I have a patient 55 years old who is a veteran of the Vietnam war. He had retained shrapnel around knee and hip. He had experienced hip pain for years and around 4 years ago the pain became so bad that he presented to my office. He was managed with NSAIDS until 2 years ago when he had an MRI and was found to have avascular necrosis of hip and had hip replacement. MRI of the knee showed OA. In your opinion do you feel that the injuries sustained and retained shrapnel could have or highly likely contributed to his development of the OA? I would appreciate your opinion regarding this issue and if you could cite any specific study that may have looked at this.
I am not aware of any study that directly addresses your patient’s particular situation. There is a strong association of joint trauma and subsequent development of OA– Dr. Allan Gelber in our Division has looked at this.