor may empty the knee joint with fluid before injecting the gel. This is one of the most effective and immediate treatments to alleviate pain associated with bone on bone knee cartilage damage.

PRP injection knee for bone on bone, no cartilage in knee

'Bone on Bone' Knee Damage: What Does it Mean? (2)

Platelet-rich plasma, also known as PRP, is a concentrated source of platelets. We obtain PRP from your whole blood. Then, the blood is spun in a centrifuge, separating the plasma from the white and red cells. This plasma contains concentrated platelets, which have many growth factors. Overall, we believe that PRP works by allowing the growth factors to settle chronic inflammatory cells leading to lower pain.

Recent studies suggest that PRP or platelet-rich plasma improves knee pain from the loss of cartilage in knee for over 12 months compared to gel injections, cortisone, and other substances.

Currently, 23 randomised trials show that PRP is better for no cartilage knee than other injections such as cortisone and hyaluronic acid. Also, we think that a type of PRP called leucocyte-poor PRP (compared to leucocyte-rich) has a good effect with less risk of a flare.

Often, 2-3 injections are needed about two weeks apart.

Combining PRP with hyaluronic acid

Recent evidence suggests that combining PRP with hyaluronic acid in the loss of cartilage in knee might be better than PRP alone. This positive effect is seen at 3, 6, and 12 months. Also, we think that adding hyaluronic acid reduces the risk of a flare after a PRP injection.

When combining treatment for knee cartilage damage, we recommend one high molecular weight hyaluronic acid and 2 PRP injections.

Surgery for ‘bone on bone’ cartilage loss in knee: what are the options?

Surgical options for bone on bone cartilage loss in knee are limited.

Firstly, keyhole surgery for knee cartilage loss is ineffective and could accelerate knee damage.

High tibial knee osteotomy can reduce pressure on the knee joint if there is a malalignment problem. However, evidence for effectiveness is not strong, and risks are real.

Finally, knee replacement surgery effectively reduces pain and improves function compared to physical therapy. Still, the sting in the tail is that 16% of people have problems after this surgery – some of these are serious. The bottom line is that surgery should only be done once your pain and activity levels become unacceptable.

Knee cartilage repair without surgery: Is it possible?

So overall, there is no current non-surgical treatment that will repair or regenerate cartilage in the knee. Even surgery for cartilage replacement is problematic. Injections such as PRP, hyaluronic acid, and stem cells have not demonstrated cartilage regeneration in arthritis. Procedures injecting stem cells into knee joints have not shown better results than any other injection, including a placebo.

Other commonly asked questions about cartilage damage in knee:

Will my knee arthritis get worse?

Not necessarily. The chances of having a knee replacement are only 30% in your lifetime. Generally, the best way to prevent the progression of knee cartilage damage is to keep a healthy lifestyle: exercise, lose weight and stop smoking. If you gain weight, your chances increase from 30% to 35%.

Does arthroscopic surgery help knee arthritis?

No. Some studies suggest it may worsen cartilage loss in knee.

When to have knee surgery for arthritis?

Generally, every person is different. But we suggest considering a knee replacement if you need to reduce your step count to 7000 or less per day due to pain. However, the good news is that most people (85%) get back to their chosen sport five months after a knee replacement. These activities include walking, skiing, and even running.

Final word from Dayton Orthopedic Surgery about no cartilage in knee

Loss of cartilage in the knee is expected as we get older. Weight loss and exercise are the best medicines to reduce pain and improve activity. Only use injections sparingly to help with lifestyle factors with a preference for knee gel and PRP. Avoid any expensive treatments like stem cells that promise regeneration. Finally, consider a knee replacement if all other treatments fail and your ability to exercise drops.


'Bone on Bone' Knee Damage: What Does it Mean? ›

First off, what does “Bone on Bone” mean? “Bone on Bone” is reference to the increased severity of OA (osteoarthritis) in a joint. Osteoartritis is the presence of inflammation of bones in a joint due to a reduction of cartilage.

How serious is bone on bone in knee? ›

Bone-on-bone knee pain, caused by advanced arthritis, can vary from person to person depending on its severity. Generally speaking, it will feel like a dull and achy pain. However, some people get a sharp pain that can bounce back and forth between those two qualities.

What can be done if your knee is bone on bone? ›

Other possible options range from pain-killing drugs, injections, exercise, weight loss, and knee braces. Typically it is recommended that you combine several of these methods in order to achieve the best results. Check out the comprehensive guide to osteoarthritis treatment.

Does bone on bone always mean knee replacement? ›

Bone-on-Bone Arthritis

Patients who have thinning of the cartilage but not bone touching bone should not undergo knee replacement surgery, except in rare circumstances.

Can bone on bone knee pain reversed? ›

Unfortunately, the effects of osteoarthritis of the knee can't be reversed. But treatment and self-care can help relieve your symptoms and slow your condition's progress.

Is walking good for bone on bone knee? ›

The answer: a resounding yes! In fact, people with knee osteoarthritis who walk for exercise are significantly less likely to go on to develop worse pain, according to a 2022 study published in Arthritis & Rheumatology.

How long can you go with bone on bone knee? ›

Knee Replacement Surgery Not a Permanent Cure

Typically, the new metal joint from a knee replacement can last between 10 and 15 years. Because of this, even with a 'perfect' procedure, many patients will need two or even more replacements in their lifetime, depending on their age at the time of the first procedure.

Do knee injections work for bone on bone? ›

The idea behind these injections is that they will temporarily restore the natural function of the knee by injecting a substance which will provide cushioning and reduce bone-on-bone contact. Individual responses vary, but many patients experience months, if not potentially a year or more of relief.

Can a knee brace help bone on bone? ›

Knee braces are one treatment option that can help reduce bone on bone pain so you can get back to doing what you love. Some knee braces are better for treating osteoarthritis than others.

Can you walk with no cartilage in your knee? ›

Severe knee cartilage loss makes walking, sitting, standing, squatting, and going up and down stairs extremely painful. People with a total loss of knee cartilage can benefit from joint injections. In many cases, surgery including a total knee replacement is needed to treat no cartilage in the knee.

How bad does your knee have to be before replacement? ›

You may be offered knee replacement surgery if: you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced. your knee pain is so severe that it interferes with your quality of life and sleep. everyday tasks, such as shopping or getting out of the bath, are difficult or impossible.

How do you fix a bone to bone knee without surgery? ›

Recommended Non-Surgical Treatment Options
  1. Bracing. We may suggest a knee brace to provide external stability to the knee joint. ...
  2. Injections and Infusions. Some medications can be injected directly into the knee to treat your pain. ...
  3. Lifestyle Modifications. ...
  4. Nutraceuticals. ...
  5. Pain Medications. ...
  6. Physical and Occupational Therapy.

When is it time for knee surgery? ›

It may be time to have knee replacement surgery if you have: Severe knee pain that limits your everyday activities. Moderate or severe knee pain while resting, day or night. Long-lasting knee inflammation and swelling that doesn't get better with rest or medications.

What happens if you wait too long for knee replacement? ›

Simply put, the longer you wait to get a knee replacement, the more wear and tear you put on your knees – and the longer you live with increasing pain, stiffness or mobility issues. But there are a few other things to consider, including: As your knee condition worsens, your quality of life can also decrease.

What medicine is good for bone on bone knee pain? ›

Osteoarthritis is typically treated with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs). These medications have an anti-inflammatory and pain-relieving effect. Examples of NSAIDs include diclofenac, ibuprofen and naproxen.

Are knee gel injections worth it? ›

The gel injections tend to be effective for about 50% of patients, but for those that it works well for those patients tend to see improvement in VAS scores for at least 4-6 months.

What is the best painkiller for knee pain? ›

Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may help ease knee pain. Some people find relief by rubbing the affected knee with creams containing a numbing agent, such as lidocaine, or capsaicin, the substance that makes chili peppers hot.

Should I keep walking if my knee hurts? ›

Do walk. Moderate walking is recommended for people with knee pain because it's a low-impact activity. If your joints are painful and stiff, start slowly and work up to 20 minutes of walking per day, recommends Stuchin.

How can I make my knee bone stronger? ›

5 Exercises to Help Strengthen Your Knees
  1. Exercise 1: Knee Extension.
  2. Exercise 2: Knee Flexion (Standing)
  3. Exercise 3: Heel and Calf Raises.
  4. Exercise 4: Wall Squats.
  5. Exercise 5: Swimming.
Jun 1, 2022

What are the signs of needing a knee replacement? ›

5 Signs You Might Need Knee Replacement Surgery
  • Persistent or reoccurring pain.
  • The pain prevents you from sleeping.
  • You have difficulty doing daily activities including walking or climbing stairs.
  • Your knees are stiff or swollen.
  • Knee deformity — a bowing in or out of the knee.

How can I get a knee replacement without surgery? ›

Platelet-Rich Plasma (PRP) Therapy

This concentrate is then injected into the damaged knee, which can facilitate an accelerated healing response. The procedure is less aggressive and less expensive than surgery. It may heal tissue with minimal or no scarring, and may alleviate further degeneration of the tissues.

Who should not have a knee replacement? ›

Those with any type of allergy. Even patients with allergies that are as simple as pollen or dander should avoid knee replacement surgery. People who are considered “allergic” have hyperactive immune systems and secrete antibodies inappropriately to rid their bodies of the thing that they have mistaken as harmful.

Do cortisone shots work for bone on bone? ›

Cortisone can make bone on bone worse by thinning out the meniscus. But one injection appears okay. Cortisone injections before knee surgery lead to greater post-surgical infection risk.

How long does it take to recover from bone on bone knee surgery? ›

Barring any complications, most patients are able to return to most normal activities and walk without the need of assistive devices between three to six weeks after surgery. Overall, it usually takes two to three months to make a complete recovery from a minimally invasive knee replacement.

Will cortisone help bone on bone knee pain? ›

Corticosteroids stimulate an immune response to control inflammation and reduce the irritation caused by bone interacting with bone. In other words, it helps relieve the symptoms caused by arthritis.

What does bone on bone pain feel like? ›

What does bone pain feel like? Bone pain usually feels dull and achy — like the pain is coming from deep inside your body. The skin near the affected area will probably feel tender to any touch. It might also hurt when you move or use that part of your body.

What does bone on bone arthritis feel like? ›

Osteoarthritis symptoms range from stiffness and mild pain to persistent, severe joint pain. Common signs include swelling and tenderness, stiffness after getting out of bed, and a crunching feeling or sound of bone rubbing on bone.

How often will Medicare cover a knee brace? ›

The reasonable useful lifetime of custom fabricated orthosis is 3 years. Replacement during the “reasonable useful lifetime,” is covered if the item is lost or irreparably damaged.

How do you live with no cartilage in your knee? ›

Strength training and aerobic conditioning exercises improve symptoms of loss of cartilage in the knee. Symptom improvement occurs from lowering chronic inflammation in the body and weight loss and muscle strength gain.

How do you fix a knee without cartilage? ›

NYU Langone doctors often recommend nonsurgical options as a first-line treatment for a knee cartilage injury. These include anti-inflammatory medication, physical therapy, and injections into the joint, including steroids; hyaluronic acid, also known as synthetic joint fluid; and platelet-rich plasma (PRP).

How can I lubricate my knees naturally? ›

Your joints' lubricating fluid allows your joints to move with more ease and less stress. To activate those juices, start your exercise routine with a gentle 5-10-minute warm-up and gradually increase your effort. Another good way to self-lube is drinking more water. Stretch regularly.

What you Cannot do with knee replacement? ›

Activities you Cannot do After Full Recovery

You shouldn't downhill ski or play contact sports such as football and soccer. In general, avoid sports that require jerking, twisting, pulling, or running. You should be able to do lower-impact activities, such as hiking, gardening, swimming, playing tennis, and golfing.

How long do you stay in hospital after knee replacement surgery? ›

Most people can leave hospital 1 to 3 days after the operation. Before you leave, a physiotherapist or occupational therapist will talk to you about managing daily activities and home exercise programmes. Following the exercises early on in your recovery will help with the long-term strength and movement in your knee.

Will I regret knee replacement? ›

A recent study found that 20% of people are unhappy with their knee replacements. Here's what can play into that dissatisfaction. Let's get one thing straight right away — knee replacements are often a smart choice. A lot of people have less knee pain and more mobility after their surgery and rehab.

What weight is too obese for knee replacement? ›

There is a range of accepted weight ranges, but the current standard is that anyone obese (greater than 100 pounds over ideal weight or a BMI of roughly 40-45) should not consider joint replacement.

What is the new injection for knee pain? ›

Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.

How painful is a total knee replacement? ›

When quantifying how much pain there is after surgery, it is relative to the patient. The pain after a knee replacement is typically no worse than one of your worst days before you had surgery. However, you can feel this way for the first two to three weeks after the day of surgery.

What is the average age for knee surgery? ›

In the United States, currently, the average age to undergo knee arthroplasty is around 65 years old. Mostly knee replacement surgery is performed in elders with severe arthritis, while those under the age of 50 are considered young and are asked to wait until the age of 65.

How long before you can walk after a knee surgery? ›

In most cases, patients can walk without help from assistive devices like crutches or a walker within six weeks after knee replacement surgery. That said, physical therapy continues after this time to help your knee and the surrounding muscles grow stronger and more flexible.

Do you go home right after knee surgery? ›

Though routine and common, a hospital stay may be required following the procedure. But with advances in surgical procedures, it's possible to go home the same day after your knee replacement surgery.

Which knee injection is best? ›

You'll likely receive a cortisone shot, also called a steroid injection, as a first-line treatment. Cortisone shots are effective for many patients in quickly reducing inflammation and pain directly inside the joint, but they come with a few precautions.

Is there any relief for bone on bone pain? ›

You may get temporary relief from bone pain by using over-the-counter pain relievers such as acetaminophen, aspirin, or ibuprofen. Osteomyelitis typically requires treatment with either oral or intravenous antibiotics.

Does Voltaren work for knee pain? ›

Voltaren Emulgel helps with the relief of localized traumatic inflammation and pain such as knee pain.

Does insurance cover knee gel injections? ›

Knee injections are covered by Medicare and by most insurance. In fact, many insurance companies will ask you to have knee injections before considering surgery. (Insurance companies understand how effective this treatment is compared to a risky knee surgery, so they almost always provide the coverage for it.)

Why do you need 3 gel shots for your knee? ›

Administered as a series of 3 injections directly into the knee (one every 7 days), GELSYN-3 works to increase the levels of healthy hyaluronic acid in the affected joint. The hyaluronic acid in GELSYN-3 safely reduces joint pain and stiffness.

Does Medicare pay for knee injections? ›

Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible. X-rays are required prior to Medicare approval. As mentioned above, there are many different injection treatments for the knees.

How do they treat bone on bone in knee without surgery? ›

Recommended Non-Surgical Treatment Options
  1. Bracing. We may suggest a knee brace to provide external stability to the knee joint. ...
  2. Injections and Infusions. Some medications can be injected directly into the knee to treat your pain. ...
  3. Lifestyle Modifications. ...
  4. Nutraceuticals. ...
  5. Pain Medications. ...
  6. Physical and Occupational Therapy.

What is the best pain relief for bone on bone knee? ›

Osteoarthritis is typically treated with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs). These medications have an anti-inflammatory and pain-relieving effect. Examples of NSAIDs include diclofenac, ibuprofen and naproxen.

What are the first signs of needing a knee replacement? ›

If one of the below applies to you, it might be time to consider knee replacement surgery.
  • Persistent or reoccurring pain.
  • The pain prevents you from sleeping.
  • You have difficulty doing daily activities including walking or climbing stairs.
  • Your knees are stiff or swollen.
  • Knee deformity — a bowing in or out of the knee.

Who is a bad candidate for knee replacement? ›

You may NOT be a good candidate if:

Your knee symptoms are not related to joint disease. Your weight is too much for the artificial joint to support. You have fragile skin or poor skin coverage over your knee. You have a severe illness or infection.

How do they fix knees without cartilage? ›

NYU Langone doctors often recommend nonsurgical options as a first-line treatment for a knee cartilage injury. These include anti-inflammatory medication, physical therapy, and injections into the joint, including steroids; hyaluronic acid, also known as synthetic joint fluid; and platelet-rich plasma (PRP).

What is the best knee support for no cartilage? ›

Healthline's picks of the best knee braces for arthritis
  • ACE Adjustable Knee Brace with Side Stabilizers.
  • PowerLix Knee Brace.
  • Vive Hinged Knee Brace.
  • KARM Adjustable Knee Brace.
  • MODVEL 2 Pack Knee Compression Sleeve.
  • Bauerfeind Sports Knee Support.
  • Shock Doctor Ultra Knee Support with Bilateral Hinges.


Top Articles
Latest Posts
Article information

Author: Delena Feil

Last Updated: 11/22/2023

Views: 6048

Rating: 4.4 / 5 (45 voted)

Reviews: 84% of readers found this page helpful

Author information

Name: Delena Feil

Birthday: 1998-08-29

Address: 747 Lubowitz Run, Sidmouth, HI 90646-5543

Phone: +99513241752844

Job: Design Supervisor

Hobby: Digital arts, Lacemaking, Air sports, Running, Scouting, Shooting, Puzzles

Introduction: My name is Delena Feil, I am a clean, splendid, calm, fancy, jolly, bright, faithful person who loves writing and wants to share my knowledge and understanding with you.