Rheumatology International

, Volume 33, Issue 1, pp 209–214 | Cite as

Changes in synovial fluid biochemical markers following arthroscopic surgery in patients with knee osteoarthritis

  • Arata Nakajima
  • Koichi Nakagawa
  • Yasuchika Aoki
  • Masato Sonobe
  • Yoshifumi Shibata
  • Masashi Yamazaki
  • Masazumi Murakami
Original Article

Abstract

Although arthroscopic surgery (AS) for knee osteoarthritis has been widely employed, scientific evidence is lacking. The purpose of this study was to investigate temporal changes in synovial fluid levels of biochemical markers associated with cartilage metabolism following AS. Twenty-five knees of 24 patients with medial knee osteoarthritis (mean age 70.5 years) were included in this study. Synovial fluids were sampled immediately before surgery and 2, 4, 8, and 12 weeks after AS. Levels of the biochemical markers chondroitin 6-sulfate (C6S), chondroitin 4-sulfate (C4S), and keratan sulfate (KS) were measured and correlations among the biochemical markers were analyzed before and after surgery. C6S, C4S, and total CS levels were the same before and after surgery; however, the KS level decreased significantly at 2 weeks after AS. A strong, positive correlation was detected between C6S and KS levels at 12 weeks, differing from the weaker correlation seen before surgery. Seven of the patients required total or unicompartmental knee arthroplasties in the 2 years following AS. In this study, the significant reduction in KS levels and the strong correlation between C6S and KS levels were shown, which indicates suppressed cartilage turnover after AS. Exploring predictive factors indicating favorable or unfavorable outcomes from AS will be important future studies.

Keywords

Arthroscopic surgery Biomarker Cartilage metabolism Knee osteoarthritis Synovial fluid 

Notes

Acknowledgments

We thank Seikagaku Kogyo Co. for measurements of CS and KS synovial fluid levels.

Conflict of interest

The authors have no conflict of interest.

References

  1. 1.
    Poole AR, Kojima T, Yasuda T, Mwale F, Kobayashi M, Laverty S (2001) Composition and structure of articular cartilage: a template for tissue repair. Clin Orthop Relat Res 391(Suppl):S26–S33PubMedCrossRefGoogle Scholar
  2. 2.
    Poole AR, Ionescu M, Swan A, Dieppe PA (1994) Changes in cartilage metabolism in arthritis are reflected by altered serum and synovial fluid levels of the cartilage proteoglycan aggrecan. Implications for pathogenesis. J Clin Invest 94:25–33PubMedCrossRefGoogle Scholar
  3. 3.
    Petersson IF, Sandqvist L, Svensson B, Saxne T (1997) Cartilage markers in synovial fluid in symptomatic knee osteoarthritis. Ann Rheum Dis 56:64–67PubMedCrossRefGoogle Scholar
  4. 4.
    Mourao PA (1988) Distribution of chondroitin 4-sulfate and chondroitin 6-sulfate in human articular and growth cartilage. Arthritis Rheum 31:1028–1033PubMedCrossRefGoogle Scholar
  5. 5.
    Yamada H, Miyauchi S, Hotta H, Morita M, Yoshihara Y, Kikuchi T et al (1999) Levels of chondroitin sulfate isomers in synovial fluid of patients with hip osteoarthritis. J Orthop Sci 4:250–254PubMedCrossRefGoogle Scholar
  6. 6.
    Thonar EJ, Lenz ME, Klintworth GK, Caterson B, Pachman LM, Glickman P et al (1985) Quantification of keratan sulfate in blood as a marker of cartilage metabolism. Arthritis Rheum 28:1367–1376PubMedCrossRefGoogle Scholar
  7. 7.
    Momohara S, Okada N, Ikari K, Mizuno S, Okamoto H (2007) Dermatan sulfate in the synovial fluid of patients with knee osteoarthritis. Mod Rheumatol 17:301–305PubMedCrossRefGoogle Scholar
  8. 8.
    Manicourt DH, Poilvache P, Nzeusseu A, van Egeren A, Devogelaer JP, Lenz ME et al (1999) Serum levels of hyaluronan, antigenic keratan sulfate, matrix metalloproteinase 3, and tissue inhibitor of metalloproteinases 1 change predictably in rheumatoid arthritis patients who have begun activity after a night of bed rest. Arthritis Rheum 42:1861–1869PubMedCrossRefGoogle Scholar
  9. 9.
    Lohmander LS (1991) Markers of cartilage metabolism in arthrosis. A review. Acta Orthop Scand 62:623–632PubMedCrossRefGoogle Scholar
  10. 10.
    Nakayama Y, Narita T, Mori A, Uesaka S, Miyazaki K, Ito H (2002) The effects of age and sex on chondroitin sulfates in normal synovial fluid. Arthritis Rheum 46:2105–2108PubMedCrossRefGoogle Scholar
  11. 11.
    Felson DT, Buckwalter J (2002) Debridement and lavage for osteoarthritis of the knee. N Engl J Med 347:132–133PubMedCrossRefGoogle Scholar
  12. 12.
    Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH et al (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347:81–88PubMedCrossRefGoogle Scholar
  13. 13.
    Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ et al (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359:1097–1107PubMedCrossRefGoogle Scholar
  14. 14.
    Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049PubMedCrossRefGoogle Scholar
  15. 15.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Reum Dis 16:494–502CrossRefGoogle Scholar
  16. 16.
    Yoshida K, Miyauchi S, Kikuchi H, Tawada A, Tokuyasu K (1989) Analysis of unsaturated disaccharides from glycosaminoglycuronan by high-performance liquid chromatography. Anal Biochem 177:327–332PubMedCrossRefGoogle Scholar
  17. 17.
    Shinmei M, Miyauchi S, Machida A, Miyazaki K (1992) Quantification of chondroitin 4-sulfate and chondroitin 6-sulfate in pathologic joint fluid. Arthritis Rheum 35:1304–1308PubMedGoogle Scholar
  18. 18.
    Yamada H, Miyauchi S, Morita M, Yoshida Y, Yoshihara Y, Kikuchi T et al (2000) Content and sulfation pattern of keratan sulfate in hip osteoarthritis using high performance liquid chromatography. J Rheumatol 27:1721–1724PubMedGoogle Scholar
  19. 19.
    Kobayashi K, Matsuzaka S, Yoshida Y, Miyauchi S, Wada Y, Moriya H (2004) The effects of intra-articularly injected sodium hyaluronate on levels of intact aggrecan and nitric oxide in the joint fluid of patients with knee osteoarthritis. Osteoarthritis Cartilage 12:536–542PubMedCrossRefGoogle Scholar
  20. 20.
    Hasegawa M, Nakoshi Y, Tsujii M, Sudo A, Masuda H, Yoshida T et al (2008) Changes in biochemical markers and prediction of effectiveness of intra-articular hyaluronan in patients with knee osteoarthritis. Osteoarthritis Cartilage 16:526–529PubMedCrossRefGoogle Scholar
  21. 21.
    Sugimoto H, Yamada H, Terada N, Kanaji A, Kato S, Date H et al (2006) Intra-articular injection of high molecular weight hyaluronan for osteoarthritis of the knee-prediction of effectiveness with biological markers. J Rheumatol 33:2527–2531PubMedGoogle Scholar
  22. 22.
    Smith GN Jr, Myers SL, Brandt KD, Mickler EA (1998) Effect of intra-articular hyaluronan injection in experimental canine osteoarthritis. Arthritis Rheum 41:976–985PubMedCrossRefGoogle Scholar
  23. 23.
    Uesaka S, Nakayama Y, Yoshihara K, Ito H (2002) Significance of chondroitin sulfate isomers in the synovial fluid of osteoarthritis patients. J Orthop Sci 7:232–237PubMedCrossRefGoogle Scholar
  24. 24.
    Sharif M, Osborne DJ, Meadows K, Woodhouse SM, Colvin EM, Shepstone L et al (1996) The relevance of chondroitin and keratan sulfate markers in normal and arthritic synovial fluid. Br J Rheumatol 35:951–957PubMedCrossRefGoogle Scholar
  25. 25.
    Campion GV, McCrae F, Schnitzer TJ, Lenz ME, Dieppe PA, Thonar EJ (1991) Levels of keratan sulfate in the serum and synovial fluid of patients with osteoarthritis of the knee. Arthritis Rheum 34:1254–1259PubMedCrossRefGoogle Scholar
  26. 26.
    Ishiguro N, Ito T, Ito H, Iwata H, Jugessur H, Ionescu M et al (1999) Relationship of matrix metalloproteinases and their inhibitors to cartilage proteoglycan and collagen turnover: analyses of synovial fluid from patients with osteoarthritis. Arthritis Rheum 42:129–136PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Arata Nakajima
    • 1
    • 2
  • Koichi Nakagawa
    • 1
  • Yasuchika Aoki
    • 1
  • Masato Sonobe
    • 1
  • Yoshifumi Shibata
    • 1
  • Masashi Yamazaki
    • 3
  • Masazumi Murakami
    • 2
  1. 1.Department of Orthopaedic SurgeryToho University Sakura Medical CenterChibaJapan
  2. 2.Department of Orthopaedic SurgeryChiba Aoba Municipal HospitalChibaJapan
  3. 3.Department of Orthopaedic SurgeryChiba University Graduate School of MedicineChibaJapan

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