Post-traumatic Arthritis

Introduction:

Inflammation in the joints following trauma or an injury is called post-traumatic arthritis. It is commonly seen in young and active individuals and is associated with stiffness and pain. It usually resolves spontaneously, but sometimes the symptoms reappear, leading to chronic arthritis.

What Is Post-traumatic Arthritis?

Inflammation of one or more joints that are associated with pain and stiffness is called arthritis. The most common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis is mainly caused due wear and tear of the cartilage, leading to rubbing of the bones against each other, causing inflammation. Post-traumatic arthritis is inflammation of the joints following trauma or an injury; it can occur immediately or a few hours following trauma, called the immediate or acute phase. It is associated with severe pain and swelling due to cell necrosis and cartilage injury. Post-traumatic arthritis resolves by itself in around two to three months, but in some severe injuries to the joint, the symptoms may persist for more than six months or may be asymptomatic initially, and after a few years, it can be symptomatic; it is termed as chronic post-traumatic arthritis.

What Are the Causes of Post-traumatic Arthritis?

• Post-traumatic arthritis is mainly seen in teenagers or young individuals, but it is a common condition that can affect anyone; it may or may not be associated with cartilage damage.

• Most osteoarthritis cases are usually post-traumatic arthritis. People who experienced trauma are more likely to develop arthritis than those who never experienced it.

• It is mainly caused by road accidents, sports injuries, military injuries, and falls from heights. Trauma can lead to wear and tear of the cartilage, resulting in weakness and damage, as it is unable to withstand stress. Severe injuries can tear the cartilage into loose fragments, separates it from the bone, and causes it to move around the joint space. It is unable to heal and becomes scar tissue, causing severe pain.

• Chronic post-traumatic arthritis can lead to post-traumatic osteoarthritis (PTOA) or post-traumatic inflammatory arthritis (PTIA). Chronic arthritis can be due to age, genetic factors, inflammatory mechanisms, low immunity, and the general health of the patient.

• Post-traumatic osteoarthritis can be due to fractures or injuries to the cartilage or ligaments, especially the anterior cruciate ligament. It frequently affects the knee joint and ankle compared to the hip and shoulder. It is usually diagnosed clinically after a long period of time.

• Post-traumatic, inflammatory arthritis is less common, and the inflammation is mainly due deposition of calcium phosphate and calcium pyrophosphate crystals following the trauma, which leads to the release of pro-inflammatory substances, triggering inflammation. It is the main cause of the development of acute gout, psoriatic arthritis, and rheumatoid arthritis.

What Are the Signs and Symptoms of Post-traumatic Arthritis?

Some of the signs and symptoms include:

• Severe pain, which is sometimes relieved on rest.

• Redness and swelling.

• Cracking sound on joint movement.

• Stiffness sometimes returns to normal inactivity.

• Restriction of movement at the joint, difficulty in walking.

• Sensitive and tender on touch.

• Joint locking or instability of the joint and unable to bear the weight.

• Reduced physical strength and fatigue.

• Synovial effusion is the leaking of synovial fluid into the surrounding tissues.

What Are the Risk Factors Associated With Post-traumatic Arthritis?

Age, excessive body weight, genetic factors, severity or multiple injuries, fractures associated with the trauma, and patients with a previous history of meniscal or ligament injury are at a greater risk of post-traumatic arthritis.

How Is Post-traumatic Arthritis Diagnosed?

• A complete history is taken by the doctor to determine the onset and duration of the condition, and a physical examination is conducted to check the range of motion of the joints.

• An x-ray is advised to check the damage to the bones and joints, the presence of bone spurs, and associated fractures.

• Magnetic resonance imaging (MRI) or computed tomography (CT Scan) is also recommended to assess the damage to the surrounding soft tissues, cartilage injuries, or damage to the associated tendons and ligaments.

• Blood tests may be advised in some cases to rule out rheumatoid arthritis.

How Is Post-traumatic Arthritis Treated?

Conservative management is usually followed to treat post-traumatic arthritis, but when it is not successful, surgical management becomes necessary. Conservative therapy includes:

• Weight loss management and following a healthy lifestyle.

• Physiotherapy includes low-impact exercises or customized exercises to strengthen the muscles and joints. Heat and ice therapy also provides relief from pain.

• Stabilizing the joint with braces, cushion shoes, and canes supports reduces the tension in the joints.

• Symptomatic treatment by analgesics like Acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), etc.

• Corticosteroid injections or hyaluronic acid injections are prescribed.

• Platelet-rich plasma injections to treat osteoarthritis, known as PRP therapy (injections containing a concentration of the patient’s own platelets which accelerate the healing process), are recently developed as an alternative to surgery and are known to be effective in restoring knee function, reducing pain, and repairing cartilage damage.

Surgical treatment in post-traumatic arthritis includes:

• Arthroscopic Debridement: To remove the debris or the broken fragments of the cartilage, arthroscopic debridement is done. Incisions are made around the knee, and an arthroscope is inserted, which visualizes the inner structures through a camera, and washes the debris and loose fragments. It reduces pain and swelling; crutches or braces are advised following the surgery to strengthen and support the joint.

• Corrective Osteotomy or Arthrodesis: The separated bony fragments are aligned together and fixed with the help of screws and plates, which stabilizes the joint, helps in weight-bearing, and reduces pain and swelling.

• Arthroplasty: When the other treatment options are unsuccessful or not possible, arthroplasty is recommended. It is done under general anesthesia and requires hospitalization for a few days. It is a surgery wherein the damaged cartilage is removed and replaced by an artificial substitute made of plastic or metal, or ceramic. The wound is closed by sutures or surgical staples, and a sterile bandage is applied. Analgesics are prescribed to relieve pain, followed by rehabilitation therapy through physical exercises.

• Meniscal Surgery: Cartilage grafting is done in some cases, preferably in young individuals, to encourage new cartilage growth.

Conclusion:

Post-traumatic arthritis is inflammation of the joint following an injury or trauma and is associated with pain and stiffness. It usually resolves spontaneously in a few months or can lead to chronic arthritis. It can be managed by medications, physiotherapy, and lifestyle modifications, but complex cases would require surgical management.