Post-traumatic arthritis: when a joint injury leads to osteoarthritis

Post-traumatic arthritis is the term doctors use for arthritis, usually osteoarthritis, that develops in a joint that has been injured. The injury might be a fracture that extended into the joint, a torn ligament or meniscus, a dislocation or repeated sprains. The NHS describes osteoarthritis as a condition in which the protective cartilage on the ends of bones breaks down, causing pain, swelling and problems moving the joint, and sometimes bony growths.

The NHS and Arthritis UK, the UK arthritis charity formerly known as Versus Arthritis, do not, in the pages read for this guide, use the label as a separate diagnosis. They describe joint injury as one of the risk factors for osteoarthritis. The advice on symptoms and treatment is therefore the same as for osteoarthritis, and this guide is based on those pages.

The NHS says almost any joint can be affected, but osteoarthritis most often causes problems in the knees, hips and small joints of the hands. After an injury, it is the joint that was hurt that is at risk, whether that is an ankle, knee, wrist or elbow.

Arthritis UK explains that osteoarthritis occurs when a joint can no longer repair itself as well as it once could, leading to changes within the joint that can be painful: the smooth cartilage becomes thinner and rougher, bony growths form and the tissues around the joint stretch so the joint is less stable. It lists, among the factors that make osteoarthritis more likely, a joint shape that is slightly unusual, which can affect the way the joint moves, and having damaged a joint in the past that did not heal properly.

The NHS says that in everyday life joints are exposed to a constant low level of damage which the body usually repairs, but that overusing a joint when it has not had enough time to heal after an injury or operation increases the risk. It also lists age, family history, obesity and being a woman as risk factors, so an injury is one of several contributors rather than a certainty.

An injury that leaves a joint misaligned or its surface damaged fits that pattern. The pages read for this guide do not give a timescale, so how long symptoms take to appear cannot be stated reliably; it can be years.

The NHS says the main symptoms of osteoarthritis are joint pain and stiffness and problems moving the joint, with swelling, tenderness and a grating or crackling sound in some people. Severity varies greatly from person to person and between joints, and symptoms can be mild and come and go, or more continuous and limiting.

Arthritis UK adds that the joint may not move as freely or as far as it used to, may give way because the muscles have weakened or the joint has become less stable, and that most people find their symptoms vary from day to day. It recommends speaking to a GP, physiotherapist or advanced practice nurse if you have joint pain, stiffness or swelling that is interfering with your daily routine, is not caused by anything obvious you have done, or is combined with other symptoms such as feeling unwell.

The NHS says a GP will ask about your symptoms and examine your joints, and may suspect osteoarthritis if you are 45 or older, have joint pain that gets worse the more you use the joint, and have morning stiffness that is not there or lasts less than 30 minutes. It says further tests such as X-rays or blood tests are not usually necessary but may be used to rule out other causes such as rheumatoid arthritis or a fractured bone.

Arthritis UK says a GP is likely to be able to diagnose osteoarthritis from your symptoms, medical history and examination, and that you will not normally need further tests or a specialist referral unless there is some doubt about the cause. After a past injury, your account of what happened and how it was treated is a key part of the history, and an X-ray may be used to look at the joint.

Prolonged morning stiffness can instead be a sign of rheumatoid arthritis, according to the NHS, which is why a different pattern of symptoms should be mentioned to the GP.

The NHS says osteoarthritis is long term and cannot be cured, but that it does not necessarily get worse and there are treatments to reduce the symptoms. For mild symptoms it suggests regular exercise, losing weight if you are overweight, suitable footwear and using devices that reduce the strain on joints during everyday activities. For more severe symptoms, painkillers and a structured exercise plan with a physiotherapist may be added.

Arthritis UK describes keeping active as protective: too much rest can increase stiffness and weaken the muscles that support a joint, while exercise strengthens them. It suggests pacing yourself, using hot or cold packs, a TENS machine, and splints, braces, supportive footwear, a stick or orthotics where useful, and notes that an occupational therapist can advise on adapting your home or workplace. It lists topical NSAIDs, capsaicin cream, paracetamol (which it says is not that effective but can help some people before exercise) and co-codamol (which it does not recommend for long-term use), and says steroid injections may be offered for pain that is very bad or suddenly becomes severe.

The NHS says that in a small number of cases, where treatments have not helped or the damage to the joint is particularly severe, surgery may be done to repair, strengthen or replace a damaged joint. Waiting times for NHS orthopaedic care vary across the UK and some people choose private treatment for faster assessment; the clinical options are the same.

Because the NHS says osteoarthritis is long term, support to cope with reduced mobility and advice on financial help where needed is part of care. Arthritis UK stresses self-management: pacing activity, adapting rather than abandoning things that matter, and being open with your healthcare team about problems.

To reduce the risk of osteoarthritis after injury, the NHS advises avoiding further injury and living a healthy lifestyle, including at least 150 minutes of moderate aerobic activity a week plus strength exercises on 2 or more days. It also suggests good posture, taking breaks if you work at a desk, and losing weight if you are overweight. It stresses that it is not possible to prevent osteoarthritis altogether.