Physiotherapy Q&A: I have loose bits of bone around my knee, do I need to do something about this?

“I am 68 years old and my right knee hurts if I walk longer than 20 minutes. The knee is also stiff every morning when I get up and try to start moving. My GP told me my recent knee X-ray has shown a bit of mild wear and tear as well as some loose bits of bone. I don’t want a knee replacement as I’m still managing to do lots of activity but do I need something done about the loose bits of bone?”

Toby Lambourne, Horder Healthcare Advanced Practitioner answers the question:

Thank you for your question which highlights a common topic I get asked about in clinic and by GP referrals. The most common outcome is no, you certainly don’t need any surgery to remove the loose bits of bone from your knee. Clinically we call these ‘loose bodies’ and it is actually fairly common for x-rays to show these. Many of us without any knee pain can often have loose bodies in the knee causing no problems whatsoever.

In very rare instances, however, when a patient complains of true locking of the knee (when the knee gets stuck in one position and you can’t unlock it) then I am suspicious that the loose body is symptomatic but this is probably only 1-2% of all the cases I see. Certainly, here your symptoms seem to fit with mild arthritic pain from the early changes on your x-ray which is a common finding in adults over 40 years old.

Managing osteoarthritis 

There are several options for managing osteoarthritis (OA) in the knee. Through an NHS referral to Sussex MSK Partnership East, various sites offer classes which include a group education session and exercise class all targeted at individuals with either OA knee or hip pain and the research outcomes are excellent. One to one physiotherapy sessions can also be arranged if you have specific individual needs or are not able to attend a class around your work hours.

Knee injections can also sometimes be helpful for pain relief. By improving your pain, an injection may help you self manage as you should then feel more able to exercise and strengthen the knee. Finally, some people require a total knee replacement (TKR). This is generally only considered where there are severe ongoing symptoms and x-ray changes and where a patient has tried conservative options as this helps in most cases.

In the first instance though, your GP is a good starting point for further assessment, initial advice and to seek an onward referral if deemed appropriate.