Bone on Bone Knee Pain

Our joints are made up of a ball and socket. Covering the ball, which is the head or end of the bone that rests in the socket, is cartilage. Cartilage is a slippery tissue that allows bones to glide smoothly over each other as we move and helps absorb the shock placed on the joints with movement. If cartilage wears away, that cushion between the joints is lost, causing an issue known as bone on bone. Knee joints are especially susceptible to this kind of wear and tear. The cause of this issue is usually osteoarthritis, which is a degenerative form of arthritis that affects the joints.

Bone on bone knee pain occurs as the bones rub together, causing friction and interfering with the knee joint’s ability to move freely. This friction can wear down the surface of the bones which can alter the bone’s shape and cause bone spurs to form. Bone on bone knee arthritis can also cause tiny pieces of bone and cartilage to break away and float within the joint space, causing further damage and pain.


Knee bone on bone symptoms begin gradually as the cartilage in the knee wears down. Along with bone on bone knee pain, which can be quite severe, other symptoms often include:

  • Stiffness, often worse after rest or sitting
  • Grating or crunching sensation and sound when moving the knee
  • Decreased flexibility and range of motion
  • Inability to bend the knee

Bone spurs are also a sign of bone on bone in the knee. Bone spurs form on the edges of the bones as our body’s natural response to degenerative changes as it rebuilds more bone to make up for the loss. This extra bone results in bony growths that can cause pain and can sometimes be felt on the outside of the knee.


Knee bone on bone is the direct result of severe degenerative changes in the knee joint from osteoarthritis. Bone on bone pain is felt when the cartilage in your knee joint has worn away and the joint space has narrowed enough to leave the bones exposed. This causes them to rub against each other when you walk.
There is no one cause of osteoarthritis, but there are several risk factors that can increase your chances of developing it.


Aging is the most common cause of bone on bone knee arthritis. Approximately 50 percent of people over 65 worldwide show some evidence of osteoarthritis in at least one joint. This is mostly due to the wearing down of knee cartilage over the years.

Other risk factors that can lead to bone on bone knee arthritis include:

  • Being overweight
  • Previous knee injury
  • Improperly formed joints
  • Medical conditions affecting the joints, such as dysplasia
  • Repetitive stress on the knee joint from certain sports and occupations
  • Family history of osteoarthritis


When the cartilage in the knee has worn away to the point of causing bone on bone knee pain, your doctor will be able to feel it and even hear it when manipulating your knee. Diagnosis will involve moving your knee to check range of motion and signs of degeneration and injury. Your doctor will also ask you questions about your medical history. This can include details of your symptoms and how long you’ve been experiencing them. Your doctor will also want to know whether or not you have a family history of osteoarthritis.

Imaging tests will be used to confirm a diagnosis of bone on bone osteoarthritis. These may include:

  • X-rays.
    These images are able to clearly show damage in the bones, including bone spurs, and narrowing of the joint space associated with osteoarthritis.
  • Magnetic resonance imaging (MRI).
    This type of scan produces 3-D images that show the bones and soft tissues in great detail, enabling the doctor to diagnose damage to the soft tissues.
  • Blood tests.
    Your doctor may order blood tests to help rule out the presence of infection and other types of arthritis.


Bone on bone knee pain treatments are the same as the treatments used for osteoarthritis of the knee. Conservative treatments are used for as long as they provide relief. Bone on bone knee treatment may include:

  • Weight loss.
    This minimizes the load placed on your hip and other joints, which can relieve pain and help to lessen future damage on the joints. If you are overweight, losing just a few pounds can result in significant improvement of pain.
  • Pain medication.
    Nonsteroidal anti-inflammatories (NSAIDs) and other pain relievers can reduce pain and inflammation.
  • Physical therapy.
    Specific exercises can help improve flexibility and strength, as well as improve your range of motion.
  • Surgery.
    There are different types of surgical procedures to treat severe osteoarthritis in the knee: knee osteotomy (which realigns the bones in the knee), joint replacement or minimally invasive arthroscopic surgery. The last surgery is performed through a small incision using a thin, flexible camera. The type of surgery you have will depend on the extent of your damage and other factors, such as age and overall state of health.