ConditionBones, joints & muscles
Post-Traumatic Arthritis
Post-traumatic arthritis is a form of osteoarthritis that develops in a joint after an injury, such as a fracture into the joint, a dislocation, a ligament tear or a meniscus tear. The injury damages cartilage or changes how the joint moves, so it wears out faster. It accounts for about 1 in 8 cases of osteoarthritis and often affects younger, active people, most commonly in the ankle, knee, hip, wrist and shoulder. Symptoms can appear months or many years after the injury.
Also called: Post-traumatic osteoarthritis, PTOA, secondary osteoarthritis after injury
At a glance
- What it is
- Osteoarthritis triggered by a previous joint injury.
- Common causes
- Fractures into the joint, ACL and meniscus tears, dislocations, repeated ankle sprains.
- Common joints
- Ankle (most cases of ankle arthritis), knee, hip, wrist, shoulder and elbow.
- Timing
- Can appear within a few years or decades after the injury.
- Symptoms
- Pain with activity, swelling, stiffness, reduced movement, grinding.
- Treatment
- Exercise, weight management, bracing, pain relief, injections, and joint surgery for severe cases.
When to get help
See a doctor within a day or two
- A hot, red, very swollen joint, especially with fever or after a joint injection or surgery (possible infection)
- A joint that locks and cannot be straightened
- A joint that repeatedly gives way, causing falls
Book a routine appointment
- Joint pain, swelling or stiffness in a joint that was injured months or years ago
- Pain that limits walking, stairs, work or sleep
- Increasing deformity, such as bowing of the knee
Usually safe to manage at home
- Mild activity-related aching in a previously injured joint that settles with rest, exercise and over-the-counter pain relief
How injury leads to arthritis
Joint injuries can lead to arthritis through several routes:
- Direct cartilage damage at the time of injury, which has limited capacity to heal
- Uneven joint surfaces after a fracture heals with a step or gap
- Instability from torn ligaments, which allows abnormal sliding and grinding
- Loss of shock absorption after meniscus damage or removal
- Malalignment that overloads one part of the joint
- Inflammation in the joint after injury, which accelerates cartilage breakdown
Injuries that commonly lead to arthritis
| Injury | Risk |
|---|---|
| ACL tear | About half develop knee osteoarthritis within 10 to 20 years, even with reconstruction |
| Meniscus tear or removal | Higher risk, especially when much meniscus is removed |
| Ankle fracture | Post-traumatic arthritis causes most ankle arthritis |
| Tibial plateau and other intra-articular knee fractures | High risk, depending on the quality of joint surface repair |
| Hip fractures and dislocations | Risk of arthritis and avascular necrosis |
| Wrist fractures and scaphoid injuries | Can cause wrist arthritis |
| Shoulder dislocations | Recurrent dislocation increases risk |
| Osteochondritis dissecans | Can lead to arthritis if the joint surface is damaged |
Symptoms
Symptoms are like those of osteoarthritis:
- Pain in the injured joint, especially with weight-bearing or activity
- Swelling and fluid in the joint
- Stiffness after rest
- Reduced range of motion
- Grinding, clicking or catching
- Instability or giving way
- Weather-related aching
- Deformity in advanced cases
Diagnosis
A doctor will ask about the original injury and its treatment and examine the joint. Tests may include:
- X-rays, often with weight-bearing views, showing joint space narrowing, bone spurs and alignment
- MRI to assess cartilage, ligaments, meniscus and bone
- CT to evaluate joint surfaces after fractures
- Joint fluid analysis if gout, infection or inflammatory arthritis such as rheumatoid arthritis are possible
Treatment
Non-surgical treatment
- Exercise and physical therapy: strengthening muscles around the joint, range-of-motion exercises and low-impact activity
- Weight management to reduce load on lower limb joints
- Activity modification: swapping high-impact sports for swimming, cycling or rowing
- Pain relief: topical NSAIDs, oral NSAIDs or acetaminophen (paracetamol) at label doses. Avoid long-term NSAIDs with stomach, kidney or heart problems
- Bracing: unloader knee braces, ankle-foot orthoses, or supportive footwear with rocker soles for ankle arthritis
- Walking aids such as a cane
- Corticosteroid injections for flares
Surgery
- Arthroscopy to remove loose bodies or fix mechanical locking (not for general arthritis "clean-out")
- Osteotomy: realigning bone to shift load to a healthier part of the joint, especially in younger people
- Ligament reconstruction for instability
- Joint fusion (arthrodesis): for the ankle, wrist or small joints, relieving pain by eliminating movement
- Joint replacement (arthroplasty): for severe knee, hip, shoulder and sometimes ankle arthritis
Joint replacements in younger patients may need revision later in life, so timing is discussed carefully.
Prevention
- Get joint injuries properly assessed and treated, including accurate repair of joint fractures
- Complete rehabilitation after ligament injuries before returning to sport
- Use injury prevention programs in sports, such as neuromuscular training for ACL injuries
- Maintain a healthy weight and muscle strength
- Avoid repeated injuries to the same joint
Frequently asked questions
What is post-traumatic arthritis?
It is osteoarthritis that develops in a joint after an injury such as a fracture, dislocation or ligament or meniscus tear. The injury damages cartilage or alters joint mechanics, causing the joint to wear out faster than normal.
How long after an injury does post-traumatic arthritis develop?
It varies. Some people develop symptoms within 1 to 2 years, especially after severe joint fractures. Others develop arthritis 10 to 20 years after injuries such as ACL tears. Early signs include persistent pain, swelling and stiffness.
Can post-traumatic arthritis be prevented?
The risk can be reduced, but not eliminated, by accurate treatment of joint fractures, good rehabilitation after ligament injuries, maintaining strength and a healthy weight, and avoiding repeated injuries.
How is post-traumatic arthritis treated?
Treatment starts with exercise, physical therapy, weight management, bracing and pain relief. Injections help flares. Severe cases may need surgery such as osteotomy, joint fusion or joint replacement.
Is post-traumatic arthritis different from osteoarthritis?
It is a type of osteoarthritis with a clear cause: a previous joint injury. It tends to affect younger people and joints like the ankle that rarely develop ordinary osteoarthritis. Treatment is similar.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Post-traumatic arthritis
- Arthritis Foundation: Post-traumatic arthritis
- American College of Rheumatology/Arthritis Foundation: Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
- Osteoarthritis Research Society International (OARSI): Guidelines for non-surgical management of knee, hip and polyarticular osteoarthritis
- CDC: Osteoarthritis