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Does Intraarticular Inflammation Predict Biomechanical Cartilage Properties?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Intact cartilage in the lateral compartment is an important requirement for medial unicompartmental knee arthroplasty (UKA). Progression of cartilage degeneration in the lateral compartment is a common failure mode of medial UKA. Little is known about factors that influence the mechanical properties of lateral compartment cartilage.

Questions/purposes

The purposes of this study were to answer the following questions: (1) Does the synovial fluid white blood cell count predict the biomechanical properties of macroscopically intact cartilage of the distal lateral femur? (2) Is there a correlation between MRI grading of synovitis and the biomechanical properties of macroscopically intact cartilage? (3) Is there a correlation between the histopathologic assessment of the synovium and the biomechanical properties of macroscopically intact cartilage?

Methods

The study included 84 patients (100 knees) undergoing primary TKA for varus osteoarthritis between May 2010 and January 2012. All patients underwent preoperative MRI to assess the degree of synovitis. During surgery, the cartilage of the distal lateral femur was assessed macroscopically using the Outerbridge grading scale. In knees with an Outerbridge grade of 0 or 1, osteochondral plugs were harvested from the distal lateral femur for biomechanical and histologic assessment. The synovial fluid was collected to determine the white blood cell count. Synovial tissue was taken for histologic evaluation of the degree of synovitis.

Results

The mean aggregate modulus and the mean dynamic modulus were significantly greater in knees with 150 or less white blood cells/mL synovial fluid compared with knees with greater than 150 white blood cells/mL synovial fluid. There was no correlation among MRI synovitis grades, histopathologic synovitis grades, and biomechanical cartilage properties.

Conclusions

The study suggests that lateral compartment cartilage in patients with elevated synovial fluid white blood cell counts has a reduced ability to withstand compressive loads.

Level of Evidence

Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Suzanne A. Maher PhD, Department of Biomechanics, Hospital for Special Surgery for help in the study design and analysis of biomechanical data; Yana Bonfman, Department of Pathology and Laboratory Medicine, Hospital for Special Surgery for histologic preparation of the osteochondral samples and the synovium; Nadja Farshad-Amacker MD, Division of Magnetic Resonance Imaging, Hospital for Special Surgery for assistance in MRI assessment of the synovium; and Jad Bou Monsef MD, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery for assistance with radiographic measurements.

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Authors and Affiliations

  1. Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Wenzel Waldstein MD & Friedrich Boettner MD

  2. Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA

    Giorgio Perino MD

  3. Division of Magnetic Resonance Imaging, Hospital for Special Surgery, New York, NY, USA

    Shari T. Jawetz MD

  4. Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA

    Susannah L. Gilbert MS

Authors
  1. Wenzel Waldstein MD
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  2. Giorgio Perino MD
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  3. Shari T. Jawetz MD
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  4. Susannah L. Gilbert MS
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  5. Friedrich Boettner MD
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Corresponding author

Correspondence to Friedrich Boettner MD.

Additional information

The institution of the authors (FB) has received funding from Smith & Nephew, Memphis, TN, USA.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Waldstein, W., Perino, G., Jawetz, S.T. et al. Does Intraarticular Inflammation Predict Biomechanical Cartilage Properties?. Clin Orthop Relat Res 472, 2177–2184 (2014). https://doi.org/10.1007/s11999-014-3583-0

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  • DOI: https://doi.org/10.1007/s11999-014-3583-0

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