Start with what your sore knee is doing today

What to notice when bone on bone appears on the X-ray

“Bone on bone” means the joint space looks very narrow on an X-ray. The X-ray can’t tell how far you can walk, whether soreness wakes you, or how steadily you use stairs; another knee with the same wear may cause much less trouble.

Notice soreness while resting, swelling, lost bend, and shorter walks. Tell your doctor if the knee buckles or won’t straighten. Those daily problems explain what the X-ray alone can’t.

Both the X-ray and your daily trouble matter.

What to try before another procedure

Light movement is often kinder than sitting through most of the day. Try a shorter walk, easy strength work, or a route with level ground. If the knee is more swollen the next morning, you’ll know the amount was too much. A walking aid or brace may steady you, while medicine rubbed on the knee may ease soreness.

Don’t force the knee through a sharp flare. Change one thing at a time, then allow enough time to judge it fairly. Check with your doctor about which medicines are safe with your health and current prescriptions.

Short walks and easy strength work are worth trying before another procedure.

What to do if the soreness won’t settle

When your own care brings too little relief, an exam can end some guessing. Bring notes about the times the knee hurts most, along with your X-ray and medicine list. The visit may cover walking, sleep, swelling, past care, and activities you now miss.

QC Kinetix can discuss non-surgical regenerative treatments, which are clinic procedures that use material from your own body. One choice is PRP, short for platelet-rich plasma; it’s made by drawing and spinning a sample of your blood to gather more platelets before the clinic places it into the sore knee. Medical providers, meaning the clinic's licensed health workers, examine you and review the choices. That’s called joint preservation because it aims to keep your knee in use without surgery. No procedure fits every knee.

You’ll know what the clinic offers before you decide.

What to know before choosing the clinic

QC Kinetix doesn’t have an office within Tempe. Central and south Tempe usually have a direct drive toward the Chandler clinic, while north Tempe may be closer to Scottsdale. The nearest office isn’t always the easiest one if repeat visits would cross your usual route.

Ask what the full visit may cost before agreeing to anything. You can also ask who’ll perform the exam, what recovery involves, and when you’d know whether the first treatment helped. Those answers protect both your time and your money.

A convenient drive matters too.

Sources

1. The Lancet's osteoarthritis Seminar states that the diagnosis of osteoarthritis is clinically based despite the widespread OVERUSE of imaging methods, that management should be tailored to the individual and focus on core treatments including self-management and education, exercise and weight loss as relevant, and that surgery should be reserved for those who have not responded appropriately to less invasive methods.

   Hunter DJ, Bierma-Zeinstra S. — Osteoarthritis.. The Lancet, 2019. DOI: 10.1016/S0140-6736(19)30417-9.

2. A 2021 JAMA review states that osteoarthritis affects an estimated 240 million people worldwide including more than 32 million in the US, that 33% of people older than 75 have symptomatic and radiographic knee OA, that diagnosis is clinical despite widespread overuse of imaging, that people with OA are more sedentary and carry a 20% higher age-adjusted mortality, and that the cornerstones of management are exercise, weight loss where appropriate and education, complemented by topical or oral NSAIDs, with opiates to be avoided.

   Katz JN, Arant KR, Loeser RF. — Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review.. JAMA, 2021. DOI: 10.1001/jama.2020.22171.

3. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

4. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, tibiofemoral bracing for tibiofemoral knee OA, topical NSAIDs for knee OA, oral NSAIDs, and intra-articular glucocorticoid injections for knee OA. Radiofrequency ablation for knee OA, acupuncture, thermal modalities, acetaminophen, duloxetine and tramadol are only CONDITIONAL recommendations.

   Kolasinski SL, Neogi T, Hochberg MC, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41142.

5. Pooling the OAI and MOST cohorts (8,002 participants followed up to 8 years, 3,417 classifiable knees), validated appropriateness criteria classified only 290 knees (8%) as receiving a TIMELY total knee replacement, 2,833 knees (83%) as potentially appropriate but not replaced more than 2 years after replacement became appropriate, and 294 knees (9% of all knees, 26% of the 1,114 replacements actually performed) as PREMATURE. Of the potentially-appropriate-but-not-replaced knees, 1,204 (42.5%) had severe symptoms.

   Ghomrawi HMK, Mushlin AI, Kang R, et al. — Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts.. Journal of Bone and Joint Surgery (American), 2020. DOI: 10.2106/JBJS.19.00432.