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Frequently Asked Questions

What is bone on bone?

Bone on bone means that there has been full thickness loss of cartilage resulting in exposed bone between two joint surfaces.This does not mean that there is no cartilage left.There is a broad spectrum of bone on bone, just a small area of exposed bone or there may be a very broad area across which cartilage has been lost.

Does bone on bone mean I need a joint replacement?

Only a small number of patients with bone on bone changes will require joint replacement. In fact, many patients with bone on bone changes experience little or no osteoarthritic symptoms. In many patients with bone on bone changes that experience symptoms, their symptoms can be managed effectively with non-surgical anti-inflammatory therapy options.

How important are the results from x-rays or MRI in determining what treatment I should have?

Imaging modalities can be helpful.  However, there is often a big disconnect between symptom severity and the changes on imaging modalities such as plain x-rays and MRI.  Two patients can have exactly the same imaging findings wherein one patient is totally disabled with pain and loss of function and the other patient has no symptoms.  The most important information for creating an effective treatment plan for managing osteoarthritis is embedded in the individual patients story.

Do I need an MRI?

There are certain situations in which information provided by an MRI may be helpful.  However, the vast majority of patients with osteoarthritis do not require an MRI in order to determine an effective treatment plan.

Is there currently a cure for osteoarthritis?

There is no cure for osteoarthritis.  Current therapies are focused on managing the symptoms of osteoarthritis but will not provide a cure.

Is there any current treatment that regenerates or regrows cartilage?

No, while there are some anecdotal instances of cartilage repair or regeneration, there is no strongly conclusive study that this is possible.  

What is the difference between unexpanded stem cells and expanded stem cell therapies?

Stem cells can be obtained from many sources but most typically from bone marrow or fat.  Aspirates or biopsies from the areas can be processed through a centrifuge and immediately injected into an osteoarthritic joint.  In this case, there are a small number of stem cells along with other biologically active cells that are being injected.  These cells can be effective in treating inflammation which in turn will help to improve patient symptoms. 


Unfortunately, there is no evidence that these treatment approaches will regenerate cartilage.  Although there are a small number of stem cells that are injected with these treatments, it is not appropriate to consider these true stem cell therapies. True stem cell therapies are when a source of stem cells such as from bone marrow, fat, umbilical cord blood or other sources has a small number of stem cells which are identified and extracted and subsequently grown over a number of weeks in a laboratory environment to create millions of stem cells.

What is the regulatory status of stem cells?

Unexpanded stem cell therapies are currently not approved in the U.S. or Canada.  There are some approved for use in Europe.  There are no expanded stem cell therapies which are currently approved for use in Canada, the U.S. or Europe. 


Expanded stem cell therapy is currently available in South Korea.  Expanded stem cell therapies have greater potential than unexpanded stem cells for regenerating cartilage.  Given our current state of knowledge, it is expected that the first generation of expanded stem cell therapies will be more effective than current biologic therapies in managing inflammation resulting in improvement in pain and function but will be unlikely to regenerate cartilage.  However, they may be effective in slowing down the natural rate of osteoarthritic progression.  It is likely that the ability to regenerate cartilage will only happen with second or third generation expanded stem cell therapies.  Certainly, the holy grail of regenerating cartilage is still many years away from clinical reality.

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