Post-traumatic arthrosis is a chronic progressive lesion of the joint that has arisen after its traumatic injury. It develops more often after intra-articular fractures, but it can also occur after injuries of soft-tissue elements (ligaments, menisci). It is manifested by pain, restriction of movements and deformation of the joint. The diagnosis is made on the basis of anamnesis, clinical data, results of radiography, CT, MRI, ultrasound, arthroscopy and other studies. Treatment is more often conservative: physical therapy, physiotherapy, symptomatic therapy. With significant destruction of the joint, endoprosthetics is performed.
ICD 10
M19.1 Post-traumatic arthrosis of other joints
Meaning
Post-traumatic arthrosis is one of the types of secondary arthrosis, that is, arthrosis that occurred against the background of previous changes in the joint. It is a fairly common pathology in traumatology and orthopedics, can develop at any age. More often than other forms of arthrosis are detected in young, physically active patients. According to various data, the probability of arthrosis after a joint injury ranges from 15 to 60%. It can affect any joints, however, post-traumatic arthrosis of large joints of the lower extremities has the greatest clinical significance, both due to its wide prevalence and due to its effect on the activity and performance of patients.
Causes
The main causes of the development of post-traumatic arthrosis are a violation of the congruence of articular surfaces, deterioration of blood supply to various joint structures and prolonged immobilization. This form of arthrosis very often occurs after intra-articular fractures with displacement. Thus, arthrosis of the knee joint often develops after fractures of the condyles of the femur and the condyles of the tibia, arthrosis of the elbow joint – after transcondylar fractures and fractures of the head of the beam, etc.
Another fairly common cause of post-traumatic arthrosis is ruptures of the capsular ligamentous apparatus. For example, osteoarthritis of the ankle joint may occur after rupture of the inter–tibial syndesmosis, arthrosis of the knee joint – after damage to the cruciate ligaments, etc. Often in the anamnesis of patients suffering from post-traumatic arthrosis, a combination of these injuries is revealed, for example, a three-ankle fracture with rupture of the inter-tibial syndesmosis.
The probability of developing this form of arthrosis increases dramatically with improper or untimely treatment, as a result of which even minor anatomical defects remain uncorrected. For example, when the relative position of the articular surfaces of the ankle joint changes by only 1 mm, the load begins to be distributed not over the entire surface of the articular cartilages, but only by 30-40% of their total area. This leads to a constant significant overload of certain areas of the joint and causes rapid destruction of cartilage.
Prolonged immobilization can provoke the development of post-traumatic arthrosis, both with intra-articular and extra-articular injuries. In conditions of prolonged immobility, blood circulation worsens and the venous-lymphatic outflow in the joint area is disrupted. Muscles shorten, the elasticity of soft-tissue structures decreases, and sometimes the changes become irreversible.
A type of post-traumatic arthrosis is arthrosis after surgical interventions. Despite the fact that surgery is often the best or only way to restore the configuration and function of the joint, surgery itself always entails additional tissue injury. Subsequently, scars form in the area of dissected tissues, which negatively affects the work and blood supply of the joint. In addition, in some cases, during the operation, it is necessary to remove the destroyed or severely damaged elements of the joint due to injury, and this entails a violation of the congruence of the articular surfaces.
Symptoms
In the initial stages, there is a crunch and minor or moderate pain, which increases with movements. At rest, pain syndrome is usually absent. A characteristic feature of arthrosis is “starting pain” – the occurrence of pain and transient stiffness of the joint during the first movements after a period of rest. Subsequently, the pain becomes more intense, occurs not only during exercise, but also at rest – “in the weather” or at night. The amount of movement in the joint is limited.
Usually there is an alternation of exacerbations and remissions. During the period of exacerbation, the joint becomes edematous, synovitis is possible. Due to constant pain, a chronic reflex spasm of the limb muscles is formed, sometimes muscle contractures develop. At rest, patients are concerned about discomfort, pain and muscle cramps. The joint is gradually deformed. Due to the pain and limitation of movement, lameness occurs. In the later stages, the joint is bent, roughly deformed, subluxations and contractures are noted.
Visual examination at the early stages does not reveal any changes. The shape and configuration of the joint are not disturbed (if there is no previous deformation due to traumatic injury). The volume of movements depends on the nature of the injury and the quality of rehabilitation measures. Subsequently, there is an aggravation of deformation and an increasing restriction of movements. Palpation is painful, when feeling, in some cases, thickenings and irregularities along the edge of the articular gap are determined. Possible curvature of the limb axis and instability of the joint. With synovitis, fluctuation is determined in the joint.
Diagnostics
The diagnosis is established on the basis of anamnesis (previous injury), clinical manifestations and results of radiography of the joint. X-rays reveal dystrophic changes: flattening and deformation of the articular area, narrowing of the articular gap, osteophytes, subchondral osteosclerosis and cystic formations. With subluxation, there is a violation of the axis of the limb and unevenness of the articular gap.
If necessary, a CT scan of the joint is prescribed to more accurately assess the condition of dense structures. If it is necessary to identify pathological changes on the part of soft tissues, the patient is referred for an MRI of the joint. In some cases, it is advisable to perform arthroscopy – a modern therapeutic and diagnostic technique that allows you to visually assess the condition of cartilage, ligaments, menisci, etc. This procedure is especially often used in the diagnosis of post-traumatic arthrosis of the knee joint.
Treatment
The treatment is carried out by orthopedic traumatologists. The main goals of treatment are to eliminate or reduce pain, restore function and prevent further destruction of the joint. Complex therapy is carried out, including local and general NSAIDs, chondroprotectors, physical therapy, massage, thermal procedures (ozokerite, paraffin), electrophoresis with novocaine, shock wave therapy, laser therapy, phonophoresis of corticosteroid drugs, UVI, etc. With intense pain and severe inflammation, therapeutic blockades with glucocorticosteroids (diprospan, hydrocortisone) are performed. With muscle spasms, antispasmodics are prescribed.
Surgical interventions can be carried out to restore the configuration and stability of the joint, as well as in cases where the articular surfaces are significantly destroyed and they need to be replaced with an endoprosthesis. During the operation, osteotomy, osteosynthesis can be performed using various metal structures (nails, screws, plates, spokes, etc.), plastic ligaments using the patient’s own tissues and artificial materials.
Surgical interventions are performed in an orthopedic or traumatology department, as planned, after an appropriate examination. In most cases, general anesthesia is used. Both open-access operations and the use of gentle arthroscopic techniques are possible. In the postoperative period, antibiotic therapy, physical therapy, physiotherapy and massage are prescribed. After the sutures are removed, patients are discharged for outpatient follow-up and rehabilitation measures are carried out.
The effect of surgical intervention depends on the nature, severity and duration of the injury, as well as on the severity of secondary arthrotic changes. It should be borne in mind that in some cases, complete restoration of joint function is impossible. With severe advanced arthrosis, the only way to restore the patient’s ability to work is endoprosthetics. If the installation of an endoprosthesis is not shown for some reason, in some cases arthrodesis is performed – fixation of the joint in a functionally advantageous position.