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Knee osteoarthritis: more than just 'bone on bone'

Posted by Nicholas Dang on
Knee osteoarthritis: more than just 'bone on bone'

People with osteoarthritis are often told phrases, such as:
⚠️ ‘You’ve got bone on bone.’
⚠️ ‘It’s caused by wear and tear.’
⚠️ ‘It’s only going to get worse.’

Unfortunately, such statements can be setting people up for failure...

Knee osteoarthritis (OA) is a condition involving changes in the knee joint (e.g., cartilage), which can sometimes be associated with knee pain and joint stiffness.

A common misconception is that knee OA is just ‘wear and tear’ and only gets worse with time.

Another misconception is that the only treatment option is a total knee replacement, where the surfaces of your bones are surgically replaced with metal and plastic. Part of this belief stems from non-surgical treatments (e.g., diet and exercise) not technically ‘restoring’ cartilage.

However, it’s critical to realise that you can reduce your pain without changing your tissue. Also, more severe knee OA on imaging doesn’t necessarily mean more pain. 1️⃣ In fact, knee OA is prevalent in people with ‘no’ pain: 4‒14% of asymptomatic adults aged <40 years and 19‒43% of adults ≥40 years on MRI. 2️⃣

There’s also strong research to show that exercise can have positive effects on pain and function. 3️⃣

Moreover, non-surgical treatments can avoid the risks associated with surgery, such as infection.

Non-surgical interventions, including education, exercise and weight loss (if relevant), are recommended as first-line treatments for knee OA because they’re effective, simpler and safer. Surgery can be a suitable option for those who don’t respond well to such interventions.

For more information, you can check out the decision aid below. 4️⃣


1️⃣ Finan et al. (2013) (PMID: 22961435)
2️⃣ Culvenor et al. (2019) (PMID: 29886437)
3️⃣ Fransen et al. (2015) (PMID: 26405113)

* Image from

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