Arthritis is not always a result of ageing. While many people believe that joint problems develop only due to wear and tear over time, fractures and significant joint injuries can also trigger a slow, long-term degenerative process known as post-traumatic arthritis (PTA). This condition develops when an injury disrupts the smooth mechanics of a joint. Over time, the cartilage wears down, pain increases, and normal daily activities become limited.
Most Indian public health data focusses on primary osteoarthritis, as the overall burden of joint degeneration is rising rapidly. However, post-traumatic arthritis represents a clinically important subset of arthritis. The estimated number of Indians living with osteoarthritis has increased from 23.5 million in 1990 to over 62 million in 2019, nearly a threefold rise, with knee osteoarthritis being the most common form.
How does a fracture lead to arthritis?
Joints are designed for smooth movement between bones. This is made possible by cartilage, a firm, slippery tissue that cushions and protects joint surfaces. When a fracture involves a joint, the cartilage may be damaged. Even the slightest irregularity in the joint surface can change how forces are distributed. Over time, abnormal stress and altered joint mechanics accelerate cartilage breakdown, eventually leading to arthritis.
Factors that increase the risk of post-traumatic arthritis
Type of fracture: Intra-articular fractures (those extending into the joint) carry the highest risk.
Quality of treatment: If the fracture is not anatomically realigned and stabilised, it may heal with residual deformity, increasing joint stress.
Inflammation: Persistent inflammation after injury contributes to ongoing cartilage degeneration and pain.
Symptoms to watch for
Post-traumatic arthritis may develop months or years after the original injury. Warning signs include:
Recurrent joint pain during daily activities
Warmth and swelling around the joint
Stiffness, especially after rest
Reduced range of movement
A grating or clicking sensation in the joint
After injury, inflammation is part of the natural healing process. However, if the cartilage is damaged or joint alignment is imperfect, inflammation may persist. Over the years, joint spaces narrow, bone spurs form, and pain becomes chronic. This process is similar to primary osteoarthritis but has a clear history of trauma.
In India, post-traumatic arthritis accounts for approximately 10-12% of all symptomatic arthritis cases, indicating that a significant proportion of degenerative joint disease is related to previous fractures or ligament injuries.
The rising incidence of osteoarthritis in India is also linked to ageing, obesity, and occupational strain. These factors, when combined with earlier joint injuries, further increase the risk of developing post-traumatic arthritis.
Prevention and long-term care
Accurate fracture treatment: Precise anatomical reduction and stable fixation help minimise future joint degeneration.
Rehabilitation: Early and guided physiotherapy restores movement and normal joint mechanics.
Lifestyle measures: Maintaining a healthy weight, avoiding high-impact activities after injury, and using braces when advised.
Regular follow-up: Periodic evaluation by an orthopaedic surgeon helps detect early degenerative changes before irreversible damage occurs.
A fracture can indeed lead to arthritis later in life. Post-traumatic arthritis is an important and growing cause of joint disability in India. Awareness of this link and timely, appropriate care can help preserve joint function, mobility, and quality of life in the years ahead.
- by Dr Manoj Kumar, Associate Consultant, SIMS Hospital, Chennai.