The Anatomy of a Joint
To understand what's really going on, we need to review basic joint anatomy. In a healthy joint:
- Bones don't directly touch each other
- Cartilage covers the ends of the bones
- A meniscus (in some joints like the knee) provides additional cushioning
- Synovial fluid lubricates the joint
The "Bone on Bone" Misnomer
When people talk about "bone on bone" conditions, they're usually referring to severe osteoarthritis. In this condition, the cartilage has worn down significantly, but it's not entirely gone. Here's why:
- Cartilage Persistence: Even in severe cases, some cartilage usually remains. It may be very thin and damaged, but it's still there.
- The Role of the Meniscus: In joints like the knee, the meniscus can also wear down. This contributes to the loss of cushioning, but again, it's rare for it to completely disappear.
- Walking Ability: If joints were truly "bone on bone," walking would be excruciatingly painful, if not impossible. The fact that many people with severe osteoarthritis can still walk (albeit with pain) suggests that some protective tissue remains.
Why the Terminology Matters
The term "bone on bone" can be misleading and potentially harmful:
- It can cause unnecessary fear and anxiety in patients
- It might lead people to believe their condition is beyond help
- It oversimplifies a complex condition
What's Really Happening?
In severe osteoarthritis, what we're often seeing is:
- Significantly thinned cartilage
- Damaged or worn meniscus (in some joints)
- Changes in the bone beneath the cartilage (subchondral bone)
- Inflammation in the joint
It's more accurate to describe this as "cartilage on cartilage" with severely compromised cushioning and lubrication.
Moving Forward
Understanding the true nature of joint degeneration is crucial for several reasons:
- It helps patients better understand their condition
- It opens up more treatment options beyond just joint replacement
- It encourages a focus on preserving and supporting remaining joint tissues
While severe osteoarthritis is indeed serious, it's important to approach it with accurate information. By understanding that some protective tissue usually remains, patients and doctors can work together on strategies to manage pain, improve function, and slow further degeneration.
Remember, if you're experiencing joint pain or have been diagnosed with osteoarthritis, always consult with a healthcare professional for personalized advice and treatment options.
Author
Dr. William J. Cole, Jr.
Dr. William J. Cole, Jr. is one of only five physicians in the world who is dual board certified in Interventional Pain Management and Regenerative Medicine. He has a passion for assisting patients with Long Covid. He sees patients from around the world in his clinics in Sarasota, Florida and Venice, Florida. Dr. Cole is dedicated to the mantra to "have the body, heal the body - naturally."
Dr. Cole lives in Sarasota, Florida with his wife Lily, and their two teenage children.
