It bothers me to no end when I hear somebody say they have to get a knee replacement because their X-ray shows that they are “bone on bone.” Or they say they will eventually have to get their knee replaced because “the arthritis is just going to keep getting worse.” Both of these statements couldn’t be further from the truth; in other words, both of those statements couldn’t be further from fact!
I can confidently say this because over the many years I’ve worked with patients who have just had a knee replacement, during that most painful first week post-op, I would constantly hear, “I’m really not looking forward to having my other knee replaced.” I’d always follow up on that question and ask why they thought it was inevitable they would need to have the other knee replaced. The most common answer I’d get is, “Well, on X-ray, the other knee was way worse and completely bone on bone. But this knee was the one that was in pain, so we [they and their surgeon] decided to replace this one first.”
Make sure you read that last sentence again. On X-ray, the knee that did not hurt was the knee that showed worse bone on bone! Yet, on the X-ray, the knee that did hurt showed lingering cartilage and was not bone on bone… For this reason, by the laws of science, you cannot say that bone on bone “causes” pain. You can say that bone on bone can be associated with pain symptoms, but you cannot say that bone on bone causes pain.
Bone, Ligament, Tendon, Muscle!
Now, I know that a lot of you reading this are probably saying, “Well, my X-ray shows bone on bone, and my knee hurts like h***! If bone on bone isn’t causing my pain, what is?!”
My response is inflammation of the surrounding soft tissues, not your bone on bone. My rationale behind that statement is that countless times, I’ve had patients come to me months and sometimes years after having a knee replacement, stating that their knee hurts more now than before the surgery!
If you know anything about knee replacement, you likely know that the surgeon removes your “old” bone-on-bone joint and replaces it with metal and plastic. So again, if your knee hurts more months and years after the surgery than it did before the surgery, you can’t blame it on your X-ray showing bone on bone anymore.
To make it as simple as possible, there are only four things that can cause a pain response in the knee: bone, ligament, tendon, muscle. Injury to any one of those four structures can cause a pain response. The surgery replaces bones and ligaments with metal and plastic, so the only things left around your knee that can cause pain are muscles and tendons.
And that, my friends, is what I’ve found is causing knee pain in 99% of the “bone-on-bone” cases I’ve seen over the years. As long as I can get your knee into full pain-free passive extension (straight) and coach you on how to strengthen the surrounding muscles to keep your knee straight and stabilized when standing on it, I can confidently say that it is highly unlikely you’ll need a knee replacement!
For more information on how to avoid a knee replacement or on how to recover from ineffective cookie-cutter rehab after your prior knee replacement, check out episode #103 of “The Berman Method” Podcast or visit Bermanpt.com!
Dr. Jake Berman, PT, DPT, is a physical therapist and the owner of Berman Physical Therapy, where they focus on treating the actual problem causing your symptoms (pain) to help you avoid taking pain pills and dangerous surgeries. So, if you’re tired of feeling “old” and you are looking for another way to keep active and mobile, call Dr. Berman at 239.431.0232 to take advantage of a FREE 30-minute taster session!