Traumatic arthrosis

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.

Development process

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.

Causes

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:

  1. 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.
  2. Injuries of menisci, ligaments – their tears, sprains adversely affect the work of the joint.
  3. After surgical treatment, the growth of coarse scar tissue occurs, which reduces the flow of blood to the damaged area.
  4. If excision of sections of the articular components has occurred, the correct location of the joint ends in the joint capsule is disrupted.
  5. 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.

Symptomatic manifestations

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.

Diagnostics

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.

Therapies

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;
  • UHF;
  • 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.

Prevention

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.

Symptoms and treatment of post-traumatic arthrosis

Under certain circumstances, fractures and damage to soft tissue articular elements can lead to post-traumatic arthrosis (code according to ICD-10 M15-M19) – a degenerative-dystrophic lesion of the movable joints of the skeleton bones. The pathological process is manifested by pain, stiffness of movements and deformation of the joint. The risk group includes elderly people and people who are professionally involved in sports.

Causes

Osteoarthritis, which develops after mechanical damage, can affect absolutely any bone joints, but, according to statistics, most often this complication occurs in large joints of the legs – hip, knee, ankle. The spherical connection of the humerus with the scapula is no less susceptible to injuries and degenerative-dystrophic changes. Typically, post-traumatic deforming arthrosis develops within the joint capsule. The greatest danger is a fracture, complicated by the displacement of bone fragments.

The impetus for the onset of the disease can be various injuries of the soft tissues of the joints:

  1. violation of the integrity of the meniscus;
  2. ligamentous apparatus stretching;
  3. rupture of muscle tissue in the articular region.

Surgical intervention can also provoke pathology if during the operation the geometry of the movable joint was disturbed. Sometimes the destruction of the cartilage tissue occurs right at the time of the injury, but most often the thinning of the cartilage is an indirect and long-term result of mechanical damage.

The following degenerative processes lead to dystrophic changes:

  1. Violation of the natural location of the articular surfaces, as a result of which some parts of the cartilage begin to undergo increased stress and rapid wear.
  2. The rupture of capillaries and nerve fibers leads to the entry of nutrients into the periarticular tissues.
  3. Trophic disorders in the joints due to scarring of damaged soft tissue segments.
  4. Hemorrhage into the cavity of the movable bone joint with rupture of blood vessels, which turns into inflammation of the synovial membrane.
  5. A protracted inflammatory reaction caused by infection of a wound.

Often the development of post-traumatic arthrosis (ICD-10 M15-M19) is caused not only by a single factor, but by their combination. Degenerative-dystrophic changes that occur in the joints after a fracture or dislocation can be associated with the mandatory immobilization of a damaged arm or leg. A prolonged stay of a limb in a static position disrupts the blood supply to the joint, leading to stagnation and atrophy of muscle fibers.

clinical picture

At first, the disease, as a rule, proceeds without pronounced symptoms. Visual examination at an early stage does not reveal changes. The configuration and shape of the bone joint is preserved. It may seem that the joint has completely recovered from the injury, however, occasionally there is pain in the limbs, especially after physical exertion and long walking. In the future, a feeling of stiffness joins in this, a slight swelling appears, localized in the affected area.

At the second stage, the joint gap is significantly narrowed, osteophytes occur. A post-traumatic lesion that extends to the hip, knee or ankle joint is accompanied by an increase in pain when climbing stairs. When inflammation covers the articular capsule and nearby ligaments, the pain becomes stronger, often becoming permanent. When pressure is applied to a joint or surrounding soft tissues, unpleasant sensations intensify. Continuous intense pain entails the formation of a reflex spasm of the muscles of the limb and a decrease in the amplitude of passive movements in the joint.

At the final stage of the disease, osteophyte formations grow on bone surfaces, the shape of the movable joint changes. The joint gap is almost invisible. Due to the destruction of the heads of bones, subluxations and weakening of the ligaments, a change in the length of the limb is observed. In some patients, connective and bone tissue gradually begins to grow together, which leads to a limitation of joint mobility and deformation. In the chronic course of the disease, an alternation of remissions and exacerbations is noted.

Diagnostic measures

If post-traumatic arthrosis is suspected, the doctor first conducts a visual examination of the affected joint. The external condition of the bone joint is evaluated, the presence or absence of deformation, swelling, redness and other signs associated with this pathology is revealed. Palpation determine the degree of pain and the nature of the seals.

A final diagnosis and clarification of the extent of damage to the joint are possible only after a series of diagnostic procedures:

  1. Arthroscopy This minimally invasive surgical procedure provides a detailed picture of the abnormalities in the movable bone joint. If necessary, allows for some medical procedures.
  2. X-ray On x-rays, changes in the joint space, the presence of cysts and osteophytes are clearly visible.
  3. Magnetic resonance imaging. It makes it possible to assess the degree of damage in tissues located near the joint.
  4. CT scan. A modern method of hardware diagnostics that allows you to study the state of bone structures.

Therapeutic methods

The treatment of post-traumatic arthrosis is mostly done by orthopedists and traumatologists. The main goal of therapy is to stop unpleasant sensations, restore lost functions and prevent the spread of the degenerative-dystrophic process.

A comprehensive therapeutic strategy is being developed, which necessarily includes the use of non-steroidal anti-inflammatory drugs of general and local action, chondoprotectors and corticosteroids. The patient is prescribed a course of physiotherapy exercises, massage, physiotherapy. With severe pain and severe inflammatory process, a blockade with glucocorticosteroids is performed. To relieve muscle cramps, muscle relaxants are used.

Surgical intervention is advisable only in cases where it is necessary to restore the configuration and stability of the bone joint, as well as when the joint structures are destroyed to such an extent that endoprosthetics can no longer be dispensed with. If the installation of the prosthesis for some reason is not possible, arthrodesis is performed – complete immobilization of the affected joint, which allows partially restoring the supporting ability of the limb.

During the operation, the specialist can perform osteotomy, osteosynthesis using metal structures, ligament plastic, in which live patient tissue or artificial materials are used. All surgical procedures are performed under stationary conditions. In most cases, general anesthesia is used.

The patient has the opportunity to choose between an open operation or a gentle arthroscopic technique, but the latter, of course, will cost much more. The result of surgery depends on the severity and nature of the injury, as well as the prescription and severity of secondary dystrophic changes. Unfortunately, it should be noted that the individual components of the joint are not always subject to recovery.

preventive measures

Alas, it is not possible to prevent or predict injury. That is why it is so important to take care of your own health and consult a doctor in a timely manner so that you do not have to treat post-traumatic arthrosis for a long and painful time.

You need to eat right, forever give up bad habits, keep weight under control, regularly take tests for hormones. Elderly people who automatically fall into the risk group should introduce special additives in the diet that strengthen joints and increase immunity.

In order not to encounter this extremely unpleasant disease, we must not forget about physical activity. Very useful for joints and overall health are hiking, skiing, swimming and dancing. Exercises that do not exceed the load allowed by the doctor can saturate the diseased joint with oxygen, thereby helping to combat its destruction.

Forgetting about the trauma, a person often closes his eyes to a slight joint pain, but, according to doctors, not a single lesion passes without a trace. Therapy of this serious disease of the musculoskeletal system is a long and serious process that requires patience and daily work on oneself. Without proper treatment, post-traumatic arthrosis threatens with partial or complete loss of mobility of the affected limb.

Post-traumatic arthrosis: symptoms, treatment methods

After an injury, the articular region undergoes degenerative and dystrophic changes. Such processes affect not only cartilage and bone tissue, but also ligaments, tendons. The listed phenomena characterize a disease called post-traumatic arthrosis. Its manifestations and treatment will be discussed later.

Post-traumatic arthrosis: causes, symptoms, degrees

Traumatic arthrosis, as the name implies, appears after trauma to a certain area. The following conditions can lead to this pathology:

  1. Sprain.
  2. Meniscus injuries.
  3. Violation of the integrity of muscle tissue in the affected area.
  4. Fractures with subsequent development of inflammation.

Such a pathological process often develops after a fracture or other injury. But in the risk group, athletes come first. After all, they are more often than other segments of the population injured in the musculoskeletal system. The second place in the risk of developing after the injury of the pathology under consideration is occupied by elderly people who have the phenomena of osteoporosis, weakness of the ligamentous apparatus, metabolic disorders and numerous chronic diseases.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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The degree of arthrosis after injury

  1. At the first degree of the pathology in question, regardless of localization, pronounced symptoms will not be observed. Possible stiffness of movements and discomfort in the limbs after a long walk. It is during this period that treatment must begin. But in most cases, patients rarely seek medical help.
  2. In the second degree, a significant narrowing of the joint space is formed and osteophytes appear. Posttraumatic arthrosis of the ankle is characterized by rapid fatigue when walking, pain and crunching during movements in the joint, cramps of the calf muscles and muscles of the foot. Gradually, the articular region is deformed. Also, with post-traumatic lesion of the knee, hip and ankle joints, an increase in pain syndrome is characteristic when climbing stairs and descending from it.
    With arthrosis after a fracture of the shoulder joint, the volume of active movements in the joint decreases, pain in the chest, clavicle or scapula area is possible.
    For the defeat of the elbow joint in the second stage, the appearance of crunch and pain during movements is characteristic.
    In the second stage of arthrosis of the big toe, a pain syndrome appears, which increases with exertion. Tissues around the affected area become inflamed, redden and swell.
  3. At the third stage of arthrosis, there is no inter-articular gap in the x-ray, multiple osteophytes are found. With damage to the ankle, hip and knee, the third stage is characterized by pain syndrome that occurs with minimal stress. Motor activity is significantly limited or impossible.

If the shoulder joint is damaged in the third stage, the patient cannot do everyday work, self-care is limited: he cannot raise his hands, hold a spoon, and dress himself.

The pathological process after an injury of the big toe at this stage leads to deformation of the articular region, pronounced constant pain in the foot, displacement of the finger due to an increase in the volume of the head of the metatarsal bone.

The defeat of the phalangeal joint of the toe leads to its displacement, deformation, pain is characterized by constancy and severity, corns appear on the sole.

Treatment of post-traumatic arthrosis

Therapy with different localization of the inflammatory process will be different. But there are general principles of treatment:

  1. Medications to stop the symptoms of the disease.
  2. Chondroprotectors for the restoration of cartilage structures.
  3. Physiotherapy exercises aimed at normalizing joint mobility, preventing muscle atrophy, and reducing the load on the articular region.
  4. Physiotherapeutic procedures to restore metabolism, reduce swelling and inflammation, improve the penetration of drugs into tissues.
  5. Massage.
  6. Surgical intervention. It is recommended in advanced cases with the ineffectiveness of conservative measures. Such treatment includes endoprosthetics, axial correction, correction of deformities.
  7. The diet for the pathology under consideration should be based on a diet enriched with vitamins and minerals. Preservatives and dyes, fatty, salty, spicy foods should also be excluded. In addition, you must drink at least 2 liters of clean water per day.

Therapy of traumatic arthrosis of the ankle, hip, knee joints

To get rid of foot arthrosis after an injury, it is necessary to use non-steroidal anti-inflammatory drugs, glucocorticosteroid hormones in the form of ointments. In addition, compresses, therapeutic infusions, UHF, baths, and mud are used to relieve puffiness and reduce the inflammatory process. A lengthy course of chondroprotectors is needed.

Women are not recommended to wear high-heeled shoes. To reduce the load on the joint, you should lose weight. To maintain muscle tone every day, you must perform exercises selected by a specialist in physiotherapy.

With hip damage, conservative therapy includes the same components. However, the third stage of the pathology can only be cured by surgery. Endoprosthetics are carried out, consisting in resection of the destroyed head of the femur and replacing it with an artificial one. Subsequently, a long rehabilitation is carried out.

Non-steroidal anti-inflammatory drugs, glucocorticosteroid hormones, antispasmodics, chondroprotectors and biostimulants are used for conservative treatment of knee pathology. Of the physiotherapeutic methods, UHF, laser therapy, and magnetotherapy are used. Acupuncture and massage give a good effect.

Treatment of post-traumatic arthrosis of the shoulder joint

With the localization of the pathological process in the joint of the shoulder, conservative treatment is performed. NSAIDs are used, with severe pain take analgesics, muscle relaxants. Chondroprotectors containing glucosamine and chondroitin are needed. In the absence of an effect, a prolonged inflammatory process, intra-articular injections of glucocorticosteroid hormones are made. Assign laser therapy, electrophoresis and phonophoresis, treatment with paraffin and mud. To improve mobility, exercises of the physiotherapy exercises complex should be performed daily.

If the listed measures were unsuccessful, the patient undergoes endoprosthetics. In the presence of contraindications, arthrodesis is used – fixation of the joint.

Conclusion

Unfortunately, the treatment of post-traumatic arthrosis is a long and complex process. To prevent the development of this pathology, injury should be avoided. If you get even a minor injury, you should contact a specialist who, after examination and examination, will develop a treatment regimen. In addition, the patient needs to make efforts to reduce weight, perform recommended exercises daily. In the process of therapy, it is important to follow a diet, include jellied meat and jelly-like food in the diet. Of great importance is the selection of comfortable shoes.

What is post-traumatic arthrosis (osteoarthrosis) and how to treat it?

Post-traumatic arthrosis of the joints is a secondary degenerative or dystrophic process caused by trauma to the limb. Injury can lead not only to the development of articular (bone or cartilage) deformity, but also to a pathological change in the soft tissues around the joint. The main symptom of post-traumatic arthrosis is pain, stiffness of movements, a change in the shape of the joint.

Causes

The main cause of post-traumatic arthrosis is pathological joint changes due to trauma. Any mechanical damage leads to a violation of the integrity of the organs and structures of the body.

Arthrosis develops not only after a fracture or severe hemorrhage. The impetus for the occurrence of the disease can be a regular blow. It leads to the defeat of the capillaries, as a result of which the tissue nutrition is disrupted, and the dystrophic process starts.

Degenerative-dystrophic syndrome develops gradually:

  • Cartilage is thinning between the joints;
  • The friction of nearby joints increases;
  • There is a slow destruction of the surface of the joint.

Post-traumatic arthrosis develops in different ways:

  • The shape of the joint is deformed, the amount of joint lubrication between the articulating cartilages decreases, limb mobility is limited. Such arthrosis occurs if the limb is broken. Increase the risk of pathology with displacement fractures;
  • Injury to ligaments, miniski, or joint capsules. These include tears or sprains. So the appearance of post-traumatic arthrosis of the ankle joint can cause a sprain of syndesmosis – tibia. And in the event of the occurrence of post-traumatic arthrosis of the knee joint, the patient has a history of complex trauma: both a fracture and a rupture of meniscus distension;
  • In the form of complications after surgery. Due to trauma to the periarticular tissues, the scarring process starts. The resulting scars prevent the entry of nutrients into the articular elements, as a result of which secondary deformation develops;
  • In addition to scarring, surgery carries the risk of changes in the geometry of the joint, due to the removal of damaged parts;
  • Symptoms of injury are often blurred, so patients do not consult a doctor. And the absence or untimely treatment is one of the reasons for the gradual development of post-traumatic arthrosis of the subtalar joint.

Classification of Arthrosis

Post-traumatic arthrosis received the code for ICD 10 (International Classification of Diseases) M19.1. Depending on the affected joint, traumatic arthrosis is divided into:

  • Damage to the ankle joint. Pain syndrome leads to pathological muscle contraction, joint deformation, gait changes;
  • Pathology of the knee. The patient begins to limp due to a decrease in the amount of joint fluid. When walking, a characteristic crunch is noticeable. At the initial stage of post-traumatic gonarthrosis, the patient complains of discomfort, over time, any movement causes pain. Often, besides the knee, the ankle joint is affected. With the progression of the disease, the joint is deformed, meteorological dependence develops;
  • Hip disorder (coxarthrosis). This is the largest joint; the patient’s ability to move normally depends on his mobility. Progression of post-traumatic coxarthrosis leads to shortening of the limb, muscle atrophy. A man walks “like a duck.” Without proper treatment, an ailment can lead to disability;
  • Deformation of the shoulder joint. A lesion develops against a background of dislocation or injury. The limb movement becomes limited, the patient cannot eat or dress on his own;
  • Pathology of the elbow joint. The cause of the lesion is a fracture and a long stay in a cast;
  • Damage to the wrist joint. At risk of injury, the patient is not able to perform even simple movements.

Symptoms and Diagnosis

Symptoms of post-traumatic osteoarthritis depend on the degree of development of the disease. In the initial stages, the disease can be asymptomatic. The appearance of a pain syndrome forces the patient to consult a doctor.

Stage One

At the initial stage, soreness appears only in case of exertion or increased physical activity. The patient continues to lead a normal lifestyle.

If you go to the doctor at this stage, then the treatment will be simple, and the prognosis is favorable.

Diagnosis of arthrosis is carried out by collecting an anamnesis, interviewing a patient, as well as radiography. The picture shows a slight symptomatology – a slight narrowing of the joint gap.

Stage Two

At the second stage, limitation of mobility is noticeable and a similar condition requires immediate treatment. The growing pain syndrome does not allow a person to lead a familiar lifestyle. A long rest helps to reduce pain. And any movement is accompanied by a crunch. Sharp pain does not allow the patient to climb the stairs.

If the cause of the development of the disease was an injury to the spinal column, then the body tilts are accompanied by an increase in pain.

A doctor can help diagnose the disease, during which changes in the functionality of the spine are noticeable. Usually a doctor diagnoses osteochondrosis, and its treatment will require more time and effort. A significant narrowing of the articular gap is noticeable in the x-ray image.

Stage Three

In the third stage, the patient is in serious condition, and treatment requires a lot of time. Limb movements are severely limited, and the pain becomes constant. An X-ray image captures the absence of inter-articular space, a continuous section of bone-cartilaginous tissue is displayed instead. This stage is an indication for disability.

Treatment and prognosis

With timely access to a doctor, the appointment of adequate treatment for post-traumatic arthrosis, the implementation of all recommendations, the prognosis is favorable. In most cases, the patient succeeds in achieving stable remission. But do not forget that arthrosis is a chronic ailment, therefore, to maintain remission, you should deal with the method of Dr. Bubnovsky and Popov.

Before starting treatment, an x-ray study is carried out, on the basis of which a therapy scheme is drawn up. An additional treatment method is to follow a special diet aimed at reducing body weight, as well as preventive treatment in sanatoriums and dispensaries.

Conservative methods

In the initial stages of arthrosis, conservative treatment methods help. The main goal of such treatment is to reduce the load on the affected area. Extra relaxation alternates with massage and a set of special exercises. Aimed at stopping pain and increasing joint mobility.

Physiotherapy exercises help prevent the progression of muscle atrophy, reduce pain in movements, and get rid of inflammation.

Medication Therapy

Drug therapy includes the appointment of:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of drugs reduces pain and fights the inflammatory process;
  • Chondroprotectors stop the destruction of articular tissue, restore cartilage elements;
  • Local gels and ointments, which include glucosamine and chondroitin, are used in the form of applications.

To relieve painful symptoms in the first degree of the disease allow ointments, which include corticosteroids – they can relieve inflammation. And to resume joint mobility, local remedies with a herbal composition are prescribed.

Physiotherapy

Physiotherapeutic procedures – electrophoresis, phonophores, massage, acupuncture, shock wave and manual therapy are necessary to develop a damaged joint and are prescribed as rehabilitation treatment for arthrosis.

The listed types of treatment help to improve the nutrition of articular tissues, normalize blood flow in the muscles, stop tissue atrophy, completely relieve pain or reduce its intensity.

Surgery

If conservative treatment of post-traumatic arthrosis of the knee or hip joint was ineffective, significant destruction of the articular surfaces is observed, and a surgical operation to replace the affected joint with an endoprosthesis is indicated. This operation allows you to restore the shape of the joint, as well as stabilize its condition.

During the surgery, fixing metal structures in the form of screws, plates, transplanted patient tissue will be used to help regenerate the ligaments, as well as an artificial implant.

Surgery is performed using general anesthesia according to the classical technique and open access, as well as under local anesthesia using arthroscopic technology.

For recovery after surgery, drug treatment (taking antibiotics, pain medications), physiotherapy, exercise therapy exercises and massage are used.

Post-traumatic arthrosis develops as a secondary disease after a limb injury. Timely diagnosis and proper treatment can achieve a stable remission. During this period, the patient can lead a familiar lifestyle.

Post-traumatic arthrosis – types, symptoms, causes and treatment

Post-traumatic arthrosis is a progressive degenerative-dystrophic joint change in a chronic course that occurs as a result of exposure to a traumatic agent.

Causes

Even minor damage can provoke the development of degenerative processes in the joint. The causes of post-traumatic arthrosis of the knee include:

  • pathology of the anatomical structure of the joint;
  • displacement of fragments;
  • damage to the capsule-ligamentous structures;
  • untimely or inadequate therapy;
  • prolonged immobilization;
  • surgical treatment of knee disorders.

Most often, this pathology occurs due to:

  • violation of the correspondence of articular surfaces;
  • a significant reduction in blood supply to various elements of the knee joint;
  • prolonged artificial immobilization.

The causes of arthrosis may be intraarticular fractures with displacement and trauma to the menisci and ligaments (for example, a gap).

Stages

Three stages of pathology are distinguished depending on the degree of manifestation:

  • I – pain occurs during physical exertion, with movements of the affected limb, a crunch in the joint is heard. Visual changes in the joint are absent. Palpation causes pain.
  • II – pronounced pain during the transition from statics to dynamics, limited movement in the morning, stiffness, intense crunch in the joint. On palpation, deformation of the joint space with uneven sections along the contour is determined.
  • III – the shape of the joint is changed, the pain becomes intense even at rest. Pain sensations intensify at night. There is limited movement. A damaged joint is sensitive to changes in weather conditions.

Depending on the localization, several types of post-traumatic arthrosis are distinguished, each of which will be described below.

Post-traumatic arthrosis of the knee

The inflammatory process covers cartilage, muscles, ligaments and other elements of the joint. The average age of patients is 55 years.

Post-traumatic arthrosis of the shoulder joint

The disease can affect one or both shoulder joints. The causes of this pathology are their displacement and stretching.

Post-traumatic arthrosis of the fingers

With damage to the cartilage of the joints of the fingers, a degenerative-inflammatory process develops.

Post-traumatic arthrosis of the ankle

This pathology occurs due to displacement and cracks.

Post-traumatic arthrosis of the hip joint

The reasons for the development of this type of disease are ligament rupture and other joint injuries.

Post-traumatic arthrosis of the elbow joint

Injuries lead to a deterioration in the condition of the elbow joint. Complicated injuries can provoke extensive cartilage damage and elbow deformation, as a result of which tissue wear is accelerated and joint mechanics are impaired.

Symptoms

Pathology is capable of being asymptomatic for some time or hiding behind the background of residual phenomena after a joint injury. With the advanced stage of the disease, clinical symptoms of arthrosis can be observed for a long period.

In the initial stages, the disease manifests itself:

The following features are characteristic of pain:

  • localization on the damaged tissue site;
  • there is no radiation;
  • aching and pulling;
  • insignificant initially painful sensations become more intense with movements;
  • at rest, they are absent and arise during movements.

Crunch increases as the disease progresses. It refers to the stable symptoms of post-traumatic arthrosis. At the same time, the nature of pain changes. They spread throughout the knee joint and are able to radiate in the area above or below the knee. The pain acquires a twisting stable character and becomes more intense.

Indicative symptoms for post-traumatic arthrosis of the knee are the appearance of soreness and stiffness when leaving a state of rest. These signs allow you to pre-diagnose the disease even without the use of other research methods. Most often they occur after sleep.

In the future, with the progression of pathology, they join:

  • swelling of adjacent soft tissues;
  • muscle spasm;
  • joint deformation;
  • lameness;
  • deterioration of the emotional and psychological state of the patient due to constant pain.

Diagnostics

The recognition of the disease is carried out on the basis of clinical symptoms, patient complaints and anamnesis. The doctor must certainly clarify whether there have been joint injuries in the patient’s past. If there is a history of injuries, the likelihood of post-traumatic arthrosis increases significantly.

The diagnosis is confirmed after examination of the patient and palpation of the damaged area. Joint radiography is performed. To clarify the diagnosis, in some cases, an MRI or CT scan is prescribed.

© Olesia Bilkei – stock.adobe.com. MRI

When conducting an x-ray picture of the disease is as follows:

  • I – narrowing of the joint space, along the edges of which are located bone growths. There are local sites of cartilage ossification.
  • II – an increase in the size of bone growths, a more intense narrowing of the joint space. The occurrence of subchondral sclerosis of the end plate.
  • III – intense deformation and sclerosis of the cartilage surfaces of the joint. Subchondral necrosis is present. The articular fissure is not visualized.

Treatment

The disease requires complex treatment. At the mild stage, drug therapy is used in combination with exercise therapy and physiotherapy. If conservative treatment does not lead to the desired effect and the pathology progresses, surgery is performed.

The goal of therapy is to prevent the destruction of cartilage, stopping pain, restoring the functionality of the joint and improving the quality of life of the patient.

Medication Therapy

In case of post-traumatic arthrosis, the following drugs are recommended:

  • Chondroprotectors. They prevent cartilage destruction and have a protective effect on the matrix.
  • Corrector metabolism. They contain vitamin and mineral complexes and nutrients.
  • NSAIDs. Reduce pain and inflammation. Drugs are used during an exacerbation of the disease.
  • Hyaluronic acid.
  • Medicines to improve microcirculation in the affected area.
  • Glucocorticosteroids. Assigned in the absence of the effect of drug therapy.
  • Means of external use (ointments, gels) based on components of plant and animal origin.

Physiotherapy

Combined therapy is used to improve metabolic processes in cartilage, relieve pain and slow joint destruction.

Physiotherapeutic treatment methods:

  • Ultrasound therapy;
  • inductothermy;
  • electrophoresis;
  • magnetotherapy;
  • ozokerite and paraffin baths;
  • phonophoresis;
  • local barotherapy;
  • bifoshit treatment;
  • acupuncture;
  • balneotherapy.

Post-traumatic arthrosis

Post-traumatic arthrosis is a chronic progressive lesion of the joint that occurs after traumatic injury. More often develops after intraarticular fractures, however, it can also occur after injuries of soft tissue elements (ligaments, menisci). It manifests itself in pain, restriction of movement and deformation of the joint. The diagnosis is made on the basis of the anamnesis, clinical data, results of radiography, CT, MRI, ultrasound, arthroscopy and other studies. Treatment is often conservative: exercise therapy, physiotherapy, symptomatic therapy. With significant destruction of the joint, endoprosthetics are performed.

ICD-10

Overview

Post-traumatic arthrosis is one of the varieties of secondary arthrosis, that is, arthrosis that has arisen 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 sources, the likelihood of arthrosis after a joint injury is from 15 to 60%. It can affect any joints, however, post-traumatic arthrosis of large joints of the lower extremities have the greatest clinical significance, both due to its widespread prevalence and because of the effect on the activity and performance of patients.

Causes

The main reasons for the development of post-traumatic arthrosis are a violation of the congruency of the articular surfaces, a deterioration in the blood supply to various structures of the joint, and prolonged immobilization. This form of arthrosis very often occurs after intraarticular fractures with displacement. So, arthrosis of the knee joint often develops after fractures of the condyles of the thigh and condyles of the tibia, arthrosis of the elbow joint – after pericondylic fractures and fractures of the head of the beam, etc.

Another fairly common cause of post-traumatic arthrosis is rupture of the capsule-ligamentous apparatus. For example, arthrosis of the ankle joint can occur after rupture of the tibiofibular syndesmosis, arthrosis of the knee joint after damage to the cruciate ligaments, etc. Often in the history of patients suffering from post-traumatic arthrosis, a combination of these injuries is revealed, for example, a three-ankle fracture with rupture of the tibiofibular syndesmosis.

The likelihood of developing this form of arthrosis increases sharply with improper or untimely treatment, as a result of which even minor unadjusted anatomical defects remain. For example, when changing the relative position of the articular surfaces of the ankle joint by only 1 mm, the load begins to be distributed not over the entire surface of the articular cartilage, but only 30-40% of their total area. This leads to constant significant overload of certain areas of the joint and causes rapid destruction of the cartilage.

Prolonged immobilization can provoke the development of post-traumatic arthrosis, both with intraarticular and extraarticular injuries. In conditions of prolonged immobility, blood circulation worsens and venous-lymphatic outflow in the joint area is impaired. The muscles are shortened, the elasticity of the soft tissue structures is reduced, and sometimes the changes become irreversible.

A type of post-traumatic arthrosis is arthrosis after surgery. 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 trauma to the tissues. 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 elements of the joint destroyed or severely damaged due to trauma, and this entails a violation of the congruence of the articular surfaces.

Symptoms of post-traumatic arthrosis

At the initial stages, a crunch occurs and minor or moderate pain intensifies with movement. At rest, pain is usually absent. A characteristic sign of arthrosis is the “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 range of motion in the joint is limited.

Usually there is an alternation of exacerbations and remissions. In the period of exacerbation, the joint becomes swollen, 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 disturbed by discomfort, pain and muscle cramps. The joint is gradually deformed. Lameness occurs due to pain and limitation of movement. In the later stages, the joint is bent, grossly deformed, subluxations and contractures are noted.

Visual examination in the early stages does not reveal changes. The shape and configuration of the joint are not broken (if there is no previous deformation due to traumatic injury). The range of movements depends on the nature of the injury and the quality of the rehabilitation measures. Subsequently, an aggravation of deformation and an increasing restriction of movements are observed. Palpation is painful, with palpation in some cases, thickenings and roughnesses along the edge of the joint space are determined. Perhaps the curvature of the axis of the limb and joint instability. With synovitis, fluctuation is determined in the joint.

Diagnostics

The diagnosis is established on the basis of an anamnesis (previous injury), clinical manifestations and results of joint radiography. On radiographs, dystrophic changes are revealed: flattening and deformation of the articular site, narrowing of the joint space, osteophytes, subchondral osteosclerosis and cystic formations. With subluxation, a violation of the axis of the limb and uneven joint space are observed.

If necessary, a CT scan of the joint is prescribed to more accurately assess the state of dense structures. If it is required to identify pathological changes in the soft tissues, the patient is referred for MRI of the joint. In some cases, it is advisable to carry out arthroscopy, a modern diagnostic and treatment 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 of post-traumatic arthrosis

Treatment is carried out by orthopedic traumatologists. The main goals of treatment are the elimination or reduction of pain, restoration of function and prevention of further destruction of the joint. Complex therapy is carried out, including NSAIDs of local and general action, chondroprotectors, exercise therapy, massage, thermal procedures (ozokerite, paraffin), electrophoresis with novocaine, shock wave therapy, laser therapy, phonophoresis of corticosteroid drugs, UHF, etc. With intensive pain and severe inflammation are performed by therapeutic blockade with glucocorticosteroids (diprospan, hydrocortisone). With muscle cramps, antispasmodics are prescribed.

Surgical interventions can be performed to restore the configuration and stability of the joint, as well as in cases where the articular surfaces are substantially destroyed and must be replaced with an endoprosthesis. During the operation, osteotomy, osteosynthesis using various metal structures (nails, screws, plates, knitting needles, etc.), plastic ligaments using the patient’s own tissues and artificial materials can be performed.

Surgery is performed in the orthopedic or trauma unit, in a planned manner, 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, exercise therapy, physiotherapy and massage are prescribed. After removal of the sutures, patients are discharged for outpatient aftercare and rehabilitation measures are carried out.

The effect of surgery depends on the nature, severity and prescription of the injury, as well as on the severity of secondary arthritic changes. It should be borne in mind that in some cases a complete restoration of joint function is impossible. With severe advanced arthrosis, the only way to return the patient to work is endoprosthetics. If the installation of the endoprosthesis for some reason is not shown, in some cases they perform arthrodesis – fixing the joint in a functionally advantageous position.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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