Bone on Bone In The Knee
By Ron Salazar, MPT
What is Bone on Bone In The Knee?
Bone on Bone in the Knee is a phrase used to describe a condition in the knee joint which involves cartilage loss/damage and is closely associated with osteoarthritis or degenerative joint disease.
Knee Anatomy and Bone on Bone
The involved anatomy of the knee joint includes the lower end of the femur (thigh bone) and the upper end of the tibia (shin bone). The cartilage of the knee lies between these bones. There is a type of cartilage that covers the end of these bones. Its surface is smooth and allows the joint surfaces to glide over each other with low friction and stress during knee movement. Another type of cartilage is the meniscus. This type of fibrocartilage is located on top of the tibia. Its function is to absorb shock at the knee joint.
What is happening when one has Bone on Bone in the Knee?
In Bone on Bone, the joint cartilage is worn down or lost to the point that when the knee is moved, the bones contact each other with high friction stresses. These joint stresses cause joint inflammation. In addition to more wearing down of the knee joint surfaces through bone on bone. This pain is due to undesired contact. This contributes to degenerative joint disease or osteoarthritis.
Signs and Symptoms
- Severe, sharp pain- especially with activity
- Decreased functional capacity- for stair ambulation, squatting, walking, doing household chores, and standing up after prolonged sitting/driving.
- Joint stiffness
- Sensation of weakness
- Clicking, grinding, and/or popping sensations
Treatments for Bone on Bone in the Knee
Weight Loss– Excess bodyweight puts more stress on the knee and contribute to cartilage degeneration. In obese individuals, excessive fat cells can negative affect the body’s making of insulin which can lead to long lasting inflammation in the body, including the knee joints. Studies show that reducing bodyweight can decrease pain from this knee condition.
Non-steroidal anti-inflammatory drugs (NSAIDS)– Can be over the counter or prescribed by physician. Can be in tablet or topical cream forms. Naproxen, Diclofenac, and Ibuprofen are examples.
Knee braces/Assistive devices for ambulation– Unloader or Off loader braces can take pressure off the bones of the knee and can reduce knee pain and inflammation to improve function. Walking aids like canes and walkers help to do the same.
Physical Therapy/Exercise– General exercise to help reduce excessive bodyweight and improve/maintain good, general health as long as it is pain free at affected knee. Physical Therapy intervention can include aerobic exercise, flexibility exercises, range of motion exercises, joint mobilizations, soft tissue mobilizations, strengthening exercises, pt. education, and modalities like moist heat, ice packs, electrical stimulation to decrease pain and inflammation as needed.
Injection Treatments by Physician
Cortisone Injection– anti-inflammatory medication
Viscosupplementation– a gel containing Hyaluronic acid is injected into the injured Knee to manage inflammation and lubricate the knee joint. Durolane, Synvisc, and Gel-One are types of hyaluronic gel injections.
Platelet Rich Plasma Injection (PRP)– plasma from the individual with Bone on Bone in the Knee/ Knee Osteoarthritis is taken from their own blood and are injected. The platelets in the plasma contain substances that reduce chronic inflammation in the joint tissue. Research has found that PRP injections administered together with Hyaluronic acid injections are very effective in managing pain/inflammation in a Bone on Bone Knee with cartilage loss.
Knee Arthroplasty or Knee Joint Replacement– surgical procedure which involves cutting and removal of the worn out, severely damaged knee joint and implanting a new knee joint made of artificial materials like titanium and plastic. The goal of this surgery is to relieve Bone on Bone in the Knee/Osteoarthritis/Degenerative Joint Disease pain and to restore function of the affected knee. Physical therapy is often needed after surgery to address post op knee impairments like pain, edema, joint mobility deficits, range of motion deficits, scar tissue mobility deficits, decreased ambulation/walking ability, decreased strength, and decreased daily living activity capacity for sitting, standing, walking, transfers, driving, squatting, stair/step/curb ambulation, and doing household chores.
Written By: Ron Salazar, MPT
Please watch this video from The Jacksonville Orthopaedic Institute on Why Knee Pain Can’t Wait!
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