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Dear Vori,

My cartilage is going away and I have bone-on-bone. Is it too late to prevent knee replacement surgery?

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Bent on Prevention
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Dear Bent on Prevention, 

Although pictures usually paint a thousand words, your x-rays are not the most powerful part of your joint replacement story—even if they show bone-on-bone.

"We treat the patient, not the x-ray," explains Jim Fiechtl, MD, a sports medicine physician at Vori Health. “The right time to have joint replacement surgery, even if you are bone-on-bone, depends on important factors like your age, overall health, and quality of life." 

"To help you make this decision," Dr. Fiechtl explains, "we would want to know answers to questions, like: Are your symptoms keeping you from doing most of your normal activities? Have you done physical therapy without improvement? Would you benefit from losing weight (every extra 10 pounds of weight places an additional 30 to 60 pounds of pressure on your knees)? Are you are eating an anti-inflammatory diet?"

With the whole picture in perspective, we can help you understand if a knee replacement is needed. If surgery can wait, you can help keep your pain under control by maintaining a healthy weight, eating an anti-inflammatory diet, getting low-impact exercise regularly, strengthening the muscles that support your knees, and taking anti-inflammatory medications (like ibuprofen) as prescribed by your physician. Additionally, bone-on-bone arthritis can sometimes lead to further wear of your bones. To be cautious, your physician may also recommend follow-up x-rays in a year or so to monitor your bone health. 

In the end, if you do need joint replacement surgery, there are similar steps you can take to optimize your outcomes. Talk with a care team to get a personalized plan for exercise, nutrition, and lifestyle to keep your knees feeling as strong as possible—for as long as possible. 

Truly yours,  

Vori Health 

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