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Early OA Following Synovial Joint Fracture

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Early Osteoarthritis

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Abstract

Excessive synovial joint loadings, acute single articular surface impacts and/or chronic repetitive aberrant contact stresses, cause joint degeneration leading to the clinical syndrome of osteoarthritis (OA). Intra-articular fractures (IAFs), joint injuries that fracture the articular surface and the underlying subchondral bone, are the injuries that most predictably lead to post-traumatic OA (PTOA). Both the acute injury and any residual joint incongruity and instability contribute to the risk of PTOA. Despite advances in IAF treatment, this risk has not decreased in the last 50 years. However, recent work shows that the potential to prevent or mitigate PTOA exists. Quantitative methods of determining IAF energy and cumulative chronic joint overloading due to residual joint incongruity predict the risk of PTOA. They define joint loading thresholds that cause PTOA in human joints making it possible to assess the efficacy of treatments intended to reduce PTOA risk. In vitro and in vivo investigations of joint biologic responses to excessive loads show that reactive oxygen species (ROS) produced by chondrocytes cause mitochondrial damage and dysfunction, chondrocyte death, matrix degradation, and articular cartilage erosion. Excessive ROS after injury also accelerates chondrocyte aging and senescence, thereby increasing the secretion of pro-inflammatory chemokines, cytokines, and matrix proteases that cause cartilage destruction. Small and large animal studies show that preventing ROS production or providing antioxidant support preserves chondrocytes and their matrix following IAFs and similar injuries. In addition to ROS, injured chondrocytes release alarmins that activate chondrocyte progenitor cells that proliferate and migrate to damaged cartilage, contributing to inflammation as well as cartilage healing. These advances in the understanding of how early pathologic responses after IAF cause PTOA provide the basis for new approaches to the prevention or mitigation of PTOA. Promising approaches include minimizing the deleterious effects of ROS, removal of senescent cells, and use of chondrocyte progenitor cells to restore articular cartilage.

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Author information

Authors and Affiliations

  1. Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA

    Don Anderson, James Martin, J. Lawrence Marsh, Jessica Goetz & Mitchell Coleman

  2. Iowa City Veterans Administration Medical Center, Iowa City, IA, USA

    J. Lawrence Marsh & Joseph Buckwalter

  3. Department of Orthopedics, Indiana University, Indianapolis, IN, USA

    Todd McKinley

  4. Department of Orthopedics and Rehabilitation, University of Iowa, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Joseph Buckwalter

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  1. Don Anderson
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  2. James Martin
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  3. J. Lawrence Marsh
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  4. Jessica Goetz
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  5. Mitchell Coleman
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  6. Todd McKinley
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  7. Joseph Buckwalter
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Correspondence to Joseph Buckwalter .

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Editors and Affiliations

  1. Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA

    Christian Lattermann

  2. Zentrum fur Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Saarland, Germany

    Henning Madry

  3. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  4. Department of Biomedical Sciences, Humanitas Research Hospital, Rozzano, Italy

    Elizaveta Kon

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Anderson, D. et al. (2022). Early OA Following Synovial Joint Fracture. In: Lattermann, C., Madry, H., Nakamura, N., Kon, E. (eds) Early Osteoarthritis. Springer, Cham. https://doi.org/10.1007/978-3-030-79485-9_9

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