Risk of Posttraumatic Arthritis by Joint Involved

  Risk of Posttraumatic Arthritis by Joint Involved
                           

                                  Dr KS Dhillon

Introduction

Post-traumatic OA represents about 12% of the global OA burden [1]. The risk of OA following significant joint trauma has been reported to range from 20% to 74% [2]. Demographics of lower limb arthritis of the hip, knee, and ankle in patients presenting to a tertiary orthopaedic centre showed that 54% of ankle arthritis, 12.5% of knee arthritis, and 8% of hip arthritis are post-traumatic in origin [3]. However, this will not reflect true prevalence in the population because many patients with post-traumatic OA may not go to the hospital for treatment. About 16% of patients with uncomplicated hip dislocation can develop OA and the figure can rise to 88% in some patients having a dislocation with severe complicated acetabular fractures [4]. The average time to clinically apparent OA in young adults with a history of joint injury was 22 years in a cohort of medical students [5]. However, in severe joint trauma arthritis may be evident within a year. The risk of OA varies with the type of fracture and the joint involved. 

Type of fracture and Joint involved and the Risk of Posttraumatic Arthritis

1.Tibial plafond fractures

Tibial plafond fractures have the highest incidence of post-traumatic OA. The incidence of post-traumatic OA following tibial plafond fractures is high on long-term follow-up. Marsh et al [6] in a study of 56 plafond fractures in 52 patients were able to follow-up 31 patients with 35 fractures between 5 and 12 years after the injury. They found the incidence of joint space narrowing (grade II OA) in 57% and severe OA (grade 3 OA) in 17% of the ankles. Although 74% of the ankles had significant OA, the presence of OA did not correlate with the clinical outcome.

2.Tibial plateau Fractures

The incidence of OA following tibial plateau fractures vary between 26% to 40%. Weigel and Marsh [7] found a 40% incidence of posttraumatic OA at the second 5 years follow up after a tibial plateau fracture.

Rademakers et al [8] found a 31% incidence of OA after tibial plateau fracture at a mean follow up of 14 years.

Manidakis et al [9] found a 26.4% incidence of OA at a mean of 20 months follow up after a tibial plateau fracture.

3.Distal radius Fractures

The incidence of OA can be as high as 65% following distal radius fractures. Knirk et al [10] found that 65% of young adults with intra-articular distal radius fracture develop OA at mean follow up at 6.7 years. 

Lameijer et al [11]  carried out a systematic review to assess the prevalence of radiological posttraumatic arthritis following distal radius fractures in non-osteoporotic patients. They found that 50% of non-osteoporotic patients developed OA of the wrist after distal radius fractures. 

4.Distal femur Fractures

Thirty-three to 36% of the patients with distal femur fractures develop OA of the knee. Rademakers et al [12] found moderate to severe OA of the knee in patients with surgically treated intra-articular fractures of the distal femur at 5 to 25 years follow up.

Egund and Kolmert [13] found that 5.8% of their patients with distal femur fractures developed arthrosis in the femoro-tibial (grade I or II) and 27% developed OA of the patellar area.

5.Distal humerus Fractures

The incidence of OA of the elbow after intra-articular fractures of the distal humerus can be between 44% to 80%. Majority of the patients the OA is mild to moderate (74%) [14].

6.Acetabulum Fractures

The incidence of OA after acetabular fractures varies between 17.5% to 38%. A study by Gänsslen et al [15] found that 17.5% of patients with acetabular fracture developed OA of the hip. 

Briffa et al [16] found a much higher incidence of OA after acetabular fracture. In their study, 38% of the patients developed OA after acetabular fractures.

Others have reported a 26.6% and a 36.8% incidence of OA after acetabular fracture [17].

7.Talus fractures

The risk of OA following talus fractures is high and the incidence of OA can range from 48% to 65%. Vallier et al [18] in a level IV study reported 65% incidence of tibiotalar OA in 26 talar body fractures at minimal follow up of 1 year. 

Sneppen et al [19] in a review of 51 patients with fractures of the body of the talus found a 50% incidence of OA of the ankle at a long term follow up.

Pajenda et al [20] reviewed the clinical outcome of 50 patients with talar neck fractures. They found mild ankle OA in 28% of their patients and severe OA was seen in 20% of the patients.

The incidence of subtalar OA varies between 8% to 61% after talus fractures. Pajenda et al [20] reported an 8% incidence of subtalar OA after talar neck fractures. 

Vallier et al [21] in a level IV study reported a 34% incidence of subtalar OA, in 26 talar body fractures at minimal follow up of 1 year.

Frawley et al [22] studied the long-term outcome of treatment of major talus fractures and they found a 61% incidence of subtalar OA in the 26 patients they studied.

8.Scaphoid fractures

The incidence of OA can be as low as 5% in patients who have scaphoid fractures that have healed normally [23] and as high as 100% in patients with symptomatic non-unions of the scaphoid fracture [24].

The incidence of OA is 53.8% in patients with malunion of the scaphoid fracture [25].

9.Ankle fractures

The incidence of OA after ankle fractures is low. It can range from 0% [26] to 14% [27].

10.Calcaneal fractures

The incidence of OA after calcaneal fractures is about 15% [28].

11.Hip fracture-Dislocation

The incidence of OA after fracture-dislocations of the hip is about 39% [29].

References

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