OS says I have 'post traumatic osteoarthritis' in TPF knee

[Douglas_Firs]

I had an x-ray last week. Radiologist reported 'mild narrowing of joint space.' My new OS said the x-ray shows I have 'unilateral post-traumatic osteoarthritis'.

I'm still a bit confused as to what 'having arthritis' means exactly. If any degree of cartilage damage is arthritis, it seems a lot of people with TPF/knee surgery have arthritis by definition. Is that what he means? Is 'osteoarthritis' simply a word for cartilage degeneration due to age, injury, wear-and-tear, etc? Or is it a disease entity itself that attacks the cartilage? You sometimes hear people refer to surgeons 'seeing a little arthritis in my knee during surgery and removing it.' Not sure what that means.

Now I am confused about the distinction between arthrofibrotic knee stiffness and arthritic knee stiffness. Am I blaming fibrosis for morning stiffness when it is in fact arthritis? If I only have mild narrowing, would I even be symptomatic at this point?

Doctor explained none of this, just called out over his shoulder as he looked at x-ray, 'by the way, you've got some arthritis.' I fear he has put me in the bin of 'arthritis sufferers' and that is why he pushed the Depo Medrol shot on me. He now sees me as algorithmically: Arthritis --> Cortisone shots --> TKR.

[The_KNEEguru]

Arthrofibrosis and Osteoarthritis are very different entities.

Arthrofibrosis is a condition that may follow an injury or surgery, particularly if there has been blood or synovial fluid in the joint. This can set off an inflammatory reaction, the fluids in the joint can become sticky and form adhesions, gumming the soft tissue folds of the joint lining together. At first the adhesions can be broken with appropriate exercise, massage and manipulation but later they may mature into scar tissue strands and then the situation is more serious. None of this process is visible on X-ray. See /KNEEnotes/knee-dictionary/arthrofibrosis

Osteoarthritis is a generally slower condition where the articular cartilage and underlying bone are stressed for some reason, and a process is triggered where the bone structure can break down and then try to repair itself, leading to bone cysts and bone spurs which can be seen on X-ray, together with breakdown of the articular cartilage which initially softens (chondromalacia), then splits into fibrils (fissures and fibrillation) and pieces can break off (loose bodies) - the final result being thinning of the depth of the cartilage which can be surmised on X-ray only as joint space narrowing. See /KNEEnotes/knee-dictionary/osteoarthritis

In arthrofibrosis the pain comes at the extremes of range of motion, where the capsular folds are being tugged, with excruciating pain.
In osteoarthritis the pain is more of a slower gnawing nature, especially at night while trying to sleep and the joint feel swollen and warm.

[The_KNEEguru]

Am I blaming fibrosis for morning stiffness when it is in fact arthritis? If I only have mild narrowing, would I even be symptomatic at this point?

In OA there is a wide disparity between the severity of the osteoarthritis indicators one can see on X-ray and the amount of pain and stiffness a patient may be experiencing. However stiffness that is worse in the morning and a gnawing discomfort particularly at night are commonly described in OA.

[Douglas_Firs]

Thanks KneeGURU,

It's quite confusing. Apparently, there are 2 forms of osteoarthritis: primary OA (no direct cause) and secondary OA (caused by injury, overuse). Everyone with a serious TPF suffers some degree of cartilage damage, which is by definition post-traumatic secondary osteoarthritis . But it's unclear to me whether all initial cartilage damage must inevitably set off the disease process of primary OA and lead to total degeneration. It seems possible that one's cartilage could be damaged by initial injury but then not degenerate significantly beyond that, at least not as a direct result of that initial insult. Or perhaps any damage to the cartilage sets the total OA breakdown process in motion. Another possibility is that primary OA could develop independently of secondary OA, as a result of aging, and so on. (I am 44 now. No family history of OA, though.)

My current stiffness, contracture, and any pain (not severe) seem like a continuation of what I experienced beginning 3 months after surgery in 2017, as I started trying to walk and regain ROM in PT. This stiffness has been present since that time to varying degrees. I had always assumed it was AF. I have no other telltale signs of symptomatic OA: no pain at rest, while sleeping, no 'gnawing' pain (knock on wood), and the stiffness has not changed in character or intensity really during this time.

The stiffness I have in the mornings and after sitting seems to be the same stiffness described by most AF contracture sufferers, whereby I need to stretch back into extension constantly, after sitting or getting out of bed and so on, to get my extension back.

OTOH, the Medrol shot has had an effect on the stiffness, at least temporarily. It has reduced it significantly. When I get out of the car after a 30 minute drive, my leg is not stiff, I no longer need to stand beside my car in the parking lot doing TKE lockouts for 2 minutes, straightening my leg before walking into the store. The overall ROM hasn't increased, but functionally it has, because I'm able to access my maximum functional end-point of my ROM without stiffness. So maybe that does in fact point to OA.

I don't now. I need to consider it more. But I am determined to come up with some kind of solution to my stiffness/limp problem.

Thank you so much for the info.

[The_KNEEguru]

You certainly are soaking up information!

Primary may be just what is says (no obvious trigger) but I suspect that a lot of 'primary' OA results from bangs and scrapes as a youngster, not only to the knees but also to the ankles causing alignment issues... Also possible knock-knees and bow legs as a child... Tight or inappropriate footware issues when young... Heeled shoes when older...

In other words I wonder if some of the 'primary' cases are more a case of cumulative insults over the years? Just my take...