This series has previously addressed post-traumatic arthritis of the shoulder and iatrogenic chondrolysis of the shoulder, knee and hip after surgery.

As indicated earlier in the series, post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. In addition to the shoulder, which has already been addressed, post-traumatic arthritis in the knee, hip, wrist and ankle are common injuries encountered in the personal injury setting. According to statistics published by the Cleveland Clinic, post-traumatic knee, wrist, hip and ankle arthritis affect more than 6 million people per year in the United States. According to the American Academy of Osteopathic Surgeons, at least 10 to 15 percent of all traumatic joint injuries will result in post-traumatic arthritis.

Understanding how injuries can lead to arthritis is critical to litigating personal injury claims not only because of the pain and suffering caused by post-traumatic arthritis but also because the treatment required for post-traumatic arthritis can be expensive and lifelong and is many times the most significant component of a claim for money damages. For instance, treatment for osteoarthritis includes massage therapy, physical therapy, prescription medication, injection therapy, arthroscopic surgery (surgical debridement), arthrodesis (joint fusion) and even arthroplasty (joint replacement).

It is well accepted in medical literature that arthritis can develop within months after a traumatic injury or could take years to develop. It can develop either through improper healing of a fractured bone or a fracture that healed properly but just over a prolonged period of time, causing atrophy and loss of function.

It can also develop because of a ligament injury that allows the bone to shift abnormally, causing undue stress on the cartilage of the adjacent joint. And, of course, it can develop because of direct trauma to the cartilage. While most defense medical examiners will concede that post-traumatic arthritis can develop after a trauma, many will refuse to acknowledge either the presence or significance of the post-traumatic arthritis. In other words, they will assert the arthritis has developed coincidental to the trauma or it doesn't exist.

In terms of the diagnosis, post-traumatic arthritis is generally diagnosed through X-ray testing, CT testing, MRI testing and sometimes blood testing. However, when cross-examining a defense medical examiner on this subject, the plaintiff's attorney needs to be aware that the diagnostic testing that demonstrates the arthritis will usually not specify whether it is post-traumatic arthritis, osteoarthritis or rheumatoid arthritis. The characterization of the particular type of arthritis is a clinical characterization based on the history of the injury and past medical records.

It is important for the plaintiff's attorney to be aware of the literature that is directly on point for the subject. For instance, Joseph A. Buckwalter published an article titled "Joint Injury, Repair and Remodeling: Roles in Post-Traumatic Osteoarthritis" in 2004, which appeared in the journal of Clinical Orthopedics and Related Research. The journal article examines the relationship between joint injury and the factors that increase the risk of post-traumatic joint degeneration.

Buckwalter was also part of a group of doctors that published an article in 2006 titled "Post-traumatic Osteoarthritis: A First Estimate of Incidence, Prevalence, and Burden of Disease," which appeared in the Journal of Orthopedic Trauma. This article seems to be the source of most of the data concerning the prevalence of post-traumatic arthritis, as there were apparently no such studies performed prior to 2006.

In 2000, an article in the journal of the Annals of Internal Medicine titled "Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis" draws a direct connection between the trauma and the subsequent arthritis.

In 2001, Lisa Coester and three of her colleagues published an article titled "Long-Term Results following Ankle Arthrodesis for Post-traumatic Arthritis," which appeared in the Journal of Bone & Joint Surgery. The article explains how arthrodesis is considered to be the accepted standard of care for end-stage ankle arthritis and it follows individuals who have undergone the procedure to see how they generally function later in life.

While this series of articles focused on post-traumatic arthritis, another related condition that also develops as a trauma is arthrofibrosis, which is a complication of injury or trauma where an excessive scar tissue response leads to painful restriction of joint motion. Although this series doesn't address arthrofibrosis, it is another important consideration for all personal injury cases. •

Brandon Swartz is a founding partner of Swartz Culleton. His practice focuses on all types of personal injury cases, including wrongful death, medical malpractice, civil rights violations, motor vehicle, premises liability, products liability, trucking accidents and workers' compensation.