The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Knee

Post-Traumatic Knee Arthritis

Post-traumatic knee arthritis develops after a significant injury to the knee — a fracture involving the joint surface, a torn ACL or PCL, or severe meniscal damage — that permanently alters the mechanics and biology of cartilage health. Unlike primary osteoarthritis, which typically affects patients in their 60s and 70s, post-traumatic arthritis often strikes patients in their 30s, 40s, and 50s, creating unique challenges for both patients and surgeons. Maryland Orthopedic Specialists' Adult Reconstruction team offers comprehensive evaluation and treatment — from non-operative management to knee arthroplasty — for patients with post-traumatic knee arthritis.

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What is post-traumatic knee arthritis?

Knee cartilage can be damaged by three injury mechanisms: - Articular fractures: Tibial plateau fractures, distal femur fractures, and patella fractures involving the joint surface disrupt cartilage directly, create step-off deformities, and initiate an inflammatory cascade that accelerates chondral breakdown over years.

Knee cartilage can be damaged by three injury mechanisms:

  • Articular fractures: Tibial plateau fractures, distal femur fractures, and patella fractures involving the joint surface disrupt cartilage directly, create step-off deformities, and initiate an inflammatory cascade that accelerates chondral breakdown over years.
  • Ligament injuries: ACL and PCL tears alter joint kinematics. Abnormal motion causes repetitive cartilage microtrauma, leading to arthritis faster than in ACL-intact knees — even after surgical reconstruction.
  • Meniscal injury and loss: The menisci act as shock absorbers, distributing load across the tibial plateau. After total or subtotal meniscectomy, contact pressures on the articular cartilage increase dramatically, causing accelerated medial or lateral compartment arthrosis.

The severity and rate of arthritic progression depend on the injury type, quality of initial treatment, residual malalignment, and patient activity levels.

Treatment options

Many patients with post-traumatic knee arthritis are younger and more active than typical knee OA patients — non-surgical management is always tried first, with surgical options tailored to age, alignment, and degree of involvement.

Non-Surgical Management

Non-surgical management is pursued first and includes activity modification and low-impact exercise such as swimming and cycling, NSAIDs and acetaminophen for pain control, physical therapy for quadriceps and hip strengthening, an unloader knee brace for compartmental offloading, and intra-articular corticosteroid or hyaluronic acid injections. PRP is an option for mild-to-moderate disease in carefully selected patients.

Surgical Procedure

Total Knee Replacement

Complete resurfacing of the knee joint — femur, tibia, and patella — with metal and polyethylene implants to eliminate arthritis pain and restore mechanical alignment. Performed at a hospital facility with full inpatient support services.

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Frequently Asked Questions

Is knee replacement appropriate for younger patients?
Yes. Age is not an absolute contraindication. For patients in their 40s–50s with truly end-stage arthritis unresponsive to conservative care, arthroplasty significantly improves quality of life. Younger patients should be counseled about implant longevity and potential future revision.
Does my prior hardware need to come out before knee replacement?
It depends. Hardware that conflicts with implant placement must be removed. Some surgeons stage hardware removal and arthroplasty separately; others combine them in one procedure. This is determined case-by-case.
What non-surgical options are available for post-traumatic knee arthritis?
Non-surgical management includes activity modification, weight loss, physical therapy to strengthen the muscles around the knee, anti-inflammatory medications, bracing, and intra-articular injections (corticosteroids or hyaluronic acid). Bracing designed to offload a specific compartment of the knee can be particularly useful when arthritis is localized. These measures can provide meaningful pain relief and delay the need for surgery for months to years. Your MOS team will develop a personalized non-operative plan tailored to your activity level and the distribution of arthritis in your knee.
How soon after a knee injury can arthritis develop?
The timing varies widely depending on the nature of the original injury. Significant cartilage damage at the time of the injury can accelerate arthritic changes that become symptomatic within five to ten years. Meniscus tears and ACL injuries — especially when associated with cartilage damage — are among the most common precursors to post-traumatic knee arthritis. Even injuries treated promptly and appropriately can eventually lead to arthritis, though timely treatment reduces the rate and severity of progression.
Will a knee replacement fix the deformity from my old fracture?
Knee replacement for post-traumatic arthritis can correct most angular deformities (bow-leg or knock-knee alignment) that have developed as a result of the injury or malunion. However, significant bony deformity may require additional steps such as corrective osteotomy performed at the same time as or before replacement. At MOS we use pre-operative X-rays and advanced templating to plan the safest approach to achieving proper alignment, which is critical for the long-term success and durability of your knee replacement.

Meet the specialists

Christopher S. Raffo, MD

Christopher S. Raffo, MD

Orthopedic Surgery · Sports Medicine

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James S. Gardiner, MD

James S. Gardiner, MD

Orthopedic Surgery · Sports Medicine

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Brian McCormick, MD

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Related conditions

ACL TearTotal Knee Replacement
Medically reviewed by Christopher S. Raffo, MD
Last reviewed May 1, 2026

References

  1. Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma. 2006;20(10):739–744. https://doi.org/10.1097/01.bot.0000246468.80any9.1a
  2. Saltzman CL, Marsh JL, Tearse DS. Treatment of displaced talus fractures: an arthroscopic approach. Clin Orthop Relat Res. 1994;299:258–267. https://doi.org/10.1097/00003086-199402000-00037
  3. Wasserstein D, Henry P, Paterson JM, Kreder HJ, Jenkinson R. Risk of total knee arthroplasty after operatively treated tibial plateau fracture. J Bone Joint Surg Am. 2014;96(2):144–150. https://doi.org/10.2106/JBJS.L.01691
  4. Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What I tell my patients about unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2016;98(8):e30. https://doi.org/10.2106/JBJS.15.01044
  5. American Academy of Orthopaedic Surgeons. Knee Arthritis. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/