A: Post-traumatic osteoarthritis causes degenerative change in the surface of a joint resulting from acceleration of normal wear and tear. There are joints in your spine, just as there is in your knee.

Injury to a joint surface can damage the articular cartilage.* Injuries to a ligament can make the joint unstable. Significant damage to supporting muscles can lead to inadequate joint stability and premature wear and tear of the articular cartilage.

Medical specialists will determine the likelihood that you will develop post-traumatic arthritis based on such factors as:

• the mechanism and location of the injury,
• your particular complaints,
• signs on examination such as loss of movement and stiffness or fluid on the joint,
• x-ray results—these may not show up until a few years after the injury,
• bone scans—these may show inflammation in a joint after the usual healing would be expected to be complete, and
• arthroscopy** of the knee, shoulder, elbow or ankle.

Rheumatologists’ advantage in the legal system is that they are the specialists who see patients with post-traumatic arthritis many years after they have injured a joint. They do not perform arthroscopy but may refer a patient to an orthopaedic surgeon for this procedure if they think it would be of value.

Some orthopaedic surgeons are good experts on this issue, but an inordinate number tend to be on the optimistic side. Before you see an orthopaedic surgeon, check with an injury lawyer to find out if the surgeon has any biases.

Your specialist may recommend an expensive brace that may require relatively frequent replacement. This expense would become part of your cost of future care claim.

Treatment for post-traumatic arthritis is advancing. The specialist may provide an opinion on the likelihood that your condition will advance to the point where you may need a fusion of your injured joint or a total joint replacement (which lasts only ten to fifteen years). He or she may also provide an opinion on the likelihood that you will not be able to continue with your present job or other physically demanding jobs when you are 50, 55 and 60 years old.

You then may need the opinion of a vocational consultant on your ability to change occupations now or in the future and the effect this may have on your income. Your future financial loss may be greater if you do not have the ability to move to a less physically demanding job that pays as well as your present job.

You may also need the opinion of an economist on the present value of income you may lose ten and twenty years from now. Your future income loss is discounted by the courts—and, therefore, by ICBC—to present value. This is based on the assumption that you will be able to gain a return on your invested award that is higher than the rate of inflation, and that wages will increase faster than the rate of inflation.

In summary, experts in the field of rheumatology, vocational rehabilitation and economics may be able to help you prove your future damages caused by post-traumatic arthritis.

*Articular cartilage is a tough, elastic tissue that covers the ends of bones in joints and enables the bones to move smoothly over one another. When articular cartilage is damaged through injury, however, it does not heal as rapidly or as effectively as other tissues in the body. Instead, the damage tends to spread, allowing the bones to rub directly against each other, resulting in pain and reduced mobility.

**In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fibre optics to the end of the arthroscope that is inserted into the joint. By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery.