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Pain: What is post traumatic osteoarthritis?

This is a big subject and I anticipate that we will need to expand on this preliminary answer.

Definition

Post traumatic arthritis is the increased wear that occurs in a joint as the direct and indirect result of injury. Arthritis is a general term for painful inflammation of a joint. Osteoarthritis is the most common form and is due to wear of the joint surface. It is a process more than a disease and takes place slowly in all joints in all of us. It is complex in its details but the overall concept is simple.

Two or more bones touch each other at a joint. The surfaces that touch are covered with a special layer of slippery, resiliant, hard wearing self lubricating joint surface. It is called articular cartilage and you see it most often on the end of a chicken bone. The end of a drumstick is blueish white, slippery and you can cut it. It's quite unlike the rest of the bone. Normally the joint surface stands up to wear very well but it has one serious "failing"; it doesn't regrow. So worn joint surface is not replaced. Once a joint begins to wear the process tends to continue and speed up as the worn parts of the joint roughen and wear the parts that touch them. The end result is bone denuded of joint surface and bone to bone contact. There is a picture of the inside of an arthritic knee in the glossary. (I will provide a link to it later).

Causes

If someone has been injured Osteoarthritis sometimes occurs earlier that would be normally expected. There are five direct and two indirect reasons.

  1. Persistent unevenness of the joint surface after a fracture. If the fracture line goes into the joint the surface may not be smooth after the fracture has healed. This roughness makes for more rapid wear.
  2. Direct damage to the joint surface. The impact of the injury may crush the joint surface or even knock bits off
  3. Loose bodies and adhesions. If these form in the joint as the result of injury they may get trapped or jammed in the joint causing damage to the (softer) joint surface.
  4. Ligament and cartilage injuries. The ligaments are the structures which keep the joint stable. If they are injured the joint may move in an abnormal way and wear is increased. In the knee there are two special structures confusingly called cartilages which may also get torn if the joint is injured. A torn cartilage may damage the joint surface over the long term.
  5. Infection. Pus is quite poisonous to joint surfaces. If a joint is infected there is a high likelihood of later osteoarthritis.
  6. Loss of mobility. This is an indirect way to cause post traumatic Osteoarthritis. If, following injury, the limb cannot move through its normal range the joints will become stiff and wear more quickly. This is thought to be due to problems nourishing the joint surface if the joint isn't moving
  7. Added stress. Sometimes the damage following an injury increases the load on uninjured joints to the point where they wear prematurely. This would occur typically in the ankle joint if the shin bone healed with a big angle in it. The ankle joint would be unevenly loaded and tend to wear quickly.

Symptoms of Post Traumatic Osteoarthritis

Long lasting pain and aching in the joint. The pain is often dull rather than sharp and may get better once you get going. Getting out of bed and taking the first few steps after sitting may be the worst. Activity may be possible but you may "pay for it" with increased pain afterwards. There is a mysterious connection with weather which has never been properly explained. Typically there is also loss of range of motion of the joint.

Xray Findings

An uneven joint surface because of fractures shows that the joint is at risk for post traumatic osteoarthritis. If the process has started the earliest sign is loss of joint surface with the bones getting closer together. Joint surface doesn't show up on Xrays so you normally see a gap between the bones of a joint.

Later signs of osteoarthritis on Xray include development or spurs at the margin of the joint and cavities in the bone. The ultimate sign on Xray is wear5ing away of the bone.

Treatment

For most people the treatment of arthritis of whatever origin is medication, exercises, weight control or sometimes bracing. Surgery can be used to evaluate the joint (arthroscopy) or sometimes to remove loose pieces and spurs (debridement). If the process has gone too far then fusion of the joint or joint replacement surgey may be needed. OS are quite reluctant to undertake joint replacement surgery on young people because of the risk of early failure.

Myles Clough Jan 22 2002


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