Chinzei Nobuaki, Hashimoto Shingo, Fujishiro Takaaki, Hayashi Shinya, Kanzaki Noriyuki, Uchida Soshi, Kuroda Ryosuke, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
Department of Orthopaedic Surgery, Wakamatsu Hospital for University of Occupational and Environmental Health, Wakamatsu-ku, Kitakyushu, Japan
J Bone Joint Surg Am. 2016 Jan 20;98(2):135-41. doi: 10.2106/JBJS.O.00443.
BACKGROUND: Femoroacetabular impingement (FAI) has been reported as a cause of hip pain in young patients and is suggested as the trigger for hip osteoarthritis (OA). The goal of this study was to quantify the metabolic profiles of articular tissues (cartilage, synovium, and labrum) harvested from patients with FAI and with end-stage OA. In addition, we sought to investigate the development of secondary OA in hips with FAI. METHODS: Tissue samples were obtained from thirty hips undergoing arthroscopic surgery for FAI with or without labral tear and thirty hips undergoing total hip arthroplasty for OA. Quantitative real-time polymerase chain reaction (PCR) was performed to determine the gene expression of inflammatory cytokines and metabolic (anabolic and catabolic) enzymes. The differences in gene expression in articular tissues from the patients with FAI were also evaluated on the basis of clinical parameters (age range and alpha angle). RESULTS: The messenger RNA (mRNA) expression of the inflammatory cytokines interleukin-1 beta (IL-1β) and IL-8 and of matrix metalloproteinase (MMP)-3 (a catabolic gene) in both the synovium and the labrum, and the expression of collagen type I alpha 1 (an anabolic gene) in the labrum, was higher in the samples from hips with OA than in those from hips with FAI (p < 0.05). In cartilage, however, the mRNA expression of the inflammatory cytokines and the catabolic genes MMP-13 and ADAMTS-4 (a disintegrin and metalloproteinase with thrombospondin motifs-4) was higher in the FAI samples compared with the OA samples (p < 0.01). When the expression of inflammatory cytokines was evaluated among the three types of tissues within each disease group, the expression levels were the highest in cartilage within the FAI samples (p < 0.01). In FAI cartilage, we found higher gene expression of aggrecan (ACAN) and ADAMTS-4 in the samples from patients with larger alpha angles (≥60°) (p < 0.01). CONCLUSIONS: Our results indicate that the metabolic conditions of articular cartilage in FAI and OA are different and that the expression of genes associated with inflammation is greater in the articular cartilage of patients with FAI compared with the synovium and the labrum. The metabolic changes were heightened by mechanical impingement. CLINICAL RELEVANCE: The articular cartilage from the impingement lesion in patients with FAI showed biologically higher inflammation and degeneration, supporting the concept that FAI may be a trigger for joint degeneration.
背景：股骨髋臼撞击症（FAI）已被报道为年轻患者髋关节疼痛的一个原因，并被认为是髋关节骨关节炎（OA）的触发因素。本研究的目的是量化从FAI患者和终末期OA患者获取的关节组织（软骨、滑膜和盂唇）的代谢谱。此外，我们试图研究FAI髋关节中继发性OA的发展情况。 方法：组织样本取自30例因FAI接受关节镜手术（伴或不伴盂唇撕裂）的髋关节以及30例因OA接受全髋关节置换术的髋关节。进行定量实时聚合酶链反应（PCR）以确定炎性细胞因子和代谢（合成代谢和分解代谢）酶的基因表达。还根据临床参数（年龄范围和α角）评估FAI患者关节组织中基因表达的差异。 结果：OA髋关节样本中，滑膜和盂唇中炎性细胞因子白细胞介素-1β（IL-1β）和IL-8以及基质金属蛋白酶（MMP）-3（一种分解代谢基因）的信使核糖核酸（mRNA）表达，以及盂唇中I型胶原α1（一种合成代谢基因）的表达，均高于FAI髋关节样本（p<0.05）。然而，在软骨中，与OA样本相比，FAI样本中炎性细胞因子以及分解代谢基因MMP-13和含血小板反应蛋白基序的解聚素和金属蛋白酶-4（ADAMTS-4）的mRNA表达更高（p<0.01）。当在每个疾病组的三种组织类型中评估炎性细胞因子的表达时，FAI样本中软骨内的表达水平最高（p<0.01）。在FAI软骨中，我们发现α角较大（≥60°）的患者样本中聚集蛋白聚糖（ACAN）和ADAMTS-4的基因表达更高（p<0.01）。 结论：我们的结果表明，FAI和OA中关节软骨的代谢状况不同，与炎症相关的基因在FAI患者的关节软骨中的表达高于滑膜和盂唇。代谢变化因机械撞击而加剧。 临床意义：FAI患者撞击损伤处的关节软骨显示出生物学上更高的炎症和退变，支持了FAI可能是关节退变触发因素的概念。
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