POST-TRAUMATIC OSTEOARTHRITIS

Osteoarthritis begins with the breakdown of articular cartilage, which is the substance that caps the ends of our long bones at joints, imparting an irreplaceable shock-absorbing function. The numerous and interwoven arms of the complex molecules of proteoglycans and collagen that make up this cartilage are essential to its elasticity and compressibility. If these become broken due to genetic defects, chemicals, or repetitive or isolated trauma, the essential functions are diminished, leading to transmission of normal everyday wear and tear stresses to the stiff, non-compressible bone. The cartilage is not capable of healing itself so the process goes on until it is recognized and treated. An example would be a fracture through the mortise (true ankle joint) which involves the articular cartilage surface. This permanent irregularity causes constant unsustainable forces to be transmitted to the tibia, which tries to grow and heal, but ends up forming osteophytes (bone spurs), which together with the irregular, abraded, and now rapidly wearing cartilage, leads to end-stage osteoarthritis. Osteoarthritis can be present in early forms. The difficult part of any personal injury case in which arthritis is claimed to be the outcome of injury therefore depends on the documentation of the development of symptoms and signs which do not pre-date the event. These symptoms and signs should be described by the expert witness using both patient historical reports and medical evidence, and must be done in a way that can be easily understood by a lay jury using audio-visual aids and references in the medical literature to support the chain of events.