Does Receiving a Bone-on-Bone Diagnosis Mean You Need Surgery?

Does Receiving a Bone-on-Bone Diagnosis Mean You Need Surgery?

This blog post was updated on October 26, 2020. Previous comments have not been removed or edited.

Without joints – in the fingers, wrists, elbows, shoulders, hips, knees and ankles - the human body would be incapable of the fluid movement so critical to daily life.

What is a Joint?

Cartilage is a smooth, rubbery connective tissue at the end of bones that allows for the perfect sliding between the bones. The main role of the synovial membrane that frames the joint is to secrete the hyaluronic acid of the synovial fluid, which fills the small space in the joint between the two bones. That fluid provides lubrication for movement as well as nutrition to the cartilage on either end of the bones of the joint.

However, decades of wear and tear can cause cartilage to break down - or osteoarthritis - which results in pain, swelling and difficulty with movement. Osteoarthritis is the most common form of arthritis, affecting about 27 million Americans, according to the Centers for Disease Control and Prevention – and making it one of the leading causes of disability. Weight-bearing joints, along with joints in the hands, feet and spine, are most commonly impacted, and about half of all people age 60 and older will experience symptoms of Osteoarthritis in the knee.

Osteoarthritis can progress. Bones may develop growths called spurs. Pieces of bone or cartilage may chip off. The body’s inflammatory process, which signals the release of proteins and enzymes, will cause further cartilage damage in the process. Ultimately, the cartilage wears away and bone rubs against bone - leading to joint damage and even more pain.

Although age is commonly linked to Osteoarthritis, other factors include:

  • Excess weight

  • Genetics

  • Gender: Before age 45, men are more likely to develop osteoarthritis. However, after age 50, women are more likely. At about age 80, one in four people have symptoms of Osteoarthritis, regardless of gender.

What are the Risks Associated with Knee Replacement Surgery?

Studies show that in the case of complete knee replacements, as many as one-third of these surgeries are actually considered outright ‘inappropriate,’ with fewer than half considered fully ‘appropriate.’ That means that in at least one out of two cases, a full knee replacement wasn’t absolutely necessary.

Besides the fact that they aren’t always necessary, there are a variety of other risks that can be caused by knee replacements:

  • Infection and healing issues
  • Swelling and stiffness
  • Blood clots
  • Bone fractures during surgery
  • Nerve damage
  • General risks of anesthesia
  • Replacement parts becoming loose, breaking, or popping out
  • Metal implant allergies

What Factors Increase Potential Risks and Complications?


Studies show that smokers seem to experience even more complications when they undergo joint replacement surgery. Two studies presented at an American Academy of Orthopedic Surgeons Annual Meeting found that patients who smoke may be at an increased risk when having total knee or hip replacements. Researchers discovered that the overall revision rate (the number of surgeries that had to be redone) was 10 times higher for smokers compared to nonsmokers. If you smoke, be sure to speak with your doctor about these risks, and look into getting help to quit smoking.

Heart Problems

A recent study published in The Journal of Bone & Joint Surgery suggests that patients with atrial fibrillation (A-Fib) who underwent joint replacement surgery had a longer stay in the hospital, increased medical care costs, and higher rates of complication. If you have A-Fib or another heart-related condition, talk with your physician or consider seeking a second opinion to investigate other treatment options.

Knee Replacement Surgery Not a Permanent Cure

Typically, the new metal joint from a knee replacement can last between 10 and 15 years. Because of this, even with a ‘perfect’ procedure, many patients will need two or even more replacements in their lifetime, depending on their age at the time of the first procedure. Although most replacements are done on patients between the age of 60 and 80, there are now people even younger being recommended for this surgery.

This translates to about 700,000 Americans, according to the CDC, now having a knee replacement every year. And, approximately 105,000 of those patients will be back in the hospital for a repeat surgery long before 15 years, especially if they are obese or extremely active.

Consider Non-Surgical Solutions for Bone-On-Bone Knees

Our specialists at Flexogenix® have listened to patients and agree that there are a variety of safer and better options for patients with a bone-on-bone diagnosis. These options include:

  • Viscosupplementation
  • Regenerative Cell Therapy
  • At-Home Treatments and Remedies

Viscosupplementation & The Knee-Flex 5-Step Protocol

Viscosupplementation is a procedure during which hyaluronic acid is injected into the joint, as an effective knee pain treatment. Hyaluronic acid is a normal component of the cartilage and fluid in the joint. Because the weight-bearing knee joint is particularly prone to injury, and osteoarthritis, Flexogenix® has created the Knee-Flex 5-Step protocol that offers nonsurgical knee pain treatment.

This treatment is administered weekly over the course of about 4-5 weeks and provides more substantial pain relief, better mobility, and better long term results. This protocol takes the very latest FDA approved non-surgical knee pain treatment, and enhances it to provide a level of results that few others can match.

The steps of the protocol are as follows:

1. First, we provide immediate pain relief.

Our day 1 priority is to help you experience life without knee pain. Using our advanced imaging techniques, we map the sensory nerves around the knee. Next, utilizing innovative procedures to reduce nerve pain around the joints, the nerves are prevented from continuing to transmit pain signals. This replaces the use of steroids and protects patients from the long-term damage often associated with steroid injections. While the pain relief is significant, it is temporary and we must remind patients that it does not replace the reconditioning necessary in steps two through five of the Knee-Flex 5-Step protocol.

2. Next, we lubricate and protect the knee joint.

Using the latest image-guidance technology, our medical team administers the injection of hyaluronic acid (HA) with pinpoint precision. The HA provides lubrication and tempers the friction within the joint to reduce cartilage wear and tear, diminish bone-on-bone pain, and increase mobility. The precision and accuracy of the image-guided injection ensures the gel-like fluid is injected directly into the joint capsule for optimal results.

3. Then, we initiate Kineti-Flex®.

With the knee pain controlled and mobility restored, the process begins to research the true health, strength, and integrity of your joints, and design your individualized medically supervised reconditioning program. This is the step where we assess the many contributing factors that actually caused your knee/joint pain, and develop a detailed conditioning prescription to correct the problems, and prevent the pain from returning again.

4. Next, we correct the knee alignment with bracing.

In concert with Kineti-Flex®, our medical team carefully examines the alignment of the joint, and whether it can benefit from either short-term or long-term bracing. As with every aspect of Flexogenix® treatments, we have extensively researched the latest innovations and advancements in bracing. When prescribed correctly, bracing can be extremely effective in unloading and redistributing pressure off the worn areas of the joint. Again, our goal is long-term joint pain relief. Effective bracing and alignment can be a key to this success.

5. Finally, we continuously promote healing.

Our final step is an advanced injection protocol to stop any further degradation of the knee joint and cartilage by promoting the body’s natural healing response with Platelet Rich Plasma (PRP). This step is essential and introduces growth factors that create a strong foundation to restore the integrity of the joint. Together with Kineti-Flex® and bracing, PRP completes a comprehensive treatment plan that has helped thousands avoid surgery. With a continued commitment to your Kineti-Flex® regimen, you can achieve a level of health and success that you never thought was possible.

Regenerative Cell Therapies for Bone-on-Bone Knees

Regenerative cell therapy is a fairly new, and rapidly growing type of joint treatment that harnesses the body’s own healing abilities. It is a far gentler, and more natural technique that avoids the radical deconstruction of a joint that occurs with a replacement. With this method, a specialist in regenerative medicine will carefully analyze the problem area and diagnose it with medical imaging. This ensures that the most appropriate treatment plan will be prescribed.

Depending on the results of imaging, the process can look something like this:

  1. Controlling the Pain: while steroids are traditionally prescribed for joint pain, these cannot be taken long-term (because of the damage they can do to the patient’s stomach and liver). A safer approach is to identify which nerves are transmitting pain in the problem areas and block them from sending signals to the brain.

  2. Reconditioning and Bracing: With the pain under control, it is time to look at what caused the joint problem in the first place and focus on addressing that problem. If you have been stressing or using the joint in the wrong way, the specialist will determine how to correct that. You may need to strengthen the joint through exercise, and in some cases, a brace can help to stabilize it.

  3. Lubricating the Joint Naturally: This involves the use of targeted hyaluronic acid injections to the affected areas (as described above in Step 2 of the Knee-Flex 5-Step Protocol). This injection decreases the bone-on-bone friction that causes pain and further damage to the joint.

  4. Helping the Body Rebuild its Own Joints: This remarkable technology uses stem cells and platelet rich plasma, substances that encourage the body to heal itself. Even better, the best specialists acquire these materials from the patient’s own body. At Flexogenix®, we take these materials from areas where they occur in high concentration and injecting them into the problem areas. Because these cells come from the patient’s own body, there is no risk of rejection or negative reaction. Instead, they go straight to work to promote healing in the most natural way possible.

At-Home Treatments and Remedies

There are a variety of at-home treatments that can help ease the symptoms of arthritis, however we recommend that you seek additional treatments, such as those mentioned above, in order to promote deeper healing and longer-term pain relief.

Examples of these treatments include:

  • Heat and Ice Therapy
  • Low-Impact Exercise, such as swimming, yoga, or cycling, to strengthen muscles and improve joint mobility
  • Assistive devices, such as braces and splints
  • Rest
  • Weight Loss: even losing as little as five pounds can help decrease the symptoms of osteoarthritis – especially in large joints such as the knees and hips

Get a Second Opinion

Many people consider joint replacement surgery to manage severe pain, however many are hesitant due to the extensive risks and potential complications associated with the procedure, as well as the lengthy rehabilitation and recovery process.

Fortunately, Flexogenix® offers non-surgical treatment options so that you can avoid these risks and get back to the active lifestyle that you deserve with little to no recovery time.

If you are considering surgery, or interested in learning more about our non-surgical solutions, contact us today to schedule a no-cost consultation. We will review all options for treatment and give you all of the information that you need to decide whether our non-surgical solutions are a good fit for you.

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† While we are in network for most major insurance carriers we have some treatment programs that are not recognized or covered by many insurance carriers.