Posts Tagged ‘bone-on-bone’

Remedies That Relieve Inflammation & Relieve Knee Pain

Friday, May 16th, 2014

Here is a request for help from one of my readers. As usual, I have preserved her privacy, while using this email for its salient teaching points. My reply follows.

Dr Bill

My mother is 83 and is bone on bone on her right knee.  After waiting 3 years she is scheduled for knee replacement in August.  She also has dementia so I am a bit worried about the anaesthetic.

Any suggestions would be good.

I also am bone on bone and need a knee replacement too.



Here, then, is my reply.

Dear SH,

I apologize for the delay in my response. I am later than usual responding because of some health issues in my family. But I must admit that I don’t visit or monitor my Dr. Bill’s Clinic inbox as often as I should.

From your description, your Mom has an end stage knee, meaning that she has end stage osteoarthritis, with exposed subchondral bone. The fact that she is 83 does not trouble me. Joint replacement surgery was originally designed for the elderly, so that is not the issue.

Dementia is the major issue, but not just for your very reasonable concerns about general anesthesia. This procedure can easily be done under spinal, or epidural, anesthesia, with the patient entirely awake, if necessary.

The problems may occur after surgery, when some older patients, even those without prior symptoms of dementia, can develop significant disorientation and confusion, on a metabolic basis.

I’ve seen this many times. In general, this postop delirium takes about three days to run its course and then, the patient usually returns to “normal,” which is really his or her compensated, natural state. It invariably scares the Hell out of the family, though. And I’ve never known a surgeon, other than myself, who routinely warned patients and families about this very common, but very scary phenomenon.

The results of all knee surgeries are a function of the surgeon’s skill, the postoperative rehabilitation (exercise) and the attitude of the patient, and these factors are roughly equal in importance.    Dementia will also make it difficult for her to cooperate in the post operative rehabilitation that is so important in achieving a satisfactory result, in terms of motion and function, after this kind of reconstructive procedure. This may result in a stiff, non-functional knee, which would be a shame, after enduring the pain of surgery and all the associated risks.

Now, only you know your Mom and the degree of her dementia. If it’s mild and early, she may be able to overcome these difficulties with close supervision and physical therapy and enjoy a good result. If she is really “out of it,” i.e., unaware of her surroundings, nonresponsive, etc., you may wish to reconsider surgery in favor of some non-surgical options. That is especially true if she is not very active, or even ambulatory.

I review a number of the various methods and proven effective treatments in my healing program, HOW TO AVOID KNEE SURGERY.

Although products that promise to “regrow” new cartilage are bogus (with the exception of very limited applications of new technology, which requires at least two surgeries and involves the restoration of cultured cartilage cells in the young), there are many nutritional, nutriceutical, and herbal remedies that relieve inflammation and relieve knee pain.

In this case, the concomitant use of a well designed knee brace, an ambulatory aid, like a cane or walker, and intra-articular injections of hyaluronic acid (Syn-Visc, etc.) might be effective in providing her pain relief and stability. The shots work about 75-80% of the time. The beauty of these shots is that they can last for months and they can be repeated. They “burn no bridges,” either, so surgery can always be done, if really needed.

You may want to consider this advice for yourself, as well.

If the nonoperative, conservative measures I recommend do not help, or relieve your pain, you can always proceed to surgery. Because again, this program “burns no bridges” (i.e., destroys no tissues, nor does it permanently alter the bone stock of the joint). But once you have surgery, you can never return to the non-surgical state.

In all cases, however, you must be guided by the advice of your own orthopaedic surgeon, who knows you (and your Mom) and most important, who has examined you (and Mom). If the surgeon feels that all nonoperative treatments have been exhausted, or that they are likely to be ineffective, then go ahead with surgery. In well-trained, experienced hands, the good to excellent results are around 95%, which is very successful, as surgical procedures go.

Anyway, I hope I’ve given you some things to think about. Please let me know what you decide and how you and your Mom fare. I wish you well. Good luck!

With best wishes,

Dr. Bill

Now, if YOU have chronic knee pain, whether in response to an injury, or as a result of arthritis, early or end stage, I strongly suggest that you try my program of proven, effective nonoperative treatments. If they work, you win BIG. If not, you can always proceed to surgery. If this makes sense to you (and it should), then please click the link. GET IT HERE!

Til next time, my friend, be well. And have a great weekend!

Yours for a pain-free tomorrowe and yolur optimal health,

Dr. Bill

P.S. No need to suffer with knee pain. Click the link. GET IT HERE.

P.P.S. Please “LIKE” Dr. Bill’s Clinic on Facebook and SHARE with anyone you think it may help. Thanks for your support!

What’s That Horrible Crunching Noise In My Knee?

Wednesday, December 3rd, 2008

So here I am, sitting in the study of the Southern Command Post, reviewing emails. And I came across one from a nice lady who is very concerned because she has knee pain, she is very heavy, given her size and worst of all, she has noises inside her joints that can actually be heard by people around her.
She was quite properly concerned because she’d like to get rid of her knee pain, and she wanted to get a copy of my newest healing program, HOW TO AVOID KNEE SURGERY (which you can get here at this link:  http://drbillsclinic.com/avoid_knee_surgery.html ), but she was afraid that it was already far too late for her–that the noise in her knees meant that all the cartilage had worn away completely, and that she had a “bone-on-bone” condition. This is what we in the trade call an “end stage knee.”
When articular cartilage, that normally coats the joint surfaces, is so diseased that it has eroded away and exposed the underlying bone, the naked bony surfaces grind upon each other with a deep, hard grinding sound and sensation that, once experienced or heard, is difficult to mistake for anything else.
It really is like rubbing two big rocks together, with grinding, rubbing and at times a mechanical ratcheting sensation. And, since the bone is where all the nerves reside, it hurts like hell! And that doesn’t count the extra pain from the inflamed lining membrane (synovium) that adds its own component to the pain.
So whether it’s osteoarthritis or rheumatoid arthritis, it’s at this end stage of disease, with exposed, bare bone, when major surgery IS truly indicated. Because at this state of the art, at this time, we cannot yet regrow new, healthy articular cartilage in a totally arthritic joint. The best we can offer is total knee replacements. And when they are indicated, they can be wonderful: pain relief, restoration of function and correction of deformity, with good to excellent results in over 95% of cases.
BUT…it’s major league surgery, with lots of risks and potential complications. So you don’t do it if you don’t HAVE to. 
However, all noise from within the joint doesn’t necessarily mean that your joints are finished and you need major surgery. Other conditions can cause noise, as well. When the lining of the joint becomes inflamed and swollen, its folds become thickened and enlarged. They rub upon each other, making a finer, more delicate crunching that we call crepitus or crepitation
If the membrane is restored to normal, the inflammation resolved, the swollen folds stop rubbing together and the noise stops. But if the condition persists for a long time, the membranous folds may become replaced with fibrous tissue (they become bands of scar tissue) and they then must be cut away surgically, to eliminate the sensation and the sound.
Then, there is degeneration of the articular cartilage surfaces, which may break apart into shredded beds of cartilage fronds, appearing like areas of “crab meat.” When these fragmented or fibrillated regions rub, one upon another, they too produce a crunching sensation, like walking in a gravel pit. 
This condition is called chondromalacia (“soft cartilage” grade III) and once this point has been reached, where there is physical disruption of the cartilage surface, it can never again return to a pristine, smooth surface. I discuss this disease and the various types of arthritis in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (manual and CD). Get it here at: http://drbillsclinic.com/eliminate_knee_pain.html  However, even though the knee is noisy, it doesn’t mean that it will immediately go on to full end stage arthritis. The knee can stabilize in this state for a long time, sometimes pain-free (if a little noisy), if treated with the exercises I teach in my PAIN-FREE PROGRAM. See what I mean at this link:   http://drbillsclinic.com/exercise_eliminate.html
The point is, this lady has nothing to lose and everything to gain by at least trying all the conservative measures that are available, to relieve knee pain. One of them, or some combination of them, may give her the knee pain relief she seeks, and buy time, until she can lose weight and make an eventual surgery safer and more likely successful. 
So the next time someone, maybe you, says, “Hey, what’s that horrible crunching noise in my knee?” now you know what some of the reasons might be. And some may well be treatable by non-surgical measures, like those in HOW TO AVOID KNEE SURGERY: http://drbillsclinic.com/avoid_knee_surgery.html   Noise doesn’t necessarily mean it’s the end of the line, or that a total knee is the only option.
Til next time, my friend, be well.
Yours for a pain-free tomorrow,
Dr. Bill 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

The Best Advice I Can Give

Tuesday, August 12th, 2008

Just the other day, I got an email from one of my subscribers, who also happens to be one of my friends from the “old days,” back when I was living in New York and practicing orthopaedics. It seems she was looking for some helpful advice for a friend of hers who apparently has arthritis of her knee. 

The woman had apparently developed gradual onset pain of her knee over the last several years. She had seen a physician and apparently had x-rays. The x-rays reportedly showed “bone-on-bone” in the inner aspect of her knee (the medial compartment). She was told that she needed a total knee replacement. But she clearly didn’t want to have surgery. So she asked my friend to ask me what she should do.
Well, I wrote back that once you have an x-ray that demonstrates “bone-on-bone,” you are pretty much committed to having a joint replacement, eventually. However, that procedure can be DELAYED, or postponed.

You see, “bone-on-bone” means that the bones of the knee joint, that you see on the x-ray, are touching each other. And that means that their protective cartilage layer has worn away. Since cartilage is invisible on an x-ray, the normal appearance of an x-ray is one of the bones appearing to “float” apart. In other words, there is a  joint “space” between them. Once the cartilage is gone, there’s nothing to hold them apart anymore–hence, the bones touch, ie., “bone-on-bone.” 

The problem is that once the cartilage has worn away, and the underlying bone is exposed, the cartilage isn’t going to grow back. That’s one of the key factors about cartilage: it lacks a blood supply. And without a blood supply, healing, or regrowth of the tissue CANNOT take place. 

Yes, yes. I know there are methods out there being promoted that CLAIM to regrow cartilage. They even show x-rays, reportedly “un-retouched,” that seem to show a new “joint space” re-formed. I saw one just recently in an in-flight airline magazine and I’ve seen them before on various web sites, which market to the credulous. 

Unfortunately, that is absolute crap! No known non-surgical method can regrow cartilage, once it’s been destroyed. 

What these magazines and websites show is actually a “before” weight bearing x-ray, in which the bones are touching, followed by a NON-weight bearing x-ray,  in which the bones APPEAR to be separated, because there’s no weight on them to press them together. 

So their claim is technically true: the x-rays ARE un-retouched. But the new “space” is  NOT from new growth of cartilage. And they’re even cleverer than that–they never actually SAY that they grow new cartilage. They show the pictures and let YOU make the inference.

Now, mind you, there ARE non-surgical methods that can help relieve pain, and forstall the need for surgery. But actually re-grow cartilage? No. ‘Fraid not. Maybe some day, with stem cells or some such, but not now.
So the best advice I can give this lady is to follow the many measures, from across the entire medical spectrum, that I teach in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you, too, can see at http://drbillsclinic.com/avoid_knee_surgery.html
These methods, conventional and alternative alike, when used together, create a SYNERGY, where the combination is far more effective than any single component alone. And these methods are proven and safe. They won’t grow new cartilage. Nothing short of a very sophisticated, two-stage surgical technique can, at this time. But they CAN give you relief of pain, buy you time, and delay a joint replacement. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
That’s all for today, my friend. Talk to you soon. Meanwhile, be well.
Yours for a pain-free tomorrow,
Dr. Bill
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved