Post-traumatic arthrosis: features of course and treatment

Development mechanism

Due to injury, a disruption occurs in the structure of articular or cartilage tissues. The bones change position in relation to each other and can no longer move safely. Cartilage ceases to perform a shock-absorbing function and becomes deformed, and a lack of synovial fluid develops in the joints. Competent treatment can stop this process.

Sometimes therapy for post-traumatic arthrosis may be needed after surgery. During surgery, soft tissues and muscles are damaged, scars form on them, which makes proper nutrition of the joints impossible. This leads to inflammation and then to degenerative phenomena.

The disease most often affects the knees, which bear the maximum dynamic load. A synovial fluid prosthesis of the knee joint or complex therapy can help solve the problem. Representatives of certain professions, such as massage therapist, painter, tennis player, are also at risk. Their degenerative phenomena manifest themselves due to regular injury to the elbow joints.

Older people are most susceptible to post-traumatic arthrosis

Diagnostics

If signs of arthrosis of the knee joint develop after an injury, you should contact an orthopedic traumatologist. The diagnosis is established based on the medical history, taking into account the nature of the injury suffered, as well as the patient’s symptoms and the results of instrumental research methods.

As a rule, the doctor initially interviews the patient about the nature of the complaints, the characteristics of pain, and other disturbing manifestations of the disease. After this, he examines the sore knee for any deformity or limitations in mobility. In most cases, these data are sufficient to suggest with a high degree of probability the presence of post-traumatic arthrosis. But for an accurate assessment of the degree of degenerative-dystrophic changes and the consequences of injury, instrumental examinations are necessarily prescribed. These may include:

X-ray of the knee joint - the resulting images assess the condition of the joint area, the presence of signs of its flattening and deformation, narrowing of the joint space, the presence of osteophytes (sharp bone protrusions), cysts, etc.;
CT scan – is prescribed if X-rays do not provide the necessary information or it is necessary to assess the condition of the knee joint with greater accuracy;
MRI – required to study soft tissue structures, which include the cartilaginous components of the joint;
arthroscopy - is prescribed in difficult cases and allows not only to visually assess the condition of cartilage, ligaments, menisci, articular surfaces of bones, but also to immediately carry out therapeutic actions to remove torn off and irreparable fragments of cartilage, etc.

Symptoms of post-traumatic arthrosis

At the initial stage, a person may not be aware of the problem and turn a blind eye to fatigue in the limbs, mild pain, and slight crunching. Symptoms often appear in the morning, but their intensity increases over time. Pain syndrome manifests itself even without physical activity.

At later stages of post-traumatic osteoarthritis, when intra-articular injection of synovial fluid prostheses is relevant, the outlines of the bones change, bone growths, growths or fusions are formed. The joint loses full motor activity.

Post-traumatic arthrosis can appear after 5-7 years

Cost of services

price 532 — Consultations with an orthopedic traumatologist.
You can see
more detailed prices for services Literature:

Bozabaev B.U. Method of treatment of deforming arthrosis of the knee joints [Electronic resource] // Bulletin of the Kazakh National Medical University. 2013. https://cyberleninka.ru/article/n/metod-lecheniya-deformiruyuschego-artroza-kolennyh-sustavov.
Klimenko I.G. Method of treatment of deforming arthrosis of the knee joint [Electronic resource] // Siberian Medical Journal (Irkutsk). 2007. https://cyberleninka.ru/article/n/sposob-lecheniya-deformiruyuschego-artroza-kolennogo-sustava-soobschenie-1.
Zorya V.I., Lazishvili G.D., Shpakovsky D.E. Deforming arthrosis of the knee joint // Littera. 2010.
Makushin V.D., Chegurov OK, Kazantsev V.I., Gordievskikh N.I. On the role of intraosseous hypertension in the genesis of pain syndrome in gonarthrosis // Genius of Orthopedics. 2000.

Characteristic symptoms as the disease progresses:

joint crunch during movement, especially after waking up in the morning;
if the disease affects the ankle, the limb may twist;
aching pain of increasing intensity, especially after a long stay in a static position or after physical activity;
in advanced cases, when it is definitely impossible to do without the best synovial fluid prostheses, the pain intensifies at night, the skin over the joint swells and turns red.

Post-traumatic arthrosis most often affects the knee joint

Main symptoms of DOA of the knee joint

With gonarthrosis of the 1st degree - in the initial stage of the disease, periodic pain occurs in the knee joint after exercise (walking, running, standing for a long time), which goes away after rest. At this stage, there is virtually no joint deformation or limitation of mobility.
Gradually, the pain becomes more frequent and intensifies, especially when going up and down stairs, as well as when starting to walk after sitting for a long time (starting pain)
With grade 2 gonarthrosis, pain in the knee during exercise becomes constant, goes away only after a long rest, the patient limps when walking
When moving there is a crunch in the joint
The range of motion in the knee joint is limited (sharp pain appears when bending “all the way”)
When examining the joint area, you may notice swelling, deformation
In case of DOA of the knee joint of the 3rd degree, which corresponds to severe gonarthrosis, pain in the joint is bothersome even at rest, does not allow one to fall asleep, the range of movements decreases significantly, patients walk on semi-bent legs, there is a pronounced deformation of the knee joint (O-shaped or X-shaped legs )

Treatment of post-traumatic arthrosis

The principles of treating osteoarthritis caused by mechanical trauma are the same as any other. It is impossible to completely cure the disease: therapy is aimed at reducing pain, restoring the lack of synovial fluid in the joint, and preventing further deformation of the joint structures.

Non-steroidal anti-inflammatory drugs are used to relieve pain.
Antispasmodics are prescribed for muscle spasms.
Chondroprotectors and biostimulants are needed to restore processes in cartilage.
In cases of severe inflammation, steroid hormones, such as corticosteroids, are indicated.
Treatment of arthrosis is supplemented with massage and paraffin therapy, exercise therapy, and various physiotherapeutic techniques.

How to help joints maintain their physical shape? An arthrologist and rehabilitation methodologist tells us what safe exercises can be done at home or in the office:

Unfortunately, it is not always possible to cope with post-traumatic arthrosis conservatively. If the injury has led to serious anatomical disorders, muscles and ligaments are damaged, and articular structures are significantly destroyed, endoprosthetics is prescribed.

In some cases, the problem can be solved with a course of intra-articular injections of the synovial fluid substitute, the Noltrex endoprosthesis. The drug is injected into the joint capsule, where it is evenly distributed on the damaged surfaces of the cartilage, moves them apart and stops painful friction.

This course of several injections relieves pain and returns normal mobility for a year or a year and a half. The main thing during this period is to avoid re-injury, otherwise any therapy becomes meaningless.

Why does arthrosis of the knee joint occur?

Most often, the cause of the development of the disease is knee injuries, especially repeated ones (damage to the menisci, dislocations, fractures, hematomas, etc.).
Frequently repeated microtraumas of the joint during sports training, with constant work “on your feet,” have a similar effect.
Excess body weight creates increased axial load and destroys the joint.
A degenerative-dystrophic process in the joint can also occur after suffering from inflammatory diseases (arthritis due to gout, psoriasis, rheumatoid arthritis, spondyloarthritis - ankylosing spondylitis).
Endocrine diseases, hormonal changes (for example, menopause), metabolic disorders aggravate pathological changes in the joint.

Pathogenesis

Arthrosis is a polyetiological disease, which, regardless of the specific causes of its occurrence, is based on a violation of the normal formation and restoration of cartilage tissue cells.

Normally, articular cartilage is smooth and elastic. This allows the articular surfaces to move freely relative to each other, provides the necessary shock absorption and thereby reduces the load on the adjacent structures (bones, ligaments, muscles and capsule). With arthrosis, the cartilage becomes rough, and the articular surfaces begin to “cling” to each other during movements. The cartilage becomes more and more disintegrated. Small pieces are separated from it, which fall into the joint cavity and move freely in the joint fluid, injuring the synovial membrane. Small foci of calcification appear in the superficial zones of the cartilage. Areas of ossification appear in the deep layers. In the central zone, cysts are formed, communicating with the joint cavity, around which, due to the pressure of the intra-articular fluid, ossification zones also form.

Causes of osteoarthritis

Age-related changes. Cartilage tissue loses its elasticity, recovers worse, and becomes more sensitive to stress. The risk of joint damage increases with age.
Genetics. The development of a nodular form is associated with a predisposition. It affects several joints.
Birth injury. Dislocation of the hip joint is common. In the absence of proper treatment, a severe form of deforming arthrosis may develop.
Congenital disorders. The presence of connective tissue dysplasia - structural weakness, leads to hypermobility of the articular elements. The disease can appear at an early age and be accompanied by changes in posture.
Injuries. Sprains, bruises and fractures lead to osteoarthritis. Athletes, as well as people who engage in heavy physical labor, often experience microdamage.
Endocrine system disorders. Metabolic disorders cause joint damage over time. Cartilage tissue is not restored due to a lack of vitamins and minerals. Varicose veins are also dangerous.
Obesity. Excess weight increases the load on the joints, causing rapid wear and tear.
Infections. Past diseases can cause disturbances in the structure of the joints and roughness of the articular surface.

Types of operations for arthrosis

There are 4 main types of surgical interventions used to treat arthrosis. They differ in technique, capabilities, prognosis and cost.

The clinics conduct:

endoprosthetics;
osteotomy;
arthrodesis;
debridement.

The doctor selects an operation to treat arthrosis, taking into account the location and degree of damage, and the presence of contraindications.

Endoprosthetics

The procedure involves replacing a damaged joint with an artificial one. The method shows high results with proper installation of the prosthesis and subsequent development of the joint. Problems will not bother you for 20 years or more. Proper rehabilitation allows you to restore the functionality of the musculoskeletal system. It should be borne in mind that osteoarthritis cannot be completely cured, so joint replacement is the optimal solution. The disadvantage of surgical treatment with the installation of an endoprosthesis is the high cost.

Osteotomy

The procedure involves cutting down part of the bone tissue, positioning the joint and bones at the correct angle. As a result, the load on the affected joint is reduced, and the progression of the disease stops. However, surgery does not eliminate the disease itself. In terms of execution, this is a complex technique that requires long-term rehabilitation.

Arthrodesis

This is one of the radical treatment methods, which involves removing joint tissue. As a result, the bones and patella fuse together. The pain goes away after surgery, and the risk of reoccurrence is eliminated. The disadvantage is limited leg mobility.

Debridement

During surgery for osteoarthritis, an arthroscope is inserted into the joint and damaged cartilage tissue is removed. The advantage of the method is the rapid relief of pain in stages 2 and 3 of arthrosis. With the help of surgical intervention, meniscus cracks are treated and the ligamentous apparatus is restored. The disadvantage of arthroscopy is the short duration of the positive effect. After 1-2 years, the discomfort returns.

Each type of operation is indicated in certain cases. If the cartilage tissue is completely destroyed, endoprosthetics is prescribed. When it is necessary to gain time and slow down the progression of degenerative arthritis, periarticular osteotomy is chosen.

Post-inflammatory (post-infectious) arthrosis

Post-inflammatory (post-infectious) arthrosis is a consequence of nonspecific chronic and acute, as well as specific inflammation of the joints, which are accompanied by the destruction of cartilage and productive-destructive changes in all elements of the joint. The disease begins slowly with clinical radiological signs of arthrosis, which gradually progresses and in its course does not differ from other deforming arthrosis. When choosing a treatment method, the age, gender and profession of the patient, the nature and time of occurrence of the inflammatory process, its exacerbation and clinical and radiological changes in the joint are taken into account.

Treatment . Patients are usually treated in a hospital setting. Conservative treatment must be pathogenetically justified. The complex of therapeutic agents should include anti-inflammatory and antibacterial agents. If they are ineffective, patients undergo surgical treatment. The optimal operation is arthrodesis (closed extrafocal or open). Arthroplasty and endoprosthetics are not used, as they threaten a relapse of the inflammatory process.

Deforming arthrosis after aseptic necrosis of the femoral head in adults or Perthes disease in children develops due to a compression fracture that occurs during loading of the pathologically altered bone. Damage to the head can be segmental or total, and very often the process is bilateral. The head of the femur is deformed and its shape does not correspond to the acetabulum.

Incongruity of the articular surfaces causes pain and limitation of movement in the joint. This leads to antalgic contraction of the muscles, increasing pressure on the femoral head, which in turn further increases pain. A vicious pathological circle arises, which is accompanied by contracture, functional shortening and dysfunction of the limb.

Proper treatment of patients with aseptic necrosis of the femoral head can prevent the occurrence of deforming arthrosis. If the limb unloading regime is not followed, the process ends with one or two-sided coxarthrosis. Conservative treatment of patients with coxarthrosis is carried out with minor deformation of the femoral head and preserved joint function during the period of exacerbation of pain. When there is significant deformation, the success of conservative therapy cannot be counted on, and patients are offered surgical treatment. The method of choice for bilateral coxarthrosis is hip arthroplasty, and when it is impossible, endoprosthetics of one joint and arthrodesis of the second are used. For unilateral coxarthrosis, arthrodesis is performed in manual workers, and in others, arthroplasty or endoprosthetics is performed.

Indications for surgical treatment

Surgery is indicated for patients with severe forms of deforming arthrosis. They resort to it if there is no effect from conservative treatment. Deforming osteoarthritis of the knee and shoulder joint does not respond well to drug therapy and requires surgical intervention.

Indications include:

severe pain that cannot be relieved with painkillers;
infection - purulent cavities have formed in the joint;
complete or partial immobility;
severe cartilage deformities;
internal damage to the joint, accumulation of bone fragments in the cavity.

Surgical treatment of osteoarthritis is a proven technique that can alleviate the patient’s condition. Drastic measures are resorted to when there is no alternative. Endoprosthetics operations show the greatest effectiveness. Treatment involves replacing joint tissue.