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Work-related Traumatic Osteoarthritis

Arthritis may develop in a joint which has been injured at work.  This arthritis may be as a direct consequence of the injury or it may be unrelated or co-incidental to the work injury.  It is important to be able to identify those features which indicate whether or not osteoarthritis of a specific joint is a probable consequence of a previous injury.

Factors which indicate osteoarthritis is not traumatic:

  • The joint was not normal prior to the injury.
  • No evidence of an effusion or structural damage was present immediately or within a few days after the injury.
  • A similar process is present in non-traumatized joints.
  • The mechanism of injury was unlikely sufficient to cause internal joint trauma.

Factors which indicate osteoarthritis is primarily due to a work related trauma include:

  • A history of a significant work related injury in a previously normal joint.
  • The original injury involved a fracture, dislocation, hemarthrosis, meniscal or cartilage injury, ligament disruption, prolonged immobilization, or severe contusion.
  • The original injury led to malalignment of the limb, distortion of the joint surface, joint laxity, or complaints of continuous pain.
  • MRI evidence of subchondral contusion or arthroscopy finding of cartilage defects in the early stages of the injury.
  • The osteoarthritis is solely or predominantly in the previously work injured joint or limb.

Time from injury to development of osteoarthritis changes:

  • Usually 2 - 5 years pass from the time of the pre-disposing injury until osteoarthritis becomes evident. With significant injury to the joint, osteoarthritic-like changes may be seen in the joint cartilage immediately after the injury.

Some specific situations with known increased risk of osteoarthritis:

  • Post meniscectomy, hip dislocation, acetabular fractures.

References

Degenerative Joint Disease of the Lower Extremity.  Sam Moon, Wendy Powell, Ted Vail,  CME Session, University of Alberta, September 1998

McCarthy, Daniel J.:  Arthritis and Allied Conditions.  9th Edition, 1979, Lea and Febiger

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