This is arthritis that results from direct injury to the joint surfaces. The injury occurs to the cartilage and/or bone tissues of the joint, and the resulting damage leaves the joint surface uneven and roughened.
This can result from athletic injuries or falls. But more often these occur from higher-energy injuries such as automobile, ATV or motorcycle accidents.
The original treatment for the trauma will include putting the injured joint back together as perfectly as possible. Often a fracture into the joint is reduced back into position and the underlying fractures of bone are stabilized in place by screws, pins, plates and rods.
Unfortunately, in some cases the damage to the joint surfaces progresses to arthritic degeneration of the joint that becomes unacceptably painful and stiff.
Conservative treatment measures include modifying one’s activities and unloading the joint with cane, crutches or walker. Also, supplemental glucosamine, Tylenol, anti-inflammatories, pain medications may help. Physical therapy to regain motion and strength and coordination is often helpful. Weight loss in the overweight patient is important.
Injections of corticosteroid can be helpful, but can be used only 3-4 times per year. ‘Viscosupplementation’ injections with hyaluronate (Synvisc) may also help. If successful, these may work for 6 months or longer.
A compartment –unloading brace for the knee can relieve pain and delay progression of knee arthritis.
When all these measures are not working, then surgery may be recommended.
If the joint damage is in a very small, localized area, possible options include:
- A localized transplant of bone and cartilage
- A micro-fracture technique to encourage ‘scar-cartilage’ to grow
In most cases the joint damage involves larger areas and some form of realignment or resurfacing in recommended:
- Realignment osteotomy of the knee
- Partial replacement of the joint such as a Uni-compartmental replacement of the knee
- Total joint replacement of the hip or knee