Post-traumatic arthritis (PTAr) is a form of

osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...

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 (SLE). ...

, 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 h ...

psoriatic arthritis Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that may occur in some people affected by the autoimmune disease psoriasis. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers ...

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 ...

, swelling, synovial effusion, pain, redness, tenderness, grinding, instability and

intra-articular 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- ...

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 significantly higher. Risk factors which increase the danger of getting post-traumatic arthritis are being

overweight Being overweight 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 more than ...

and

physical activity Physical activity is defined as any voluntary movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/07/2018 ...

. 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 (Mass versus weight, weight) and height of a person. The BMI is defined as the human body weight, body mass divided by the square (algebra), square of the human height, body height, and is ...

(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 Augustinians, Augustinian ...

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 Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...

; 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. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...

collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...

rupture, swelling of the

cartilage Cartilage is a resilient and smooth type of connective tissue. Semi-transparent and non-porous, it is usually covered by a tough and fibrous membrane called perichondrium. In tetrapods, it covers and protects the ends of long bones at the joints ...

hemarthrosis Hemarthrosis is a bleeding into joint spaces. It is a common feature of hemophilia. Causes It usually follows injury but occurs mainly in patients with a predisposition to hemorrhage such as those being treated with warfarin (or other anticoagu ...

, 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 (: matrices or matrixes) or MATRIX may refer to: Science and mathematics * Matrix (mathematics), a rectangular array of numbers, symbols or expressions * Matrix (logic), part of a formula in prenex normal form * Matrix (biology), the m ...

degradation,

leukocyte White blood cells (scientific name leukocytes), also called immune cells or immunocytes, are cells of the immune system that are involved in protecting the body against both infectious disease and foreign entities. White blood cells are genera ...

infiltration,

inflammatory mediator Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', ''d ...

s, deficient

lubricants A lubricant (sometimes shortened to lube) is a substance that helps to reduce friction between surfaces in mutual contact, which ultimately reduces the heat generated when the surfaces move. It may also have the function of transmitting forces ...

, and

apoptosis Apoptosis (from ) is a form of programmed cell death that occurs in multicellular organisms and in some eukaryotic, single-celled microorganisms such as yeast. Biochemistry, Biochemical events lead to characteristic cell changes (Morphology (biol ...

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 () literally means 'joint pain'. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication Medication (also called medicament, medicine, pharmaceutic ...

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 a set of information the physicians collect over medical interviews. It involves the patient, and ev ...

. Additionally,

radiographic Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical ("diagnostic" radiography and "therapeu ...

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 or weight. Strictly speaking, body weight is the measurement of mass without items located on the person. Practically though, body weight may be measured with clothes on, but without shoes or heavy accessori ...

are important in both 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 conn ...

often involve educating the affected person about how to practice a healthy lifestyle. Under professional supervision, weight loss can be complemented by targeted muscle-strengthening exercises that improve joint support and help reduce pain.

Therapeutic measures

Physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

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

efficacy Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as '' effectiveness'', and it has often been used synonymously, although in pharmacology a distinction is now often made betwee ...

massage therapy Massage is the rubbing or kneading 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 pa ...

and

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

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 Indication (medicine), therapeutic drug class which Analgesic, reduces pain, Anti-inflammatory, decreases inflammation, Antipyretic, decreases fever, and Antithrombotic, prevents bl ...

s (NSAIDs). For more moderate symptoms,

paracetamol Paracetamol, or acetaminophen, is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely available over-the-counter drug sold under various brand names, including Tylenol and Panadol. Parac ...

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. Cortisol is converted by the action of the enzyme corticosteroid 11-beta-dehydrogenase ...

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 invo ...

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 Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pai ...

resurfacing are recommended. As

clinical studies Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...

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 (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

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 Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...

costs each year.

References

External links

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