Post-traumatic arthrosis is a destructive disease that slowly progresses and leads to the destruction of the joint. The cause of the pathology is mechanical damage after injury of varying severity. The precursor of the disease can be both an intraarticular fracture and a slight bruise. As a result of degeneration, pain, crunch, impaired movement function with subsequent deformation of the joint appears. At the first stages, arthrosis is treated conservatively, advanced forms may require the replacement of a destroyed joint with an artificial implant.
Post-traumatic arthrosis is based on degenerative-dystrophic changes that develop after damage to the joint tissue as a result of a bruise, dislocation, fracture, as well as complete or incomplete rupture of menisci.
At the initial stage, the pathology affects the cartilage tissue, which gradually softens and becomes thinner.
Dystrophy is accompanied by a decrease in the quality of the synovial fluid, as a result of which cell nutrition is disrupted.
With the dynamic development of destructive processes, the cartilage loses its ability to retain moisture and shrinks, covered with cracks. Over time, erosion forms on the thin joint layer, which expose the bone surface. The destruction of the cartilage protection leads to a redistribution of the load. In the course of the compensatory reaction, the bone thickens and grows, forming osteophytes.
Morphological changes are expressed in a decrease in the joint space and a decrease in the production of synovial fluid. As a result, the joint is deformed and loses the physiological range of motion. Destructive processes affect all components of the joint, which is not amenable to treatment and leads to disability of the patient.
Post-traumatic arthrosis appears for three main reasons:
- prolonged immobilization for therapeutic immobilization;
- violation of the anatomically correct arrangement of articular surfaces relative to each other;
- poor blood circulation in the injured area.
Options for the development of degeneration in the post-traumatic period:
- After intraarticular fractures, the shape of the joint changes due to deformation as a result of mechanical damage. Modifications lead to improper load distribution, which leads to tissue damage amid decreased synthesis of articular secretion.
- Injuries of menisci, ligaments – their tears, sprains adversely affect the work of the joint.
- After surgical treatment, the growth of coarse scar tissue occurs, which reduces the flow of blood to the damaged area.
- If excision of sections of the articular components has occurred, the correct location of the joint ends in the joint capsule is disrupted.
- Lack of qualified assistance and diagnosis entails a disruption of the joint and tissue destruction.
During prolonged immobilization of the limb, the cause of arthrosis is a violation of the blood supply and nutrition of the tissues of the joint. Inadequate blood flow due to inactivity for a long period.
Moreover, in this case, the disease appears regardless of the location of the injury.
Post-traumatic arthrosis begins gradually and at the initial stage has a latent course. The only manifestation may be fatigue and unpleasant discomfort in the joint, which is often attributed to muscle fatigue. After a while, a person begins to notice a crunch at the site of the movable joint of the bones during movement, which begins to be accompanied by a pain symptom.
Characteristic of pain with arthrosis:
- in strength – in the first stages is weak, the intensity increases as the pathology progresses;
- by nature – “starting”, appears in the morning after a long rest, after a small physical activity decreases;
- in duration – short-term at the initial stage, occurs after physical exertion, subsequently goes into a chronic course, often occurs at night.
Often patients complain of aching and soreness in the joint when the weather changes. Weather sensitivity is a hallmark of post-traumatic arthrosis. In addition, movements in the joint are difficult, stiffness appears. The amplitude and range of motion is sharply limited.
The first stages are rarely diagnosed, so the disease invariably flows into the stage of irreversible changes in the joint. In this case, the disease passes into the chronic stage and proceeds by alternating stages of exacerbation and remission. In the acute period, the joint swells due to inflammation of the synovial membrane. Synovitis is accompanied by the filling of the capsule with exudate due to a violation of the function of reverse absorption with an excessive amount of effusion.
With constant pain, muscle tension appears, which provokes articular contracture. Soreness and discomfort appear not only with tension, but also in a calm state. Often the appearance of convulsive contractions of the periarticular muscles. The joint is gradually deformed, there is a violation of the gait – lameness. In advanced cases, in the absence of adequate treatment, contractures are replaced by ankylosis of the affected joint.
Post-traumatic arthrosis is confirmed by x-ray examination and anamnestic data. During the conversation, the orthopedist clarifies the presence and nature of the previous injury, the availability of surgical treatment and the duration of fixation of the damaged area. After an X-ray, the doctor pays attention to the size of the joint space, the degree of deformation of the articular surfaces, the presence and number of osteophytes.
If it is necessary to assess the state of cartilage and connective tissue, computed tomography or magnetic resonance imaging is performed. An additional method of examining the surface of the joint from the inside is arthroscopy. The list of diagnostic procedures may vary depending on the location of the disease.
Therapeutic measures include conservative and surgical treatment. The main goal of non-surgical therapy is to reduce or eliminate soreness, restore motor capabilities and inhibit destructive joint damage. A positive effect is achieved by a set of procedures that include:
The list of drugs that treat post-traumatic arthrosis include:
- Nonsteroidal anti-inflammatory drugs – Diclofenac, Indomethacin, Ketoprofen to reduce pain sensitivity and prevent inflammatory processes.
- Glucocorticosteroids – Diprospan, Hydrocortisone with the ineffectiveness of NSAIDs, can be used to introduce into the joint against inflammation and swelling of the tissues.
- Muscle relaxants – Sirdalud, Midokalm with muscle spasm and tension.
Chondroprotectors are a special group of drugs that directly combat the destruction of articular cartilage at the cellular level. Teraflex, Don, Arthra contain glucosamine and chondroitin, which is a component of chondrocyte (cartilage cells). Medicines have a cumulative effect, therefore, they are used for long courses.
Means with hyaluronic acid (Ostenil, Fermatron) act quickly and are administered by the intraarticular method. Synovial fluid substitute reduces pain, improves mobility and maintains a therapeutic effect for a long time.
Physiotherapeutic methods of treatment:
- electrophoresis with analgesic effect with Novocaine, Lidocaine;
- thermal applications with paraffin;
- shock wave therapy;
- exposure to laser beams;
- phonophoresis with steroid hormones (Dexamethasone, Prednisolone).
These methods are applicable only in the stage of remission, acute inflammation is a contraindication for physiotherapeutic procedures. Massage and exercise therapy improve the functionality of the affected joint, restore blood supply and muscle tissue. The movements of physiotherapy exercises are selected by the orthopedic surgeon together with a physiotherapist.
Classes begin with simple movements that run smoothly at a slow pace. For a good result, it is important to regularly conduct exercise therapy sessions and follow medical recommendations for dosing the load. Exceeding the permissible limits may cross out all previous treatment.
A destroyed joint in the terminal stage of post-traumatic arthrosis is not amenable to conservative therapy. If you do not take total measures, the patient is limited in motor ability, and will suffer chronic pain. It is possible to restore physiological functionality only by a surgical method of replacing a broken joint with an artificial prosthesis.
With timely access to a doctor, the prognosis of the disease is favorable. Attempting self-medication or ignoring injury can have dire consequences.
So that post-traumatic arthrosis does not appear, careful attention to your health after an injury of any level is required. Even a simple bruise can trigger degenerative changes. Therefore, one should be careful, observe safety rules everywhere, wear comfortable shoes. To prevent frequent injuries – to strengthen endurance and train muscle strength with regular physical education exercises. If injury cannot be avoided, hurry up with a visit to the doctor and follow the further recommendations of the medical specialist.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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