Bone-on-bone arthritis is not a clinical term. However, people may use it to refer to advanced or severe osteoarthritis (OA). At this point, the “wear and tear” or degeneration is severe enough that there is bone-to-bone contact between the joints.

OA is the most common form of arthritis and affects the joints. More than 32.5 million adults in the United States are living with the condition.

The two main causes of OA are joint injury and general wear and tear as people age.

OA is a progressive condition, meaning that it worsens over time.

This article explains what bone-on-bone arthritis is, the signs and symptoms, and how people can manage the condition.

A person with bone-on-bone arthritis swimming to help alleviate the pain.Share on Pinterest
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People use bone-on-bone arthritis to refer to advanced-stage or severe osteoarthritis (OA). Doctors may also call it end-stage OA.

Healthy joints have a layer of tissue, or cartilage, inside. It covers the surface of the bones and allows for smooth gliding of the joint. The joints also contain synovial fluid, which cushions the end of the bones and helps reduce friction with movement.

When a person develops OA, the cartilage thins, and the surface becomes rough. As a result, the joint does not move as smoothly as before.

Over time, the body’s attempts to repair the damage can further affect the joint. For example:

  • extra bone can form at the edge of the joints, called osteophytes or bone spurs
  • the joint lining can thicken and produce more fluid than usual, making the joint swell up
  • the tissues around the joint can stretch, making the joint less stable

Healthcare professionals often divide cases of OA into three stages:

  • Early stage: A person still has a good amount of cartilage cover on the joint. A person can experience sharp pain when moving the joint.
  • Mid-stage: The cartilage has become worn, and there may be some bald patches. A person may experience pain and joint locking. The pain will be more constant, affecting a person’s ability to perform daily activities.
  • Advanced stage: There is significant cartilage loss, and the spaces between the joints are narrow. The bone tissue becomes thick and rigid, and bone spurs can develop. There can be bone-to-bone contact during this stage. Individuals will experience a constant dull ache alongside intermittent episodes of intense pain.

Is it reversible?

There is no cure for OA or way to reverse the joint damage. However, people can help manage their symptoms.

Those with advanced stage OA will experience pain, swelling, and stiffness at the affected joint. People will also have difficulty moving the affected joint.

A 2022 article notes that a person with advanced stage OA will experience a dull, constant, aching pain. They will also experience intermittent episodes of intense pain, which can affect a person’s ability to engage in daily activities.

According to the United Kingdom’s National Health Service (NHS), the muscle surrounding the affected joint may look smaller and feel weak.

Some people may find the joint buckles when in use.

People can try the following methods to manage the pain associated with advanced-stage OA:

  • Using hot therapy: A heating pad or hot pack can help relieve pain and stiffness. People should apply heat to the affected joint 2–3 times a day for 20 minutes. People should be careful not to burn their skin.
  • Using cold therapy: A person can apply an ice pack twice a day, for 15–20 minutes at a time. Individuals should check their skin every 5 minutes to ensure they are not getting ice burn.
  • Achieving and maintaining a moderate weight: This can help to relieve the pressure on the joints. For those who are overweight or have obesity, losing 1 pound (lb) of weight can reduce the load on the affected joint by 3–6 lb.
  • Taking pain medication: Pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce swelling and pain. Examples include ibuprofen and acetaminophen. Doctors may also prescribe pain relief medications at higher strengths.
  • Exercising: Although exercising with advanced stage OA may feel uncomfortable, it is important to take part in low impact physical activity, such as swimming, walking, and riding a bike. People can try gentle exercises to reduce pain and swelling. This can include:
    • range-of-motion exercises to help flexibility
    • aerobic exercise to strengthen the heart and lungs and build stamina
    • strengthening exercises to increase muscle strength to help protect the joints
  • Using walking aids and supportive devices: To help relieve the pressure on the joints, people may wish to use a walking aid or wear braces and splints.

When using hot and cold therapy, people may benefit from alternating between the two. Gently massaging the area afterward may also help to relieve pain.

The Centers for Disease Control and Prevention (CDC) also suggest that people join a self-management class, such as the Arthritis Self-Management Program (ASMP). The workshops teach people how best to manage their pain.

Doctors may recommend glucocorticoid injections. The physician will inject the drug, which is a steroid, directly into the joint to ease swelling and pain.

Patient advocacy group, Versus Arthritis, notes that it can take between a few hours and 1 week for the person to feel the effects of the medication. One injection tends to work for around 2 or more months.


In some people with advanced-stage OA, doctors may suggest surgery. They may suggest an operation called total joint replacement, or total joint arthroplasty.

A doctor may recommend surgery as a last resort when other treatments have not worked.

During the operation, the surgeon replaces the damaged joint with one made from metal, plastic, or ceramic. This reduces pain and helps people to move the joint.

However, it is important to note that artificial joints can wear out, and some people will need repeat surgery in the future.

It may not be possible to prevent OA from developing. However, those in the early stages of the condition can take measures to slow its progression.

A person should take part in regular exercise but avoid activities that place extra strain on the joints, such as running.

They should also achieve and maintain a moderate body mass index (BMI).

To diagnose advanced-stage OA, a doctor will:

  • ask about the symptoms
  • examine the affected joint or joints
  • perform an X-ray
  • perform blood tests

According to the Arthritis Foundation, people should speak with a doctor if they experience:

  • joint symptoms, such as pain or swelling, that last for 3 or more days
  • several episodes of joint symptoms in 1 month

Those with OA should speak with a doctor to discuss how they will monitor the progression of their condition.

People use bone-on-bone arthritis to refer to advanced stage OA.

At advanced stage OA, there is very little cartilage left. The bone tissue also thickens and becomes rough, and bone spurs develop. This means that there can be bone-to-bone contact between the joints.

People with advanced stage OA will experience a constant dull ache and intermittent episodes of intense pain.

Although there is no way to reverse the damage, people can take measures to help manage their symptoms, such as applying hot and cold therapy, exercising, and maintaining a moderate weight.