What isn't the surgeon telling you?
Bone-on-Bone does NOT mean that your joint is “shot". Bone-on-Bone simply means that your fibrous meniscus spacer has thinned, and it looks like the bones are touching on an X-ray.
Our college basketball player is completely bone-on-bone on his x-ray but has no pain. If the radiologist or surgon did not know his age or the history of meniscus surgery, he would be classified as severe grade 4 osteoarthritis.
Why doesn't he have pain?
There are actually two types of cartilage in your knee.
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The meniscus, which is type 4 collagen and is fibrous and leathery
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The articular cartilage, which is type 2 collagen and is a hard enamel.
So, our basketball player has no pain or swelling, because he has a nice thick, hard shell of Articular cartilage protecting the nerve endings that live underneath inside of his bone.
Why do you have Pain?
You have knee pain and swelling, because this articular cartilage has developed shallow spots or cavities which get deeper over time, the sensory nerves underneath are less protected and feel more pain when you put pressure on that spot.
The medical term for these cavities is Chondromalacia (ICD-code M94.26) and is code used to bill for a total knee replacement operation.
What Does this Mean?
So you’re not truly bone on bone, you are hard articular cartilage on hard articular cartilage with shallow spots or cavities. When those cavities get deep enough, just like a toothache, you start to have pain because the nerve endings under the cartilage are not protected like they should be.
How are Joint Replacements like Dental Crowns?
Knee replacement surgery is exactly like having a crown on your tooth. Just like the dentist grinds away the top of the tooth to remove the painful nerve endings.
The orthopedic surgeon will saw away the ends of your bone, removing the painful nerve endings beneath the cavities. Then, like the porcelain cap, a titanium implant is glued to the ends of the bone, so we can walk.
Whether you have simple arthritic pain from Chondromalacia or a colpased joint. Orthopedic Surgeons have one tool in their box.
It's like going to the dentist who doesn't know how to do a filling or root-canal, so EVERYONE gets a crown!
