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Synovial fluid crystals and cartilage fragments in osteoarthritis of the knee joint
O s t e o a r t h r i t i s and Cartilage Vol. 1 No. 1
77
T r e a t m e n t of e v o l u t i v e o s t e o a r t h r i t i s of t h e hip with i n t e r t r o c h a n t e r i c osteotomy L. DE PALMA AND A. MASINI
Clinical Orthopaedics, Catholic University of Rome, Italyo Since 1966 osteotomy has been considered as a valid alternative surgical procedure in the treatment of osteoarthritis. It is performed in patients in whom a total hip replacement would not be suitable. To prevent pathology, the inclination and the declination angle of the proximal metaphysis of the femur allows a better distribution of tension and loads in the hip joint. Although the mechanical effect of the intertrocanteric osteotomy is considered important, the biological effect of this operation should be emphasized. Pain in osteoarthritis is often due to venous engorgement of the venous plexus of the proximal epiphysis of the femur. This causes joint effusions which are responsible for tension of the synovial membrane containing numerous pain receptors. Osteotomy results in reduced endosteal venous pressure and is associated with diminishing pain. The osteotomy line from which new
arterial vessels arise gives a new blood supply to the subchondral bone of the epiphysis of the femur. This allows the cartilaginous surface to be repaired by fibrocartilage. It was possible to achieve good or satisfactory results in patients with severe radiological findings if joint function was preserved. From 1968-1988 we operated on 935 hips in our department, 548 for a r t h r i t i c conditions. Seventy-one per cent achieved good results at 10 year follow-up; 44~o achieved good results at 20 year follow-up. We believe that this surgical procedure should be performed in cases where the patient will be able to experience a long painfree period while r e t a i n i n g their own hip. It is understood that a total hip replacement can be carried out at a later stage.
CALCIUM CRYSTALS S y n o v i a l fluid c r y s t a l s and cartilage f r a g m e n t s in o s t e o a r t h r i t i s of the k n e e joint ANGELA SWAN, GERALDINE PRICE, SARAH HEWLETT AND PAUL DIEPPE
Bristol University Department of Medicine, Rheumatology Unit, Bristol Royal Infirmary, Bristol, U.K. The significance of synovial fluid crystals in osteoarthritic (OA) joints remains unclear. In this study the presence of crystals has been related to the quantity of inflammatory cells and cartilage fragments in the synovial fluid, to assess the relationships with evidence of acute inflammation and joint damage respectively. Consecutive synovial fluids (106) aspirated from OA knee joints have been examined. Pyrophosphate (CPPD) crystals were detected by conventional polarized light microscopy, and Alizarin red S stain was used to detect particles containing apatite (HA). The presence of cartilage fragments was graded on 0-2 scale. The number of white cells present Was also estimated. At the time of aspiration, knee pain scores and tenderness were recorded on 0-3 point scales. The association between crystals and cartilage fragments was significant. In this study, particles of crystals and cartilage were
Presence of crystals None CPPD HA CPPD & HA
Fluid vol. > 105 No. (mean) WBC
Cartilge (2)
Pain Tend (3) (3)
29 15 26
8.2 13.4 14.8
6 6 8
10 8 17
10 8 14
6 3 12
36
32.0
11
25
17
12
frequently present in OA synovial fluids. Their presence was associated with large volumes of fluid and painful joints, but not with inflammation. Joint particles in OA synovial fluid may appear in p h a s e ~ o f disease activity, associated with measured pain and joint damage, but are not associated with acute inflammation.
77
T r e a t m e n t of e v o l u t i v e o s t e o a r t h r i t i s of t h e hip with i n t e r t r o c h a n t e r i c osteotomy L. DE PALMA AND A. MASINI
Clinical Orthopaedics, Catholic University of Rome, Italyo Since 1966 osteotomy has been considered as a valid alternative surgical procedure in the treatment of osteoarthritis. It is performed in patients in whom a total hip replacement would not be suitable. To prevent pathology, the inclination and the declination angle of the proximal metaphysis of the femur allows a better distribution of tension and loads in the hip joint. Although the mechanical effect of the intertrocanteric osteotomy is considered important, the biological effect of this operation should be emphasized. Pain in osteoarthritis is often due to venous engorgement of the venous plexus of the proximal epiphysis of the femur. This causes joint effusions which are responsible for tension of the synovial membrane containing numerous pain receptors. Osteotomy results in reduced endosteal venous pressure and is associated with diminishing pain. The osteotomy line from which new
arterial vessels arise gives a new blood supply to the subchondral bone of the epiphysis of the femur. This allows the cartilaginous surface to be repaired by fibrocartilage. It was possible to achieve good or satisfactory results in patients with severe radiological findings if joint function was preserved. From 1968-1988 we operated on 935 hips in our department, 548 for a r t h r i t i c conditions. Seventy-one per cent achieved good results at 10 year follow-up; 44~o achieved good results at 20 year follow-up. We believe that this surgical procedure should be performed in cases where the patient will be able to experience a long painfree period while r e t a i n i n g their own hip. It is understood that a total hip replacement can be carried out at a later stage.
CALCIUM CRYSTALS S y n o v i a l fluid c r y s t a l s and cartilage f r a g m e n t s in o s t e o a r t h r i t i s of the k n e e joint ANGELA SWAN, GERALDINE PRICE, SARAH HEWLETT AND PAUL DIEPPE
Bristol University Department of Medicine, Rheumatology Unit, Bristol Royal Infirmary, Bristol, U.K. The significance of synovial fluid crystals in osteoarthritic (OA) joints remains unclear. In this study the presence of crystals has been related to the quantity of inflammatory cells and cartilage fragments in the synovial fluid, to assess the relationships with evidence of acute inflammation and joint damage respectively. Consecutive synovial fluids (106) aspirated from OA knee joints have been examined. Pyrophosphate (CPPD) crystals were detected by conventional polarized light microscopy, and Alizarin red S stain was used to detect particles containing apatite (HA). The presence of cartilage fragments was graded on 0-2 scale. The number of white cells present Was also estimated. At the time of aspiration, knee pain scores and tenderness were recorded on 0-3 point scales. The association between crystals and cartilage fragments was significant. In this study, particles of crystals and cartilage were
Presence of crystals None CPPD HA CPPD & HA
Fluid vol. > 105 No. (mean) WBC
Cartilge (2)
Pain Tend (3) (3)
29 15 26
8.2 13.4 14.8
6 6 8
10 8 17
10 8 14
6 3 12
36
32.0
11
25
17
12
frequently present in OA synovial fluids. Their presence was associated with large volumes of fluid and painful joints, but not with inflammation. Joint particles in OA synovial fluid may appear in p h a s e ~ o f disease activity, associated with measured pain and joint damage, but are not associated with acute inflammation.