What is Post-Traumatic Arthritis? 

Post-traumatic arthritis (PTA) develops after acute, direct trauma to a joint. It can develop soon after or many years after an injury.

Symptoms can include joint pain and swelling, which often increase during activity and decrease with rest, and stiffness after extended periods of inactivity. Symptoms often recover spontaneously, but symptoms persisting after 6 months are considered chronic PTA.¹

PTA is relatively common, affecting more than 5 million people every year, and makes up around 12% of all osteoarthritis cases.¹ 

Currently, there are no specific treatments for preventing the progression and evolution of PTA, so prevention strategies are very important.¹

Prevention includes 3 different strategies:³

• Primary Prevention: preventing joint injury, for example during sports and exercise
• Secondary Prevention: slowing down or preventing the onset of symptomatic PTA after joint injury 
• Tertiary Prevention: reducing the progression of PTA and improving joint function, once it has developed 

The risk of developing PTA after significant joint trauma is as high as 75%.⁵ Therefore, prevention strategies are very important.

Causes and Risk Factors for Post-Traumatic Arthritis

To provide smooth joint movement, where two bone surfaces meet, they are covered by a thin layer of articular cartilage. Trauma can cause damage to the articular cartilage of the joint, resulting in weakened cartilage that is no longer able to withstand the stress of normal day-to-day activities, leading to PTA as the articular cartilage layer begins to break down.⁶

The joint trauma/injury can include any kind of acute physical trauma, such as a sports injury, vehicle accident or a fall, and can include intra-articular fractures, or meniscus, ligamentous or chondral injuries⁴

Joint trauma is the highest risk factor for PTA, as 13.9% of patients with a history of joint injury during adolescence developed knee arthritis, whereas 6% of those without a history of joint trauma.¹

Here is a list of common risk factors for PTA, however, it is important to remember that although these factors increase your risk of developing PTA, they don’t guarantee that you will develop PTA.³

Risk Factors for PTA³

• Joint trauma/injury 
• Sport and exercise participation 
• Re-injury 
• Early/premature return to sport following a joint injury 
• Obesity and being overweight 
• Physical inactivity 
• Muscle weakness 
• Altered neuromuscular control 
• Fear of movement 
• Poor diet 
• Insufficient/ill-timed exercise therapy 
• Joint dysplasia 

PTA can develop at any age, although it affects younger adults more than other forms of osteoarthritis.¹ Also, the risk of a joint injury leading to PTA increases with age at the time of injury.

The most commonly affected joints by PTA are the knee and ankle, although it can also develop in your hip, fingers, wrists, shoulder etc. 

Although sports and exercise have many benefits for your overall health, they are the leading cause of lower extremity musculoskeletal injury.³ 40% of all injuries that require medical attention are due to sports and recreational activities.. If you have suffered a sports/exercise-related joint injury, you are a perfect patient to be targeted with strategies aimed at PTA prevention. 

Importance of Prevention 

Preventing the onset/progression of PTA is very important as arthritis can significantly impact patients’ quality of life, and ability to participate in activities they enjoy, and can lead to significant pain and mobility disability.

Prevention can lead to:

• Reduced Pain and Discomfort 
• Preservation of Joint Function 
• Prevention of Disability
• Avoidance of Secondary Complications 
• Enhanced Quality of Life 

Prevention strategies can include preventing joint trauma,  injury management, rehabilitation and lifestyle modifications. 

Lifestyle Modifications 

There are some lifestyle modifications, that help to reduce your risk of developing PTA at any stage, with or without a joint trauma or history of joint trauma.

• Maintaining a healthy weight: being overweight can put extra stress on your joints, and makes you more likely to have inflammation in your body, increasing your risk of developing PTA⁷
• Healthy diet and nutrition: healthy low-fat, low-sugar, balanced diets, as well as plenty of fresh fruit and vegetables, help to maintain your joint health⁷ 
• Staying hydrated: water is important for lubrication of your joints! Synovial fluid between your joints provides shock absorption, lubrication and cushioning for your joints, and water makes up a large proportion of this synovial fluid, meaning hydration is very important⁸ 
• Exercise: exercise is beneficial at any stage, without injury, post-injury, or even with the onset of PTA symptoms. Exercise helps your muscles to become stronger, providing better support for your joints, and making them more supple. Additionally, exercise leads to the release of endorphins, which are natural painkillers and help you to feel good, and it helps you to get a good sleep which can help the body to repair itself⁷ 

Preventing Joint Trauma

Although it isn’t possible to completely reduce your risk of injuring yourself, making sure to always warm up properly, and ensuring you know the correct form for sports and exercise can help to prevent your risk of injury. 

Preventing PTA Following Joint Trauma 

Seek medical treatment straight after injury. Healthcare providers can implement strategies to reduce inflammation, stabilize the joint and promote healing.²

It is important to stick to any exercises that a physiotherapist or other healthcare provider gives you, as these will help you maintain the health of your joints. 

Initiating treatment early gives you a better chance of being able to restore your joint function, improving your quality of life and ability to perform daily activities, and decreasing your risk of developing PTA.

Make sure you meet your return to sport criteria after injuring yourself, and don’t go back to sports/exercise any earlier than recommended by a physiotherapist or healthcare provider. Premature return to sport can increase your risk of re-injury, which greatly increases your risk of developing subsequent symptomatic PTA.

Delaying treatment can lead to further complications from your injury, including joint deformities, instability and secondary injuries.²

Prevention of PTA Progression After Symptom Onset 

Although exercise may feel uncomfortable, or painful, maintaining a moderate exercise routine even with PTA symptoms can be very beneficial. Low-impact exercise, such as swimming, cycling, brisk walking or yoga is best. You can try different activities to see which works best for you or ask for advice from a physiotherapist on what would work best for your specific pain and joints affected.⁷

The best way to exercise with PTA is to start very gently and gradually progress towards strengthening. 

Medical Interventions and Therapies for PTA

It is important to visit your GP or another healthcare professional, to help you manage your pain and any other symptoms associated with PTA. This is a list of some interventions that they may suggest:

• Wearing a brace: wearing a brace around a joint can help to support it, reducing tension and holding it in place
• Activity modifications: modifying daily activities to reduce the strain they put on your painful joints, such as kitchen tasks, can help you to feel more independent. An occupational therapist may be able to help you create personalised modifications for your life^2,7 
• Physiotherapy: a physical therapist can create personalised exercises and movements, which can help increase strength and flexibility around your joint⁷
• Medications for pain management and inflammation: oral medicines such as nonsteroidal anti-inflammatory drugs (including ibuprofen, naproxen or celecoxib) 
• Injections: such as hyaluronic acid injections 
• Surgery: when conservative treatment approaches are not working to improve your pain levels and quality of life, the doctor may suggest a surgical approach. This can include removing the damaged tissues in your joint (debridement), joint fusion (arthrodesis) or a full joint replacement. If you have tried alternative conservative treatment approaches, and they are not helping, it is important to discuss these options with your doctor

Some of these may work very well for you, and some may not. It’s important to try a few, see what works for you, and discuss with a healthcare professional to develop a personalised treatment plan for your symptoms. 

Psychological Support and Mental Well-Being 

Being in pain, particularly chronic pain, can often lead to anxiety and depression. A joint injury that prevents you from being able to participate in activities that you enjoy, or suffering from symptomatic PTA can impact your quality of life and mental well-being hugely. 

Talking to a partner, relative or friend about how you’re feeling can help you to feel supported and understood. Additionally, cognitive behavioural therapy or mindfulness can also help.⁷

If you are struggling with low mood or anxiety, it is important to see your GP, as they will be able to help you find some strategies to start feeling better. 

Summary 

Early intervention following joint injury, or on-set of symptomatic joint pain is very important to preserve joint function, manage pain levels and reduce the risk of onset or progression of PTA. If you experience joint trauma or are experiencing joint pain, it is very important to seek medical treatment as soon as you can and stick to any treatment plans that a physiotherapist or GP may give you.