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Subchondral pressures and perfusion during weight bearing
Michael Beverly1, Barbara E Marks2, David W Murray2
1Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Headington, Oxford, OX3 7LD, UK. michael.beverly@btinternet.com.
Journal of Orthopaedic Surgery and Research
|July 1, 2020
Summary
Loading significantly increases subchondral intraosseous pressure (IOP) in joints, partly via hydraulic transmission. Repeat loading suggests a potential intraosseous one-way valve mechanism, offering new insights into joint physiology.
Area of Science:
- Biomechanics
- Orthopedics
- Physiology
Background:
- Joints experience substantial forces, yet subchondral bone pressure and perfusion dynamics during loading remain poorly understood.
- Investigating these factors is crucial for understanding joint health and disease.
Purpose of the Study:
- To develop an in vitro calf foot model to investigate intraosseous pressure (IOP) and subchondral perfusion during weight-bearing conditions.
- To elucidate the relationship between applied load, perfusion, and pressure within the subchondral bone.
Main Methods:
- Utilized freshly harvested calf forefeet, perfused with serum.
- Measured IOP at three distinct sites using intraosseous needles and pressure transducers.
- Applied static and dynamic loading, simulating walking, under various perfusion and tourniquet conditions.
Main Results:
- Subchondral IOP increased significantly with static loading, irrespective of perfusion status (p < 0.0001).
- IOP was directly proportional to applied load (R² = 0.984) and frequently exceeded perfusion pressure.
- Repetitive loading resulted in a decrease in IOP, suggesting a potential hydraulic valve mechanism.
Conclusions:
- Physiological loading and increased perfusion significantly elevate subchondral IOP, indicating force transmission through hydraulic pressure in subchondral bone.
- The observed decrease in IOP with repetitive loading points to a novel intraosseous one-way valve system.
- This study provides a new framework for understanding subchondral perfusion physiology and joint loading mechanics.
