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Does intraarticular inflammation predict biomechanical cartilage properties?
Wenzel Waldstein1, Giorgio Perino, Shari T Jawetz
1Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Clinical Orthopaedics and Related Research
|March 26, 2014
Summary
Elevated synovial fluid white blood cell counts in knees may indicate poorer lateral compartment cartilage quality, potentially impacting medial unicompartmental knee arthroplasty success. Further research is needed to confirm these findings.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Rheumatology
Background:
- Medial unicompartmental knee arthroplasty (UKA) requires intact lateral compartment cartilage.
- Cartilage degeneration in the lateral compartment is a known failure mode for medial UKA.
- Factors influencing lateral compartment cartilage mechanical properties are not well understood.
Purpose of the Study:
- To determine if synovial fluid white blood cell (WBC) count predicts biomechanical properties of macroscopically intact lateral femoral cartilage.
- To investigate the correlation between MRI-graded synovitis and cartilage biomechanical properties.
- To examine the relationship between synovial histopathology and cartilage biomechanical properties.
Main Methods:
- Prospective study of 84 patients (100 knees) undergoing total knee arthroplasty (TKA) for varus osteoarthritis.
- Preoperative MRI for synovitis grading, synovial fluid WBC count, and synovial tissue histology.
- Macroscopic cartilage assessment (Outerbridge grade) and biomechanical/histologic analysis of osteochondral plugs from macroscopically intact cartilage (Outerbridge grade 0 or 1).
Main Results:
- Knees with synovial fluid WBC count ≤150 cells/mL demonstrated significantly greater aggregate and dynamic modulus compared to those with >150 cells/mL.
- No significant correlation was found between MRI synovitis grades and biomechanical cartilage properties.
- No significant correlation was found between synovial histopathology grades and biomechanical cartilage properties.
Conclusions:
- Elevated synovial fluid WBC counts are associated with reduced compressive load-bearing capacity in lateral compartment cartilage.
- Synovial inflammation, indicated by WBC count, may negatively affect the mechanical integrity of otherwise macroscopically normal cartilage.
- These findings suggest a potential link between systemic inflammation and cartilage health relevant to knee arthroplasty outcomes.
