Post-traumatic arthritis (PTA) is a form of

osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the ...

following an injury to a joint.

Classification

Post-traumatic arthritis is a form of

and the former can occur after the latter. However, post-traumatic arthritis can also occur after the development of chronic inflammatory arthritis. Generally, post-traumatic arthritis is classified in two groups: post-traumatic osteoarthritis and post-traumatic inflammatory arthritis.

Post-traumatic osteoarthritis

Post-traumatic osteoarthritis is the most common variation of post-traumatic arthritis. Between 20 and 50% of all osteoarthritis cases are preceded by post-traumatic arthritis. Patients having post-traumatic osteoarthritis are usually younger than osteoarthritis patients without any previous physical injuries.

Post-traumatic inflammatory arthritis

Less common is post-traumatic inflammatory arthritis, accounting for between 2 and 25% of all post-traumatic arthritis cases. There are reports about a connection between previous physical injury and

inflammatory arthritis Inflammatory arthritis is a group of diseases which includes: rheumatoid arthritis, psoriatic arthropathy, inflammatory bowel disease, adult-onset Still's disease, scleroderma, juvenile idiopathic arthritis, and systemic lupus erythematosus ( ...

, such as

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and ...

psoriatic arthritis Psoriatic arthritis is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. ...

Signs and symptoms

The symptoms of post-traumatic arthritis are similar to the ones occurring with

. General symptoms are

stiffness Stiffness is the extent to which an object resists deformation in response to an applied force. The complementary concept is flexibility or pliability: the more flexible an object is, the less stiff it is. Calculations The stiffness, k, of a b ...

, swelling, synovial effusion, pain, redness, tenderness, grinding, instability and intra-articular bleeding of the injured

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...

. As a result of these symptoms, post-traumatic arthritis often comes along with the loss of ability.

Risk factors

Since post-traumatic arthritis usually occurs after injuring a joint, the risk of having post-traumatic arthritis after such an injury is significant higher. Risk factors which increase the danger of getting post-traumatic arthritis are being

overweight Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary. , excess weight reached epidemic proportions globally, with m ...

and

physical activity Physical activity is defined as any voluntary bodily movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/ ...

. The prevalence of post-traumatic arthritis is much higher when doing heavy work and overusing the injured joints. Examinations also revealed that a

body mass index Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...

(BMI) increase of five units results in a 35% higher risk of post-traumatic arthritis. It is reported that

genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar worki ...

do have an influence on the prevalence of post-traumatic arthritis. According to newer examinations, the sex of the patients may also have an influence on post-traumatic arthritis, since females are affected by post-traumatic arthritis more frequently than males.

Pathogenesis

The process of post-traumatic arthritis can be divided into three phases: immediate, acute, and chronic.

Immediate phase

This phase usually begins a few seconds after the

injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or ...

; it is characterized by cell

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dig ...

, collagen rupture, swelling of the cartilage, hemarthrosis, and the loss of

glycosaminoglycan Glycosaminoglycans (GAGs) or mucopolysaccharides are long, linear polysaccharides consisting of repeating disaccharide units (i.e. two-sugar units). The repeating two-sugar unit consists of a uronic sugar and an amino sugar, except in the case o ...

s (GAGs).

Acute phase

In this phase, acute post-traumatic arthrosis emerges.

Matrix Matrix most commonly refers to: * ''The Matrix'' (franchise), an American media franchise ** '' The Matrix'', a 1999 science-fiction action film ** "The Matrix", a fictional setting, a virtual reality environment, within ''The Matrix'' (franchi ...

degradation,

leukocyte White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mul ...

infiltration,

inflammatory mediator Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

s, deficient lubricants, and apoptosis can occur. Typically, the acute phase comes hours after the injury.

Chronic phase

The chronic phase occurs months or years after the trauma. Typical symptoms are

joint pain Arthralgia (from Greek ''arthro-'', joint + ''-algos'', pain) literally means ''joint pain''. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication. According to MeSH, ...

and dysfunction.

Diagnosis

Post-traumatic arthritis is diagnosed with the help of a patient's

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other pe ...

. Additionally, radiographic

imaging Imaging is the representation or reproduction of an object's form; especially a visual representation (i.e., the formation of an image). Imaging technology is the application of materials and methods to create, preserve, or duplicate images. ...

can assist in diagnosing post-traumatic arthritis.

Management

It is not possible to cure the acute post-traumatic arthritis in order to prevent a chronic post-traumatic arthritis. There are many different options to manage chronic post-traumatic arthritis.

Lifestyle

Since being overweight is a risk factor for post-traumatic arthritis, lifestyle changes that help manage

body weight Human body weight is a person's Mass versus weight, mass or weight. Strictly speaking, body weight is the measurement of weight without items located on the person. Practically though, body weight may be measured with clothes on, but without shoe ...

are important in the treatment and prevention of the condition. Lifestyle changes and

weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other con ...

often involve educating the affected person about how to practice a healthy lifestyle.

Therapeutic measures

Physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patie ...

may help reduce pain and other symptoms of post-traumatic arthritis. The efficacy of

massage therapy Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In Eu ...

and

manual therapy Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of ...

are not yet proven.

Medication

Post-traumatic arthritis is treated symptomatically with

nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...

s (NSAIDs). For more moderate symptoms,

paracetamol Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decreases body temperature; it is inferi ...

is also used. Another medical treatment approach is the injection of

cortisone Cortisone is a pregnene (21-carbon) steroid hormone. It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of the ...

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are in ...

into the affected joint.

Surgery

If medications, lifestyle changes, and physical therapy are not enough to reduce the symptoms, especially the pain, surgery and other such interventions for managing post-traumatic arthritis are available. In many cases,

joint replacement Replacement arthroplasty (from Greek ''arthron'', joint, limb, articulate, + ''plassein'', to form, mould, forge, feign, make an image of), or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional j ...

or cartilage resurfacing are recommended. As clinical studies have demonstrated, such surgical methods can be effective at reducing symptomatic pain and the costs associated with management of the condition.

Epidemiology

About 12% of all

cases in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., federal district, five ma ...

are classified as post-traumatic osteoarthritis. This means that over 5.6 million people are affected by post-traumatic osteoarthritis only in the United States. Females are more often affected than males. Post-traumatic arthritis costs the US health care system approximately 3.06 billion (0.15%) of total health care costs each year.

References

External links

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