https://www.medicalnewstoday.com/articles/bone-on-bone-arthritis?utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=MNT%20Daily%20News&utm_content=2025-02-19&apid=&rvid=1e7f7a9239bb44f191dc979b8fe5e634e587dfe020b84a653d2040468a8b342b#pain-managementWhat is bone-on-bone arthritis?
Medically reviewed by Daniel Wiznia, MD — Written by Amanda Barrell on November 15, 2022
Overview
Symptoms
Pain management
Treatment
Prevention
Diagnosis
Contacting a doctor
Summary
Bone-on-bone arthritis is not a clinical term. However, people may use it to refer to advanced or severe osteoarthritis (OA). At this point, the “wear and tear” or degeneration is severe enough that there is bone-to-bone contact between the joints.
OA is the most commonTrusted Source form of arthritis and affects the joints. More than 32.5 millionTrusted Source adults in the United States are living with the condition.
The two main causes of OA are joint injury and general wear and tear as people age.
OA is a progressive condition, meaning that it worsens over time.
This article explains what bone-on-bone arthritis is, the signs and symptoms, and how people can manage the condition.
What is bone-on-bone arthritis?
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People use bone-on-bone arthritis to refer to advanced-stage or severe osteoarthritis (OA). Doctors may also call it end-stage OA.
Healthy joints have a layer of tissue, or cartilage, inside. It covers the surface of the bones and allows for smooth gliding of the joint. The joints also contain synovial fluid, which cushions the end of the bones and helps reduce friction with movement.
When a person develops OA, the cartilage thins, and the surface becomes rough. As a result, the joint does not move as smoothly as before.
Over time, the body’s attempts to repair the damage can further affect the joint. For example:
extra bone can form at the edge of the joints, called osteophytes or bone spurs
the joint lining can thicken and produce more fluid than usual, making the joint swell up
the tissues around the joint can stretch, making the joint less stable
Healthcare professionals often divide cases of OA into three stagesTrusted Source:
Early stage: A person still has a good amount of cartilage cover on the joint. A person can experience sharp pain when moving the joint.
Mid-stage: The cartilage has become worn, and there may be some bald patches. A person may experience pain and joint locking. The pain will be more constant, affecting a person’s ability to perform daily activities.
Advanced stage: There is significant cartilage loss, and the spaces between the joints are narrow. The bone tissue becomes thick and rigid, and bone spurs can develop. There can be bone-to-bone contact during this stage. Individuals will experience a constant dull ache alongside intermittent episodes of intense pain.
Is it reversible?
There is no cureTrusted Source for OA or way to reverse the joint damage. However, people can help manage their symptoms.
Signs and symptoms
Those with advanced stage OA will experience pain, swelling, and stiffness at the affected joint. People will also have difficulty moving the affected joint.
A 2022 articleTrusted Source notes that a person with advanced stage OA will experience a dull, constant, aching pain. They will also experience intermittent episodes of intense pain, which can affect a person’s ability to engage in daily activities.
According to the United Kingdom’s National Health Service (NHS), the muscle surrounding the affected joint may look smaller and feel weak.
Some people may find the joint buckles when in use.
Ways to manage the pain
People can try the following methods to manage the pain associated with advanced-stage OA:
Using hot therapy: A heating pad or hot pack can help relieve pain and stiffness. People should apply heat to the affected joint 2–3 times a day for 20 minutes. People should be careful not to burn their skin.
Using cold therapy: A person can apply an ice pack twice a day, for 15–20 minutes at a time. Individuals should check their skin every 5 minutes to ensure they are not getting ice burn.
Achieving and maintaining a moderate weight: This can help to relieve the pressure on the joints. For those who are overweight or have obesity, losing 1 pound (lb) of weight can reduce the load on the affected joint by 3–6 lbTrusted Source.
Taking pain medication: Pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce swelling and pain. Examples include ibuprofen and acetaminophen. Doctors may also prescribe pain relief medications at higher strengths.
Exercising: Although exercising with advanced stage OA may feel uncomfortable, it is important to take part in low impact physical activity, such as swimming, walking, and riding a bike. People can try gentle exercises to reduce pain and swelling. This can include:
range-of-motion exercises to help flexibility
aerobic exercise to strengthen the heart and lungs and build stamina
strengthening exercises to increase muscle strength to help protect the joints
Using walking aids and supportive devices: To help relieve the pressure on the joints, people may wish to use a walking aid or wear braces and splints.
When using hot and cold therapy, people may benefit from alternating between the two. Gently massaging the area afterward may also help to relieve pain.
The Centers for Disease Control and Prevention (CDC)Trusted Source also suggest that people join a self-management class, such as the Arthritis Self-Management Program (ASMP)Trusted Source. The workshops teach people how best to manage their pain.
Treatment
Doctors may recommend glucocorticoid injections. The physician will inject the drug, which is a steroid, directly into the joint to ease swelling and pain.
Patient advocacy group, Versus Arthritis, notes that it can take between a few hours and 1 week for the person to feel the effects of the medication. One injection tends to work for around 2 or more months.
Surgical
In some people with advanced-stage OA, doctors may suggest surgery. They may suggest an operation called total joint replacement, or total joint arthroplasty.
A doctor may recommend surgery as a last resort when other treatments have not worked.
During the operation, the surgeon replaces the damaged joint with one made from metal, plastic, or ceramic. This reduces pain and helps people to move the joint.
However, it is important to note that artificial joints can wear out, and some people will need repeat surgery in the future.
Prevention
It may not be possible to prevent OA from developing. However, those in the early stages of the condition can take measures to slow its progression.
A person should take part in regular exercise but avoid activities that place extra strain on the joints, such as running.
They should also achieve and maintain a moderate body mass index (BMI).
Diagnosis
To diagnose advanced-stage OA, a doctor will:
ask about the symptoms
examine the affected joint or joints
perform an X-ray
perform blood tests
When to contact a doctor
According to the Arthritis Foundation, people should speak with a doctor if they experience:
joint symptoms, such as pain or swelling, that last for 3 or more days
several episodes of joint symptoms in 1 month
Those with OA should speak with a doctor to discuss how they will monitor the progression of their condition.
Summary
People use bone-on-bone arthritis to refer to advanced stage OA.
At advanced stage OA, there is very little cartilage left. The bone tissue also thickens and becomes rough, and bone spurs develop. This means that there can be bone-to-bone contact between the joints.
People with advanced stage OA will experience a constant dull ache and intermittent episodes of intense pain.
Although there is no way to reverse the damage, people can take measures to help manage their symptoms, such as applying hot and cold therapy, exercising, and maintaining a moderate weight.
Last medically reviewed on November 15, 2022
OsteoarthritisPain / Anesthetics
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What is severe osteoarthritis?
Medically reviewed by Stella Bard, MD — Written by Beth Sissons on November 4, 2022
What is severe osteoarthritis?
Stages of OA
Symptoms
Risk factors
Can you stop OA from worsening?
Complications of severe OA
Treatment
Can lifestyle choices help?
When to contact a doctor
Outlook
Summary
Severe osteoarthritis (OA) is an advanced stage of the disease. It occurs when most of the cartilage around a joint has worn away. Severe OA may cause constant pain and reduced joint function.
OA is a degenerative joint disease. People with severe OA have extensive joint damage, which may increase the severity of symptoms such as pain and reduced range of motion.
This article looks at the stages of OA progression, symptoms of severe OA, steps that may help prevent OA from worsening, and treatment options.
What is severe osteoarthritis?
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Severe OA is the advanced stage of the disease when there is extensive damage to the joint. In severe OA, most of the cartilage protecting the joints has worn away.
This can cause increased severity of symptoms, including persistent pain and stiffness that may make it difficult to carry out everyday activities. People may also experience pain at night.
Stages of OA
In the early stagesTrusted Source of OA, the articular cartilage, which covers the ends of bones at the joints, becomes thinner and rougher. Over time, the cartilage erodes or disappears completely, affecting more of the bone surface.
Healthcare professionals may classify OA into four stages:
Stage 1 (early OA): Minor wear and tear of the joints with little to no pain.
Stage 2 (mild OA): People may experience pain and stiffness as the cartilage wears down. Bone spurs may appear on X-rays.
Stage 3 (moderate OA): Erosion may occur in the cartilage, and everyday activities may become more difficult or uncomfortable.
Stage 4 (severe OA): Almost all cartilage has worn away, resulting in chronic inflammation. People may experience fairly constant pain and stiffness, which affects everyday activities.
Symptoms of severe OA
People with advanced stage OA may experience pain more constantly and have bouts of unpredictable pain. Severe OA may also cause pain at night, which may affect sleep.
Severe OA may make it more difficult to carry out certain everyday tasks or activities due to pain, stiffness, or reduced range of motion.
Severe OA may causeTrusted Source joint deformity and swelling. People may feel that a joint gives way or buckles, affecting balance and stability.
Other symptoms of OA include:
aching joints or pain during or after activity
joint stiffness, usually after resting or first thing in the morning
swelling around a joint
reduced range of motion, which may improve with movement
crepitus, a clicking or popping sound when moving a joint
muscle weakness around a joint, which may make the joint buckle or feel unstable
Risk factors
Risk factors for OA include:
being over the age of 50 years
joint injury
overuse of a joint
obesity
misalignment of bones or joints
issues with muscle support
having family members with OA
being female
environmental factors, such as occupation, activity levels, diet, and bone density
Factors that may increase the riskTrusted Source of OA progressing rapidly and severely include:
obesity
older age
OA that affects multiple joints
varus deformity, which affects the alignment of bones
Is it possible to prevent OA from getting worse?
For most people, OA will not steadily worsen over time. The condition can affect everyone differently, but individuals may find the condition peaks after a few years. After this, symptoms may stay the same or even improve.
Some people may find they have periods of joint pain and periods of improvement.
Treatments and lifestyle changes may help slow the progression of OA and prevent the condition from worsening.
Complications of severe OA
Severe OA may cause complications, such as:
deformity from swollen joints
difficulty sleeping due to pain
difficulty exercising, staying physically active, or carrying out everyday tasks
joint instability, which may lead to falls
tingling or numbness in the arms or legs due to nerve compression
depression, anxiety, or other mental health conditions due to reduced quality of life
Additionally, severe cases of spinal OA may affectTrusted Source bladder and bowel function.
Treatment
Although treatment cannot reverse joint damage from OA, it may help slow the disease’s progression, reduce pain, and increase joint function.
Treatments for OA include:
pain relief medications, such as acetaminophen
topical creams, gels, and patches, such as capsaicin cream
nonsteroidal anti-inflammatory drugs
duloxetine, a drug to treat chronic pain
corticosteroid or hyaluronic acid injections into the joint
regular exercise and physical activity
alternative therapies, such as massage
wearing supportive garments, such as braces and straps
using mobility aids, such as canes and walkers
heat or cold therapy
For severe OA, people may require surgery. This may include repairing joint damage or replacing a joint.
Learn more about arthritis surgery.
Can lifestyle choices help?
Certain lifestyle choices may help slow the progression of OA and improve overall health. People may wish to:
maintain a moderate weight, which can reduce inflammation and extra stress on the joints
eat a nutritious, balanced diet
control blood sugar, as high levels can increase the risk of cartilage breaking down
maintain range of motion as much as possible by stretching and staying active each day
listen to the body and rest as necessary
warm up and cool down properly before exercise to protect the joints
minimize stress, and take time to relax
avoid smoking and limit alcohol
get enough quality sleep
Learn about natural treatments for osteoarthritis.
When to contact a doctor
People can contact a doctor if they have symptoms of OA. Other conditions may cause similar symptoms, but getting the correct diagnosis and beginning any necessary treatment is important.
If someone finds it difficult to manage severe OA or treatments appear to be ineffective, they can talk with a doctor. A doctor may refer them to a physical therapist, occupational therapist, or orthopedic surgeon to discuss surgical options.
People can also consult a doctor, a mental health professional, or a support group if severe OA affects their mental health and overall well-being. The Arthritis Foundation can connect people with arthritis and their caregivers with peer-led support groups.
Learn about online support groups.
Outlook
Although severe joint damage is not reversible, treatments may help slow disease progression, decrease pain, and improve joint function.
For severe OA, joint replacement surgery may provide the best long-term outlook, with successful outcomes in more than 80%Trusted Source of cases. Joint replacements may last 10–15 years, after which people may need repeat surgery.
Summary
Severe OA involves extensive damage in the joint, with most of the cartilage worn away.
This increases the severity of symptoms, and people may experience more constant pain, limited range of motion, and decreased function. Severe OA may affect everyday activities, sleep, and quality of life.
Treatments and lifestyle changes, such as medication, a nutritious diet, and exercise, may help slow the progression of OA and improve symptoms.
Additionally, surgery to repair damage or replace the joint may be necessary if other treatments are ineffective.
Last medically reviewed on November 4, 2022
Body AchesOsteoarthritisSurgeryRehabilitation / Physical Therapy
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What are some natural treatments for osteoarthritis?
Medically reviewed by Monisha Bhanote MD, FCAP, ABOIM, CCMS, YMTS — Written by Amanda Barrell on April 27, 2022
Do they help?
Heat or cold therapy
Physical therapy
Supportive devices
Lifestyle changes
Supplements
Mind-body
Acupuncture
TENS
Outlook
Summary
Some people with osteoarthritis (OA) find relief from natural treatments, such as physical therapy and acupuncture. Many experts recommend a combination of drug-based and natural treatments for people with OA.
OA is the most common form of arthritis, affecting more than 32.5 millionTrusted Source adults in the United States.
OA happens when the cartilage inside a joint breaks down and wears away, leading to changes in the bone in the joint. The joints that OA most commonly affects are the hands, hips, and knees.
There is evidence that certain nonpharmacological treatments for OA are beneficial for some people. Physical therapy and lifestyle changes, for example, can help people manage their symptoms.
This article describes some common natural treatments for OA, including heat and cold therapy, supplements, and acupuncture.
Do natural treatments help osteoarthritis?
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There is no cureTrusted Source for OA. When prescribing treatments, doctors aim to help people manage their symptoms so that they can have a good quality of life.
Doctors tend to recommend a combination of natural and pharmacological, or drug-based, treatments. The options include physical activity, physical therapy, and pain medications.
Although there is evidence that some natural treatments are beneficial for people with OA, more research is necessary to confirm the benefits of others.
Below are some common natural treatments for OA.
Learn more about osteoarthritis.
Heat or cold therapy
Applying heat or cold to the affected joint may help reduce the pain and swelling associated with OA.
A 2021 study involving 117 people with OA in the knee found that heat therapy and cold rub gel effectively improved pain and joint function.
The Arthritis Foundation explains that applying heat to a sore joint makes the blood vessels in the area expand. This helps more blood, oxygen, and nutrients flow to inflamed tissues. Increasing circulation in this way can relax stiff muscles and joints.
The organization adds that cold treatment has the opposite effect and reduces inflammation. Due to this, it might be a better choice when a person has a flare-up.
A person can try heat therapy by:
taking a hot shower with a water temperature of 92–100℉
applying a warm compress, such as an electric heat pad or a moist washcloth that the person has heated in the microwave
soaking in a warm pool or bathtub for about 20 minutes
A person can try cold therapy by:
wrapping a bag of frozen vegetables in a thin towel and using it as a cold compress
buying a reusable ice or gel pack
putting a towel in the freezer for 15 minutes and then applying it to the sore area
using a cold rub gel
Learn more about heat and cold therapy.
Physical therapy
Physical therapy can help a person move safely and effectively. Physical therapists tailor therapy programs to individuals’ needs, but they usually include stretches and targeted exercises.
Physical therapy can offer a person with OA the following benefits:
helping maintain flexibility and range of motion
strengthening the muscles to help support the damaged joint
increasing the strength of the muscles surrounding the joint
maintaining fitness
helping a person perform their daily activities
Learn about 10 exercises for knee arthritis.
Supportive devices
The Arthritis Foundation suggests that supportive devices can protect the joints and help a person perform daily tasks. A physical therapist, occupational therapist, or orthotist can fit a person with braces or splints that help align and support the joints.
Canes and walkers can reduce the load that the body places on damaged joints while walking. This can make it easier for people with severe OA to get around.
Supportive devices include:
braces
splints
canes
walkers
gloves and wrist straps
Learn about mobility aids.
Lifestyle changes
Doctors often recommend that people with OA adopt or maintain certain lifestyle habits, such as eating a nutritious, well-balanced diet and getting plenty of exercise and sleep. Controlling cholesterol levels and keeping blood pressure within the healthy range may also minimize OA symptoms. Where applicable, it can also help to quit smoking.
People with OA can benefit from reaching or maintaining a moderate body mass index (BMI), as excess body weight can put additional pressure on damaged joints.
The authors of a 2018 review in the journal Rheumatology note that certain foods may help ease the inflammation associated with OA symptoms. Beneficial foods include oily fish, such as sardines, mackerel, and salmon, as well as avocados and walnuts, which contain omega-3 fatty acids. The researchers recommend eating one or two portions per week and taking a daily fish oil supplement.
Supplements
According to the Arthritis Foundation, the evidence that supplements effectively treat OA symptoms is limited. A person should talk with a doctor before taking supplements, as these can interfere with prescribed medications.
Popular supplements for OA include:
fish oil
glucosamine and chondroitin
vitamin D
methylsulfonylmethane (MSM)
pycnogenol
S-adenosyl-L-methionine (SAMe)
Boswellia serrata
curcumin
avocado/soybean unsaponifiables (ASUs)
willow bark
undenatured type II collagen (UC-II)
Learn about the eight best supplements for arthritis.
Mind-body
Mind-body approaches, such as yoga, tai chi, and cognitive behavioral therapy (CBT), might help some people manage their OA symptoms.
In 2019Trusted Source, the American College of Rheumatology (ACR) and the Arthritis Foundation reviewed the available evidence on various OA treatments. Based on this information, they:
strongly recommend tai chi for people with knee or hip OA, as it can help people improve their strength and balance
conditionally recommend yoga for people with knee OA
conditionally recommend CBT for people with knee, hip, or hand OA
Acupuncture
Acupuncture is a component of traditional Chinese medicine. It involves a qualified therapist inserting thin needles through the skin at specific sites to balance the body’s energy flow or life force. In recent years, many people have suggested that acupuncture may help ease the pain of OA.
A 2019 reviewTrusted Source looked at the evidence for the use of acupuncture to treat knee OA. The authors conclude that acupuncture may effectively reduce pain and improve knee function. However, they highlight that more research is necessary to confirm its benefits.
Learn about acupuncture for arthritis.
Transcutaneous electrical stimulation (TENS)
TENS uses low voltage electric currents to treat pain.
The ACR and Arthritis Foundation guidelinesTrusted Source strongly advise people with knee or hip OA not to use TENS. The reasons for this are that scientific studies on the use of TENS in OA are of low quality, and there is no evidence to suggest that TENS is beneficial for people with OA.
Outlook
OA usually develops slowly over time, but it can develop more rapidly after an injury.
Having OA can increase the risk of complications for some people. Painful joints make it harder to exercise, which increases the risk of gaining weight. Carrying excess weight can lead to diabetes, high blood pressure, high cholesterol, and heart disease.
Although there is no cure for OA, it is possible to manage the symptoms and maintain a good quality of life.
Summary
OA develops when the cartilage inside the joints breaks down. It can cause pain, stiffness, and swelling. There is no cure for OA, and the condition tends to worsen over time.
Doctors usually recommend a combination of natural and drug-based treatments.
Natural treatments for OA include physical therapy, lifestyle changes, heat and cold therapy, and supportive devices.
People may find relief from their symptoms through different approaches. Before trying a new treatment, a person may wish to talk with a doctor.
Last medically reviewed on April 27, 2022
OsteoarthritisRheumatologyComplementary Medicine / Alternative Medicine
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What exercises should people with osteoarthritis avoid?
Medically reviewed by Gregory Minnis, DPT, Physical Therapy — Written by Peter Morales-Brown on December 23, 2024
Exercises to avoid
Why are they not suitable?
Other tips
Treatments
Exercises to include
Summary
High impact exercises may stress joints, worsening the symptoms of osteoarthritis. However, regular physical activity with low impact exercises is essential to help manage the disease.
Osteoarthritis is the most common type of arthritis worldwide, causing joint pain and loss of function. Experts recommend that people with osteoarthritis keep physically active to help manage their weight and to help prevent their symptoms from worsening. However, some types of exercise may be unsuitable, as they can cause stress on the joints.
People may be able to start or continue exercises they enjoy by making adaptations such as avoiding running on hard surfaces or ensuring they warm up and stretch properly.
Exercises to avoid
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The Centers for Disease Control and Prevention (CDC)Trusted Source advises that physical activity is beneficial for people with arthritis. It can reduce pain and improve someone’s function and quality of life. However, the CDC recommends engaging in joint-friendly exercises for arthritis, which put less stress on the body and reduce the risk of injury or worsening symptoms.
The Arthritis Foundation (AF) notes that aerobic activity can help maintain flexibility and improve muscle strength. However, it also advises that people with osteoarthritis should not take part in high impact aerobics or running without their doctor’s approval.
If someone runs, plays basketball, or partakes in any other high impact activity, it is advisable to avoid doing so on hard surfaces. Additionally, people need to avoid engaging in daily high impact activity and make sure to take rest days. They also note that while strength training helps make joints more stable, people must avoid over-training or jerking weights quickly.
If performing exercises that involve stretching, such as yoga and tai-chi, the Arthritis Foundation states that someone must ensure they warm up first. They should also avoid bouncing when holding a pose or stretching.
Why are these exercises bad for osteoarthritis?
A 2023 systematic review notes that repetitive impact and loading in athletes can result in damage to the articular cartilage. This is the smooth tissue that covers the ends of bones where they meet at joints.
Health experts advise that when damage occurs to the articular cartilage with repetitive use, arthritis may develop over time. In addition, an injury that may occur during sport or exercise may make a person more likely to develop osteoarthritis.
Other researchTrusted Source notes that mechanical stress and atypical joint mechanics cause inflammation and destruction of the joint. The erosion of the articular cartilage eventually extends down to the bone, causing clusters and outgrowths of bone at the joint. The research authors advise people to avoid activities that overload the joints and worsen pain.
Other tips for osteoarthritis
EvidenceTrusted Source suggests that people with overweight and osteoarthritis need to maintain a moderate weight to help their symptoms. They note that each pound of weight loss can decrease the load on the knee by three- to six-fold.
In addition, people can make dietary changes to support osteoarthritis. The AF recommends focusing on a diet rich in whole foods to help counteract inflammation. It suggests trying the Mediterranean diet, which studies confirm has many health benefits, including helping arthritis by curbing inflammation. The Mediterranean diet includes the following foods that may help with pain and swelling in osteoarthritis:
oily fish
fruits and vegetables
beans and legumes
whole grains
nuts and seeds
olive oil
The Arthritis Foundation notes that nightshade vegetables such as eggplant and bell peppers contain antioxidants that can benefit health. However, they also contain solanine, which may trigger arthritis pain in some people. The AF states there is no scientific evidence that nightshade vegetables trigger arthritis flares. The organization advises people to monitor the individual effects on their symptoms.
Treatments for osteoarthritis
In addition to diet and lifestyle strategies, a doctor may recommend other treatments for osteoarthritis, depending on the severity. These may includeTrusted Source:
medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
injections into the joints
surgery
physical therapy using braces, splints, or assistive devices
orthotics for shoes
Someone can consult their doctor about which treatments are suitable for them.
Exercises to include
Exercise and physical activity is an essential part of managing osteoarthritis. Well-rounded exercises can include:
muscular endurance and strength training
stretching and joint mobility trains to improve range of motion
aerobic fitness to improve stamina and cardiovascular endurance
Therefore, people can try a combination of the following exercises:
walking
swimming
non-swimming aquatic exercises that people perform in water
using the elliptical training machine
cycling
jogging
yoga or Pilates
basic stretching exercises for hamstrings, neck, back, and shoulders
weight-bearing exercises using dumbbells or resistance bands
Summary
Exercise is essential for managing osteoarthritis, and people need to ensure they take on regular physical activity. However, it is important to avoid high impact exercises that can damage the joints and worsen symptoms.
If a person engages in these activities, it is essential that they warm up properly and stretch to help prevent pain and stiffness. People also need to avoid training on hard surfaces wherever possible. Jerking or bouncing during exercise may worsen symptoms, as may overtraining or overloading the joints.
A combination of low impact activities can help manage osteoarthritis. This can include a combination of strength, flexibility, and aerobic activities, such as such as walking, yoga, and suitable weight training. It is also advisable for a person living with osteoarthritis to check with a doctor before taking up new activities.
Last medically reviewed on December 23, 2024
OsteoarthritisSports Medicine / Fitness
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What is autologous chondrocyte implantation (ACI)?
Medically reviewed by Darragh O'Carroll, MD — Written by Beth Sissons on December 4, 2024
Purpose
Who can have ACI?
Procedure
Preparation
Recovery from ACI surgery
Risks
Success rate
Summary
Autologous chondrocyte implantation (ACI) is a two-step surgical procedure to restore cartilage around a joint and treat cartilage defects.
Cartilage is the connective tissue found throughout the body that protects joints and bones. Cartilage consists of cells called chondrocytes.
“Autologous” means the transplant only involves cells or tissues from a person’s own body rather than a donor.
ACI is a procedure in which healthcare professionals take a small sample of cartilage from the affected area and extract the chondrocytes.
Professionals in a laboratory then expand and increase the number of chondrocytes. Finally, a surgeon returns the expanded chondrocytes into the affected area.
This article explains the purpose of ACI, who may have the procedure, and what to expect before, during, and after the procedure.
What is the purpose of ACI?
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The purpose of ACI is to treat articular cartilage defects or damage. Articular cartilage, or hyaline cartilage, is the cartilage covering the ends of bones where they form joints.
Injury or wear and tear can damage articular cartilage. Articular cartilage has a limited ability to heal itself, so medical treatments are necessary to stimulate new cartilage growth.
Without treatment, articular cartilage defects can cause severe pain, negatively affect joint function, and possibly lead to osteoarthritis.
ACI may permanently resolveTrusted Source cartilage defects. ACI usually treats issues relating to the distal femur, which is where the thigh bone joins the knee.
Surgeons may also use ACI to treat problems with the kneecap, but ACI is suitable for any joint with articular cartilage, such as the:
ankle
hip
shoulder
elbow
big toe
Who is a good candidate for ACI?
ACI is a treatment option for certain people with articular cartilage defects. Doctors may consider it when other treatments have not worked. Experts generally recommend ACI for younger people, and it may be a good option for children or young adults.
ACI may also benefit athletes who are able to stop intensive training and competitions for 9 to 12 months. It may help improve an athlete’s quality of life after they retire from their sport. ACI may have the best outcomes among those who have not had any previous surgery on the bone.
Younger people with a single injury may be suitable candidates for procedures that restore articular cartilage. Older people or people with multiple problems within one joint may be less likely to benefit from cartilage restoration.
Read about nonsurgical treatments for knee arthritis.
What does the ACI procedure involve?
ACI involves two stages: harvesting and implantation.
What does harvesting in ACI involve?
The first stage of ACI is to “harvest,” or remove, the cartilage cells from the affected joint. A surgeon will use arthroscopy to remove a small section of cartilage from a non-weight-bearing part of the joint.
Arthroscopy is a minimally invasive procedure in which a surgeon creates a small incision in the affected area. They then insert an arthroscope, which is a small instrument with a light and camera, into the joint.
The camera images appear on a screen, allowing a surgeon to see inside the joint and carry out the procedure. Once a surgeon has removed the cartilage sample, they close the incision.
A laboratory then receives the cartilage sample and separates the chondrocytes from the tissue. Next, the laboratory cultures or multiplies the chondrocytes for 3 to 5 weeks, increasing the cartilage cells to around 5 to 10 million cells in number.
What does implantation in ACI involve?
People have a second surgical procedure to implant the increased number of chondrocytes.
For implantation, a surgeon will use arthrotomy, a procedure that involves opening a joint. The surgeon will smooth over and prepare the area of damage and then cover it with a patch.
A surgeon then injects the new chondrocytes underneath the patch. The chondrocytes begin to grow within the joint, gradually replacing the area of damage with healthy cartilage.
Preparing for ACI surgery
People will need to follow a doctor’s instructions to prepare for ACI surgery. A doctor will discuss what to expect before, during, and after the procedure, and how to prepare. A person can follow these general preparation steps:
Aim to get as healthy as possible in the weeks leading up to surgery, including staying physically active if possible, eating a healthy, balanced diet, and getting good quality sleep.
If people smoke, stop smoking for as long as possible before surgery, as smoking can increase the risk of complications with surgery and healing.
Follow any instructions around food, drink, and medication before surgery.
Find some loose-fitting, comfortable clothes to wear after surgery.
Arrange transportation to get home from the surgery, as people will not be able to drive following the procedure.
Recovery from ACI surgery
Recovery after ACI will include proper wound care and pain management. After ACI, people will follow a physical therapy rehabilitation program to help them recover. This includes therapies such as:
motion training to help restore normal movement
partial weight bearing on the affected joint, gradually increasing weight bearing over 3 months until the joint can fully bear weight
using a continuous passive motion (CPM) machine, which moves the joint by itself to help restore movement
How long is the recovery period after ACI?
A rehabilitation program may last for around 10 to 12 weeks. Physical therapy aims to strengthen the joint and support muscles to restore normal mobility and range of motion.
People may need to wait several months before it is safe to return to strenuous activities or sports. Complete healing may take 12 to 15 months.
What are the risks or side effects of ACI?
As with all types of surgery, ACI has potential risks and complications. The most common complication of ACI is a thickening of the patch that the surgeon inserts into the joint in the implantation stage. Thickening can occur due to an increase in friction and poor surgical technique.
In current procedures, doctors use bioengineered patches rather than patches created from another area of the body. Bioengineered patches have led to complication rates falling below 10%.
In around 5% of cases, the graft may partially or completely loosen. The term for this is “delamination,” and it is a serious complication of ACI. People may require further surgery to treat delamination.
What is the success rate of ACI knee surgery?
A 2022 review found that, in 161 people who received ACI for knee osteoarthritis, the treatment resulted in sustained clinical improvements for up to 11 years, with a failure rate of around 10% in this time frame.
A 2019 studyTrusted Source, which lasted 18 years, examined the success rates of different ACI grafts in the knee. The graft’s 10-year survival rate was 86%.
Arthritis resources
To discover more evidence-based information and resources for arthritis, visit our dedicated hub.
Summary
ACI is a surgical treatment to regenerate cartilage. It can help treat cartilage defects, improve function, and reduce the risk of osteoarthritis.
ACI is a two-step procedure. A surgeon removes cartilage cells from the affected area, and a laboratory then increases the number of cartilage cells.
A surgeon implants the new cartilage cells in the affected area, which then grow and replace the damaged cartilage.
Full recovery may take several months and involves physical therapy to help restore normal mobility to the joint.
OsteoarthritisSurgeryRehabilitation / Physical TherapyArthritis
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What is bone-on-bone arthritis?
Medically reviewed by Daniel Wiznia, MD — Written by Amanda Barrell on November 15, 2022
Overview
Symptoms
Pain management
Treatment
Prevention
Diagnosis
Contacting a doctor
Summary
Bone-on-bone arthritis is not a clinical term. However, people may use it to refer to advanced or severe osteoarthritis (OA). At this point, the “wear and tear” or degeneration is severe enough that there is bone-to-bone contact between the joints.
OA is the most commonTrusted Source form of arthritis and affects the joints. More than 32.5 millionTrusted Source adults in the United States are living with the condition.
The two main causes of OA are joint injury and general wear and tear as people age.
OA is a progressive condition, meaning that it worsens over time.
This article explains what bone-on-bone arthritis is, the signs and symptoms, and how people can manage the condition.
What is bone-on-bone arthritis?
David Madison/Getty Images
People use bone-on-bone arthritis to refer to advanced-stage or severe osteoarthritis (OA). Doctors may also call it end-stage OA.
Healthy joints have a layer of tissue, or cartilage, inside. It covers the surface of the bones and allows for smooth gliding of the joint. The joints also contain synovial fluid, which cushions the end of the bones and helps reduce friction with movement.
When a person develops OA, the cartilage thins, and the surface becomes rough. As a result, the joint does not move as smoothly as before.
Over time, the body’s attempts to repair the damage can further affect the joint. For example:
extra bone can form at the edge of the joints, called osteophytes or bone spurs
the joint lining can thicken and produce more fluid than usual, making the joint swell up
the tissues around the joint can stretch, making the joint less stable
Healthcare professionals often divide cases of OA into three stagesTrusted Source:
Early stage: A person still has a good amount of cartilage cover on the joint. A person can experience sharp pain when moving the joint.
Mid-stage: The cartilage has become worn, and there may be some bald patches. A person may experience pain and joint locking. The pain will be more constant, affecting a person’s ability to perform daily activities.
Advanced stage: There is significant cartilage loss, and the spaces between the joints are narrow. The bone tissue becomes thick and rigid, and bone spurs can develop. There can be bone-to-bone contact during this stage. Individuals will experience a constant dull ache alongside intermittent episodes of intense pain.
Is it reversible?
There is no cureTrusted Source for OA or way to reverse the joint damage. However, people can help manage their symptoms.
Signs and symptoms
Those with advanced stage OA will experience pain, swelling, and stiffness at the affected joint. People will also have difficulty moving the affected joint.
A 2022 articleTrusted Source notes that a person with advanced stage OA will experience a dull, constant, aching pain. They will also experience intermittent episodes of intense pain, which can affect a person’s ability to engage in daily activities.
According to the United Kingdom’s National Health Service (NHS), the muscle surrounding the affected joint may look smaller and feel weak.
Some people may find the joint buckles when in use.
Ways to manage the pain
People can try the following methods to manage the pain associated with advanced-stage OA:
Using hot therapy: A heating pad or hot pack can help relieve pain and stiffness. People should apply heat to the affected joint 2–3 times a day for 20 minutes. People should be careful not to burn their skin.
Using cold therapy: A person can apply an ice pack twice a day, for 15–20 minutes at a time. Individuals should check their skin every 5 minutes to ensure they are not getting ice burn.
Achieving and maintaining a moderate weight: This can help to relieve the pressure on the joints. For those who are overweight or have obesity, losing 1 pound (lb) of weight can reduce the load on the affected joint by 3–6 lbTrusted Source.
Taking pain medication: Pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce swelling and pain. Examples include ibuprofen and acetaminophen. Doctors may also prescribe pain relief medications at higher strengths.
Exercising: Although exercising with advanced stage OA may feel uncomfortable, it is important to take part in low impact physical activity, such as swimming, walking, and riding a bike. People can try gentle exercises to reduce pain and swelling. This can include:
range-of-motion exercises to help flexibility
aerobic exercise to strengthen the heart and lungs and build stamina
strengthening exercises to increase muscle strength to help protect the joints
Using walking aids and supportive devices: To help relieve the pressure on the joints, people may wish to use a walking aid or wear braces and splints.
When using hot and cold therapy, people may benefit from alternating between the two. Gently massaging the area afterward may also help to relieve pain.
The Centers for Disease Control and Prevention (CDC)Trusted Source also suggest that people join a self-management class, such as the Arthritis Self-Management Program (ASMP)Trusted Source. The workshops teach people how best to manage their pain.
Treatment
Doctors may recommend glucocorticoid injections. The physician will inject the drug, which is a steroid, directly into the joint to ease swelling and pain.
Patient advocacy group, Versus Arthritis, notes that it can take between a few hours and 1 week for the person to feel the effects of the medication. One injection tends to work for around 2 or more months.
Surgical
In some people with advanced-stage OA, doctors may suggest surgery. They may suggest an operation called total joint replacement, or total joint arthroplasty.
A doctor may recommend surgery as a last resort when other treatments have not worked.
During the operation, the surgeon replaces the damaged joint with one made from metal, plastic, or ceramic. This reduces pain and helps people to move the joint.
However, it is important to note that artificial joints can wear out, and some people will need repeat surgery in the future.
Prevention
It may not be possible to prevent OA from developing. However, those in the early stages of the condition can take measures to slow its progression.
A person should take part in regular exercise but avoid activities that place extra strain on the joints, such as running.
They should also achieve and maintain a moderate body mass index (BMI).
Diagnosis
To diagnose advanced-stage OA, a doctor will:
ask about the symptoms
examine the affected joint or joints
perform an X-ray
perform blood tests
When to contact a doctor
According to the Arthritis Foundation, people should speak with a doctor if they experience:
joint symptoms, such as pain or swelling, that last for 3 or more days
several episodes of joint symptoms in 1 month
Those with OA should speak with a doctor to discuss how they will monitor the progression of their condition.
Summary
People use bone-on-bone arthritis to refer to advanced stage OA.
At advanced stage OA, there is very little cartilage left. The bone tissue also thickens and becomes rough, and bone spurs develop. This means that there can be bone-to-bone contact between the joints.
People with advanced stage OA will experience a constant dull ache and intermittent episodes of intense pain.
Although there is no way to reverse the damage, people can take measures to help manage their symptoms, such as applying hot and cold therapy, exercising, and maintaining a moderate weight.
Last medically reviewed on November 15, 2022
OsteoarthritisPain / Anesthetics
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What is severe osteoarthritis?
Medically reviewed by Stella Bard, MD — Written by Beth Sissons on November 4, 2022
What is severe osteoarthritis?
Stages of OA
Symptoms
Risk factors
Can you stop OA from worsening?
Complications of severe OA
Treatment
Can lifestyle choices help?
When to contact a doctor
Outlook
Summary
Severe osteoarthritis (OA) is an advanced stage of the disease. It occurs when most of the cartilage around a joint has worn away. Severe OA may cause constant pain and reduced joint function.
OA is a degenerative joint disease. People with severe OA have extensive joint damage, which may increase the severity of symptoms such as pain and reduced range of motion.
This article looks at the stages of OA progression, symptoms of severe OA, steps that may help prevent OA from worsening, and treatment options.
What is severe osteoarthritis?
10’000 Hours/Getty Images
Severe OA is the advanced stage of the disease when there is extensive damage to the joint. In severe OA, most of the cartilage protecting the joints has worn away.
This can cause increased severity of symptoms, including persistent pain and stiffness that may make it difficult to carry out everyday activities. People may also experience pain at night.
Stages of OA
In the early stagesTrusted Source of OA, the articular cartilage, which covers the ends of bones at the joints, becomes thinner and rougher. Over time, the cartilage erodes or disappears completely, affecting more of the bone surface.
Healthcare professionals may classify OA into four stages:
Stage 1 (early OA): Minor wear and tear of the joints with little to no pain.
Stage 2 (mild OA): People may experience pain and stiffness as the cartilage wears down. Bone spurs may appear on X-rays.
Stage 3 (moderate OA): Erosion may occur in the cartilage, and everyday activities may become more difficult or uncomfortable.
Stage 4 (severe OA): Almost all cartilage has worn away, resulting in chronic inflammation. People may experience fairly constant pain and stiffness, which affects everyday activities.
Symptoms of severe OA
People with advanced stage OA may experience pain more constantly and have bouts of unpredictable pain. Severe OA may also cause pain at night, which may affect sleep.
Severe OA may make it more difficult to carry out certain everyday tasks or activities due to pain, stiffness, or reduced range of motion.
Severe OA may causeTrusted Source joint deformity and swelling. People may feel that a joint gives way or buckles, affecting balance and stability.
Other symptoms of OA include:
aching joints or pain during or after activity
joint stiffness, usually after resting or first thing in the morning
swelling around a joint
reduced range of motion, which may improve with movement
crepitus, a clicking or popping sound when moving a joint
muscle weakness around a joint, which may make the joint buckle or feel unstable
Risk factors
Risk factors for OA include:
being over the age of 50 years
joint injury
overuse of a joint
obesity
misalignment of bones or joints
issues with muscle support
having family members with OA
being female
environmental factors, such as occupation, activity levels, diet, and bone density
Factors that may increase the riskTrusted Source of OA progressing rapidly and severely include:
obesity
older age
OA that affects multiple joints
varus deformity, which affects the alignment of bones
Is it possible to prevent OA from getting worse?
For most people, OA will not steadily worsen over time. The condition can affect everyone differently, but individuals may find the condition peaks after a few years. After this, symptoms may stay the same or even improve.
Some people may find they have periods of joint pain and periods of improvement.
Treatments and lifestyle changes may help slow the progression of OA and prevent the condition from worsening.
Complications of severe OA
Severe OA may cause complications, such as:
deformity from swollen joints
difficulty sleeping due to pain
difficulty exercising, staying physically active, or carrying out everyday tasks
joint instability, which may lead to falls
tingling or numbness in the arms or legs due to nerve compression
depression, anxiety, or other mental health conditions due to reduced quality of life
Additionally, severe cases of spinal OA may affectTrusted Source bladder and bowel function.
Treatment
Although treatment cannot reverse joint damage from OA, it may help slow the disease’s progression, reduce pain, and increase joint function.
Treatments for OA include:
pain relief medications, such as acetaminophen
topical creams, gels, and patches, such as capsaicin cream
nonsteroidal anti-inflammatory drugs
duloxetine, a drug to treat chronic pain
corticosteroid or hyaluronic acid injections into the joint
regular exercise and physical activity
alternative therapies, such as massage
wearing supportive garments, such as braces and straps
using mobility aids, such as canes and walkers
heat or cold therapy
For severe OA, people may require surgery. This may include repairing joint damage or replacing a joint.
Learn more about arthritis surgery.
Can lifestyle choices help?
Certain lifestyle choices may help slow the progression of OA and improve overall health. People may wish to:
maintain a moderate weight, which can reduce inflammation and extra stress on the joints
eat a nutritious, balanced diet
control blood sugar, as high levels can increase the risk of cartilage breaking down
maintain range of motion as much as possible by stretching and staying active each day
listen to the body and rest as necessary
warm up and cool down properly before exercise to protect the joints
minimize stress, and take time to relax
avoid smoking and limit alcohol
get enough quality sleep
Learn about natural treatments for osteoarthritis.
When to contact a doctor
People can contact a doctor if they have symptoms of OA. Other conditions may cause similar symptoms, but getting the correct diagnosis and beginning any necessary treatment is important.
If someone finds it difficult to manage severe OA or treatments appear to be ineffective, they can talk with a doctor. A doctor may refer them to a physical therapist, occupational therapist, or orthopedic surgeon to discuss surgical options.
People can also consult a doctor, a mental health professional, or a support group if severe OA affects their mental health and overall well-being. The Arthritis Foundation can connect people with arthritis and their caregivers with peer-led support groups.
Learn about online support groups.
Outlook
Although severe joint damage is not reversible, treatments may help slow disease progression, decrease pain, and improve joint function.
For severe OA, joint replacement surgery may provide the best long-term outlook, with successful outcomes in more than 80%Trusted Source of cases. Joint replacements may last 10–15 years, after which people may need repeat surgery.
Summary
Severe OA involves extensive damage in the joint, with most of the cartilage worn away.
This increases the severity of symptoms, and people may experience more constant pain, limited range of motion, and decreased function. Severe OA may affect everyday activities, sleep, and quality of life.
Treatments and lifestyle changes, such as medication, a nutritious diet, and exercise, may help slow the progression of OA and improve symptoms.
Additionally, surgery to repair damage or replace the joint may be necessary if other treatments are ineffective.
Last medically reviewed on November 4, 2022
Body AchesOsteoarthritisSurgeryRehabilitation / Physical Therapy
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What are some natural treatments for osteoarthritis?
Medically reviewed by Monisha Bhanote MD, FCAP, ABOIM, CCMS, YMTS — Written by Amanda Barrell on April 27, 2022
Do they help?
Heat or cold therapy
Physical therapy
Supportive devices
Lifestyle changes
Supplements
Mind-body
Acupuncture
TENS
Outlook
Summary
Some people with osteoarthritis (OA) find relief from natural treatments, such as physical therapy and acupuncture. Many experts recommend a combination of drug-based and natural treatments for people with OA.
OA is the most common form of arthritis, affecting more than 32.5 millionTrusted Source adults in the United States.
OA happens when the cartilage inside a joint breaks down and wears away, leading to changes in the bone in the joint. The joints that OA most commonly affects are the hands, hips, and knees.
There is evidence that certain nonpharmacological treatments for OA are beneficial for some people. Physical therapy and lifestyle changes, for example, can help people manage their symptoms.
This article describes some common natural treatments for OA, including heat and cold therapy, supplements, and acupuncture.
Do natural treatments help osteoarthritis?
FG Trade/Getty Images
There is no cureTrusted Source for OA. When prescribing treatments, doctors aim to help people manage their symptoms so that they can have a good quality of life.
Doctors tend to recommend a combination of natural and pharmacological, or drug-based, treatments. The options include physical activity, physical therapy, and pain medications.
Although there is evidence that some natural treatments are beneficial for people with OA, more research is necessary to confirm the benefits of others.
Below are some common natural treatments for OA.
Learn more about osteoarthritis.
Heat or cold therapy
Applying heat or cold to the affected joint may help reduce the pain and swelling associated with OA.
A 2021 study involving 117 people with OA in the knee found that heat therapy and cold rub gel effectively improved pain and joint function.
The Arthritis Foundation explains that applying heat to a sore joint makes the blood vessels in the area expand. This helps more blood, oxygen, and nutrients flow to inflamed tissues. Increasing circulation in this way can relax stiff muscles and joints.
The organization adds that cold treatment has the opposite effect and reduces inflammation. Due to this, it might be a better choice when a person has a flare-up.
A person can try heat therapy by:
taking a hot shower with a water temperature of 92–100℉
applying a warm compress, such as an electric heat pad or a moist washcloth that the person has heated in the microwave
soaking in a warm pool or bathtub for about 20 minutes
A person can try cold therapy by:
wrapping a bag of frozen vegetables in a thin towel and using it as a cold compress
buying a reusable ice or gel pack
putting a towel in the freezer for 15 minutes and then applying it to the sore area
using a cold rub gel
Learn more about heat and cold therapy.
Physical therapy
Physical therapy can help a person move safely and effectively. Physical therapists tailor therapy programs to individuals’ needs, but they usually include stretches and targeted exercises.
Physical therapy can offer a person with OA the following benefits:
helping maintain flexibility and range of motion
strengthening the muscles to help support the damaged joint
increasing the strength of the muscles surrounding the joint
maintaining fitness
helping a person perform their daily activities
Learn about 10 exercises for knee arthritis.
Supportive devices
The Arthritis Foundation suggests that supportive devices can protect the joints and help a person perform daily tasks. A physical therapist, occupational therapist, or orthotist can fit a person with braces or splints that help align and support the joints.
Canes and walkers can reduce the load that the body places on damaged joints while walking. This can make it easier for people with severe OA to get around.
Supportive devices include:
braces
splints
canes
walkers
gloves and wrist straps
Learn about mobility aids.
Lifestyle changes
Doctors often recommend that people with OA adopt or maintain certain lifestyle habits, such as eating a nutritious, well-balanced diet and getting plenty of exercise and sleep. Controlling cholesterol levels and keeping blood pressure within the healthy range may also minimize OA symptoms. Where applicable, it can also help to quit smoking.
People with OA can benefit from reaching or maintaining a moderate body mass index (BMI), as excess body weight can put additional pressure on damaged joints.
The authors of a 2018 review in the journal Rheumatology note that certain foods may help ease the inflammation associated with OA symptoms. Beneficial foods include oily fish, such as sardines, mackerel, and salmon, as well as avocados and walnuts, which contain omega-3 fatty acids. The researchers recommend eating one or two portions per week and taking a daily fish oil supplement.
Supplements
According to the Arthritis Foundation, the evidenc
December 02, 2015, 04:48:55 AM
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