Post-traumatic Arthritis: Difference between revisions

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== Definition/Description  ==
== Definition/Description  ==


Post-traumatic arthritis is a secondary [[osteoarthritis]] that occurs after an injury or direct trauma to the specific joint.<ref>Cleveland Clinic. Post-traumatic arthritis. Available from:http://www.massagetoday.com/mpacms/mt/article.php (accessed 4 April 2019).</ref><ref name="brugioni et al.">Brugioni DJ, Falkel J. [https://books.google.co.za/books?id=soqBVfoRwu4C&printsec=frontcover&dq=Total+knee+replacement+rehabilitation.+The+knee+owner%E2%80%99s+manual&hl=en&sa=X&ved=0ahUKEwi0lZzoi7nhAhXSxoUKHcibCMoQ6AEIKjAA#v=onepage&q=Total%20knee%20replacement%20rehabilitation Total knee replacement rehabilitation: The knee owner’s manual]. Alameda CA: Hunter House Inc, 2004.</ref>  
Post-traumatic arthritis is a secondary [[osteoarthritis]] that occurs after an injury or direct trauma to the specific [[Joint Classification|joint]].<ref>Cleveland Clinic. Post-traumatic arthritis. Available from:http://www.massagetoday.com/mpacms/mt/article.php (accessed 4 April 2019).</ref><ref name="brugioni et al.">Brugioni DJ, Falkel J. [https://books.google.co.za/books?id=soqBVfoRwu4C&printsec=frontcover&dq=Total+knee+replacement+rehabilitation.+The+knee+owner%E2%80%99s+manual&hl=en&sa=X&ved=0ahUKEwi0lZzoi7nhAhXSxoUKHcibCMoQ6AEIKjAA#v=onepage&q=Total%20knee%20replacement%20rehabilitation Total knee replacement rehabilitation: The knee owner’s manual]. Alameda CA: Hunter House Inc, 2004.</ref>  


== Clinically Relevant Anatomy&nbsp;  ==
== Clinically Relevant Anatomy&nbsp;  ==


Trauma can cause damage to the articular [[cartilage]] of the [[Joint Classification|joint]], which results in weakening cartilage that is not able to withstand the stress. The articular cartilage layer start to break down as a result of this.<ref name="brugioni et al." />  
Trauma can cause damage to the articular [[cartilage]] of the [[Joint Classification|joint]], which results in weakening [[cartilage]] that is not able to withstand the stress. The articular [[cartilage]] layer start to break down as a result of this.<ref name="brugioni et al." />  


== Epidemiology/Etiology&nbsp;  ==
== Epidemiology/Etiology&nbsp;  ==


It is important to differentiate between regular arthritis and post-traumatic arthritis. Post-traumatic arthritis develops as a result of a trauma, while regular arthritis develops gradually without any apparent outside reason.<ref name=":0" /><ref name="saltzman et al." /> Post-traumatic arthritis makes out about 12% of [[osteoarthritis]] cases.<ref name=":1">Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F, Scanu A. [https://rmdopen.bmj.com/content/2/2/e000279?utm_source=trendmd&utm_medium=cpc&utm_campaign=rmd&utm_content=consumer&utm_term=0-A Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation.] RMD open 2016;2(2):e000279.</ref> Symptom onset can be as long ago as 2-5 years after an injury to the joint was sustained.<ref name=":0">Ombregt L, Bisschop P, Ter Veer HJ. A system of orthopaedic medicine. Elsevier Limited, 2003.</ref><ref name="saltzman et al.">Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. The Iowa orthopaedic journal 2005;25:44.</ref> The [[cartilage]] can be bruised when too much pressure is exerted on it. This can happen without any superficial appearance of damage. The injury to the [[Joint Classification|joint]] does not show up until months later. More severe injury to the cartilage can cause loose fragments when the cartilage comes loose from the bone. These loose pieces are not able to heal, and move around in the joint, and can result into catching and subsequent pain. These defects does not heal as with bone, but are instead filled with scar tissue. Broken off cartilage need to be surgically removed from the joint.<ref name="Diagnosing">Cleveland Clinic. Post-Traumatic Arthritis: Diagnosis and Tests. Available from: https://my.clevelandclinic.org/health/diseases/14616-post-traumatic-arthritis/diagnosis-and-tests (accessed  6 April 2019).</ref>
Any injury to any [[Joint Classification|joint]] can lead to traumatic arthritis. It is important to differentiate between regular arthritis and post-traumatic arthritis. Post-traumatic arthritis develops as a result of a trauma, while regular arthritis develops gradually without any apparent outside reason.<ref name=":0" /><ref name="saltzman et al." /> Post-traumatic arthritis makes out about 12% of [[osteoarthritis]] cases.<ref name=":1">Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F, Scanu A. [https://rmdopen.bmj.com/content/2/2/e000279?utm_source=trendmd&utm_medium=cpc&utm_campaign=rmd&utm_content=consumer&utm_term=0-A Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation.] RMD open 2016;2(2):e000279.</ref> Symptom onset can be as long ago as 2-5 years after an injury to the joint was sustained.<ref name=":0">Ombregt L, Bisschop P, Ter Veer HJ. A system of orthopaedic medicine. Elsevier Limited, 2003.</ref><ref name="saltzman et al.">Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. The Iowa orthopaedic journal 2005;25:44.</ref> The [[cartilage]] can be bruised when too much pressure is exerted on it. This can happen without any superficial appearance of damage. The injury to the [[Joint Classification|joint]] does not show up until months later. More severe injury to the cartilage can cause loose fragments when the cartilage comes loose from the bone. These loose pieces are not able to heal, and move around in the joint, and can result into catching and subsequent pain. These defects does not heal as with bone, but are instead filled with scar tissue. Broken off cartilage need to be surgically removed from the joint.<ref name="Diagnosing">Cleveland Clinic. Post-Traumatic Arthritis: Diagnosis and Tests. Available from: https://my.clevelandclinic.org/health/diseases/14616-post-traumatic-arthritis/diagnosis-and-tests (accessed  6 April 2019).</ref>
== Characteristics/Clinical Presentation&nbsp;  ==
== Characteristics/Clinical presentation&nbsp;  ==


There are several symptoms that can indicate a case of post-traumatic arthritis. It includes the following:<ref name=":1" />
There are several symptoms that can indicate a case of post-traumatic arthritis. It includes the following:<ref name=":1" />
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* Intolerance to weight-bearing activities  
* Intolerance to weight-bearing activities  
* Joint instability  
* Joint instability  
A diagnose of post-traumatic arthritis can be considered, even more when this condition develops at an early age. Post-traumatic arthritis normally recovers spontaneously, but if the symptoms are still present after 6 months, it is seen as chronic.<ref name=":1" />  
A diagnose of post-traumatic arthritis can be considered, even more when this condition develops at an early age. Post-traumatic arthritis normally recovers spontaneously, but if the symptoms are still present after 6 months, it is seen as chronic.<ref name=":1" /> Sometimes pain comes and goes over a long period of time. The pain may or may not be accompanied by inflammation of the joint or surrounding area. Often the symptoms would disappear without any major medical intervention, these symptoms may re-appear after a while. <ref name="brugioni et al." />  


== Differential Diagnosis ==
== Differential diagnosis ==
* [[Osteoarthritis]]
* [[Osteoarthritis]]
* [[Rheumatoid Arthritis|Rheumatoid arthritis]]
* [[Rheumatoid Arthritis|Rheumatoid arthritis]]
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* Various pathologies related to specific joints
* Various pathologies related to specific joints


== Diagnostic Procedures ==
== Diagnostic procedures ==
 
* [[X-Rays|X-rays]]
Sometimes pain comes and goes over a long period of time. The pain may or may not be accompanied by inflammation of the joint or surrounding area. Often the symptoms would disappear without any major medical intervention, these symptoms may re-appear after a while. <ref name="brugioni et al." /><br>Any injury to any bone can lead to traumatic arthritis. The doctor should be informed if there has been such injury so the correct investigative measures are employed to identify the disease. <br>You should also observe whether similar symptoms are manifested with other parts of the body. If yes, then it might not be traumatic arthritis. If not, then further investigation can be done to rule out any possibility of mistaken diagnosis. Normally, an MRI would be a good test to pinpoint the exact condition of the joint.<ref>Books (Google) “A system of orthopaedic medicine, Volume 1”; L. Ombregt, P. Bisschop, H.J. ter Veer; Elsevier limited; 2003</ref>&nbsp;<ref name="Diagnosing" />
* [[MRI Scans|MRI]]<ref name=":0" /><ref name="Diagnosing" />
 
Human studies and experimental models have revealed that a series of inflammatory mediators are released in synovial fluid immediately after the joint trauma. These molecules have been proposed as markers of disease and as a potential target for the development of specific and preventative interventions. Currently, chronic PTA cannot be prevented, although a large number of agents have been tested in preclinical studies. Given the relevance of inflammatory reaction, anticytokines therapy, in particular the inhibition of interleukin 1 (IL-1), seems to be the most promising strategy. At the present time, intra-articular injection of IL-1 receptor antagonist is the only anticytokine approach that has been used in a human study of PTA. Despite the fact that knowledge in this area has increased in the past years, the identification of more specific disease markers and new therapeutic opportunities are needed.


== Outcome Measures  ==
== Outcome Measures  ==
* [[Hip Disability and Osteoarthritis Outcome Score]]  [[Osteoarthritis|[8]]]
* [[Hip Disability and Osteoarthritis Outcome Score]]
* [[Knee Injury and Osteoarthritis Outcome Score]]
* [[Knee Injury and Osteoarthritis Outcome Score]]
* '''Western Ontario and McMaster universities osteoarthritis index''' (WOMAC) [[WOMAC Osteoarthritis Index]],
* Western Ontario and McMaster universities osteoarthritis index (WOMAC) [[WOMAC Osteoarthritis Index]],
* '''Algofunctional index''' (AFI)
* Algofunctional index (AFI)
* '''Intermittent and constant osteoarthritis pain index'''(ICOAP) [[Osteoarthritis|[9]]]
* Intermittent and constant osteoarthritis pain index (ICOAP) 
* '''West-Haven-Yale Multidimensional Pain Inventory''' (Assesses chronic pain in individuals and Recommended for use in conjunction with behavioral and psycho-physiological strategies)
* West-Haven-Yale Multidimensional Pain Inventory (Assesses chronic pain in individuals and Recommended for use in conjunction with behavioral and psycho-physiological strategies)
* '''Oxford Hip Scale''' (A 12 item subjective questionnaire to measure the outcome of total hip replacement)
* Oxford Hip Scale
* '''Oxford Knee Score''' (Developed as an outcome measure to be used with patients having a total knee replacement).
* Oxford Knee Score
* '''McGill Pain Questionnaire Short-Form''' (The short-form McGill Pain Questionnaire was created to assess both the intensity and quality of pain)
* McGill Pain Questionnaire Short-Form 
 
== Medical Management    ==
 
== Physical Therapy Management&nbsp;  ==


Conservative treatment measures includes modifying the patient’s activities and unloading the joint with crutches or walker. Also, supplemental glucosamine, anti-inflammatory medicaments, pain medications may help. Physical therapy to regain motion and strength and coordination is often helpful. Weight loss in the overweight patient is important and exercise.&nbsp;<ref>N. Wei (MD) © 2004; “Traumatic arthritis” http://www.arthritis-treatment-and-relief.com/traumatic-arthritis.html</ref><br>When this non-surgical treatment is not successful, surgery can be considered.&nbsp;<ref>Diagnosing Traumatic Arthritis © 2007-2008; “The Factors That Lead To The Correct Diagnosis Of Traumatic Arthritis” (http://www.thehealthcarecenter.com/traumatic_arthritis.html)</ref><br>
== Medical management    ==
Conservative management is the treatment of first choice, and surgery is only considered when this fails. Surgical management will determine on the joint affected, as well as the extent of damage to the joint. For example, post-traumatic hip arthritis might be managed with a [[Total Hip Replacement|hip replacement]] when conservative management fails. Medical management can not stop the disease process of post-traumatic arthritis, but it can be used to manage the symptoms. Supplemental glucosamine and anti-inflammatory pain medications are normally prescribed to patients.<ref name="Diagnosing" /> Management will be very similar to that of [[osteoarthritis]].


== Key Research  ==
== Physiotherapy management&nbsp;  ==
 
== Resources&nbsp;  ==
 
- Pubmed <br>- Web of Knowledge<br>- Pedro


Conservative management includes:<ref name="Diagnosing" />
* Activity modification
* Unloading the joint with a mobility assistive device
* Exercise program aimed at regaining range of motion, strength and coordination
* Weight management
Physiotherapy also plays a big role in the post-surgical management of these patients. The type of surgery will determine the physiotherapy approach.<ref name="Diagnosing" />
== Clinical Bottom Line  ==
== Clinical Bottom Line  ==
add text here <br>
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
<div class="researchbox">
<div class="researchbox">
<rss>Feed goes here!!</rss>
Post-traumatic arthritis is secondary osteoarthritis that forms after a specific injury to a joint. Symptom can present as long as 2-5 years post injury. Conservative management includes analgesia, as well as physiotherapy. Surgical management is considered when conservative management fails, and again physiotherapy plays a crutial part in the post-operative rehabilitation of these patients.
</div>  
</div>  
== References  ==
== References  ==
 
<references />[[Category:Vrije Universiteit Brussel Project|Template:VUB]]
see [[Adding References|adding references tutorial]]. <br><br> <references />,[[Lynn Leemans]]&lt;/div&gt;
 
[[Category:Vrije Universiteit Brussel Project|Template:VUB]]
[[//www.pinterest.com/pin/create/extension/|//www.pinterest.com/pin/create/extension/]]

Revision as of 21:05, 8 April 2019

Original Editors - Lynn Leemans Top Contributors - Lynn Leemans, Leana Louw, Admin, Lucinda hampton, Anthonia Abraham, Laura Ritchie, WikiSysop and Kim Jackson  

Definition/Description[edit | edit source]

Post-traumatic arthritis is a secondary osteoarthritis that occurs after an injury or direct trauma to the specific joint.[1][2]

Clinically Relevant Anatomy [edit | edit source]

Trauma can cause damage to the articular cartilage of the joint, which results in weakening cartilage that is not able to withstand the stress. The articular cartilage layer start to break down as a result of this.[2]

Epidemiology/Etiology [edit | edit source]

Any injury to any joint can lead to traumatic arthritis. It is important to differentiate between regular arthritis and post-traumatic arthritis. Post-traumatic arthritis develops as a result of a trauma, while regular arthritis develops gradually without any apparent outside reason.[3][4] Post-traumatic arthritis makes out about 12% of osteoarthritis cases.[5] Symptom onset can be as long ago as 2-5 years after an injury to the joint was sustained.[3][4] The cartilage can be bruised when too much pressure is exerted on it. This can happen without any superficial appearance of damage. The injury to the joint does not show up until months later. More severe injury to the cartilage can cause loose fragments when the cartilage comes loose from the bone. These loose pieces are not able to heal, and move around in the joint, and can result into catching and subsequent pain. These defects does not heal as with bone, but are instead filled with scar tissue. Broken off cartilage need to be surgically removed from the joint.[6]

Characteristics/Clinical presentation [edit | edit source]

There are several symptoms that can indicate a case of post-traumatic arthritis. It includes the following:[5]

  • Swelling of the joint
  • Synovial effusion
  • Pain in the joint
  • Intolerance to weight-bearing activities
  • Joint instability

A diagnose of post-traumatic arthritis can be considered, even more when this condition develops at an early age. Post-traumatic arthritis normally recovers spontaneously, but if the symptoms are still present after 6 months, it is seen as chronic.[5] Sometimes pain comes and goes over a long period of time. The pain may or may not be accompanied by inflammation of the joint or surrounding area. Often the symptoms would disappear without any major medical intervention, these symptoms may re-appear after a while. [2]

Differential diagnosis[edit | edit source]

Diagnostic procedures[edit | edit source]

Outcome Measures[edit | edit source]

Medical management[edit | edit source]

Conservative management is the treatment of first choice, and surgery is only considered when this fails. Surgical management will determine on the joint affected, as well as the extent of damage to the joint. For example, post-traumatic hip arthritis might be managed with a hip replacement when conservative management fails. Medical management can not stop the disease process of post-traumatic arthritis, but it can be used to manage the symptoms. Supplemental glucosamine and anti-inflammatory pain medications are normally prescribed to patients.[6] Management will be very similar to that of osteoarthritis.

Physiotherapy management [edit | edit source]

Conservative management includes:[6]

  • Activity modification
  • Unloading the joint with a mobility assistive device
  • Exercise program aimed at regaining range of motion, strength and coordination
  • Weight management

Physiotherapy also plays a big role in the post-surgical management of these patients. The type of surgery will determine the physiotherapy approach.[6]

Clinical Bottom Line[edit | edit source]

Post-traumatic arthritis is secondary osteoarthritis that forms after a specific injury to a joint. Symptom can present as long as 2-5 years post injury. Conservative management includes analgesia, as well as physiotherapy. Surgical management is considered when conservative management fails, and again physiotherapy plays a crutial part in the post-operative rehabilitation of these patients.

References[edit | edit source]

  1. ↑ Cleveland Clinic. Post-traumatic arthritis. Available from:http://www.massagetoday.com/mpacms/mt/article.php (accessed 4 April 2019).
  2. ↑ 2.0 2.1 2.2 Brugioni DJ, Falkel J. Total knee replacement rehabilitation: The knee owner’s manual. Alameda CA: Hunter House Inc, 2004.
  3. ↑ 3.0 3.1 3.2 Ombregt L, Bisschop P, Ter Veer HJ. A system of orthopaedic medicine. Elsevier Limited, 2003.
  4. ↑ 4.0 4.1 Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. The Iowa orthopaedic journal 2005;25:44.
  5. ↑ 5.0 5.1 5.2 Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F, Scanu A. Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. RMD open 2016;2(2):e000279.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Cleveland Clinic. Post-Traumatic Arthritis: Diagnosis and Tests. Available from: https://my.clevelandclinic.org/health/diseases/14616-post-traumatic-arthritis/diagnosis-and-tests (accessed 6 April 2019).
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