"My knee hurts and my doctor says I have bone-on-bone arthritis. Do I need surgery?"
I have talked about this question before on this blog, but the question continues to arise in my office so I know you may still have this question, too. A standard story that I see in my office is a patient with six months of knee pain. He or she had an x-ray that revealed "bone-on-bone" osteoarthritis and present with the very understandable question - Do I need surgery?
The first thing to understand about the above scenario is the following - the patient has only had pain for six months, but seven months ago if an x-ray of the knee had been taken, it would have looked largely the same! In other words, the osteoarthritis did not begin six months ago. The osteoarthritis has been there for many years. The reason the pain began only six months ago is likely because, for whatever reason, inflammation developed in the knee at that time. This patient probably did not have any trauma that resulted in the inflammation. Usually, there was no "incident" where he or she stepped in a pot hole or fell down. Sometimes, a long car ride may set the pain off, or taking a long walk in new shoes. Typically, though, the pain just gradually builds through normal activities. Therefore, since the anatomy did not change six months ago, what we need to address is the inflammation in the knee. We need to reduce the inflammation - which should take the pain away - and then teach the patient ways to stretch and strengthen the muscles around the knee so that the inflammation and pain do not return.
There are many ways to reduce the inflammation in the knee. Sometimes, structured physical therapy is enough to reduce the inflammation and strengthen the surrounding structures. Sometimes, an injection of steroid or injection series of hyaluronic acid is needed to reduce the inflammation. Depending on the extent of the condition, more treatment may be necessary to reduce or eliminate pain and return a person to normal function.
If you are having knee pain, please don't try and self-diagnose your condition. Several things can cause knee pain. Instead, talk with your doctor and explain your symptoms. While knee pain may be caused by osteoarthritis, there are many other causes as well that, if left undiagnosed can cause a bigger problem, so ask your doctor. An accurate diagnosis is the first step to returning to your active, pain-free life.