Li Guangyi, Chen Lianzhi, Zheng Qiujian, Ma Yuanchen, Zhang Changqing, Zheng Ming Hao
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth, Australia.
J Orthop Translat. 2019 Nov 20;24:190-197. doi: 10.1016/j.jot.2019.10.014. eCollection 2020 Sep.
Residual hip dysplasia is the most common underlying condition leading to secondary osteoarthritis (OA) of the hip. Subchondral bone alterations in OA secondary to hip dysplasia (HD-OA) are poorly investigated. The aim of the present study was to analyse the microarchitecture, bone remodelling and pathological alterations of subchondral bone in femoral heads from patients with HD-OA.
Subchondral bone specimens were extracted from both weight-bearing and non-weight-bearing regions of femoral heads from 20 patients with HD-OA and 20 patients with osteoporotic femoral neck fracture, during hip replacement surgery. Micro-CT and histological examination were performed to assess the microarchitecture and histopathological changes.
The weight-bearing subchondral bone showed significantly more sclerotic microarchitecture and higher bone remodelling level in HD-OA as compared with osteoporosis. In the non-weight-bearing region, the two diseases shared similar microarchitectural characteristics, but higher bone remodelling level was detected in HD-OA. Distinct regional differences were observed in HD-OA, whereas the two regions exhibited similar characteristics in osteoporosis. In addition, HD-OA displayed more serious pathological alterations, including subchondral bone cyst, metaplastic cartilaginous tissue, bone marrow oedema and fibrous tissue, especially in the weight-bearing region.
Osteoarthritic deteriorations of subchondral bone induced by hip dysplasia spread throughout the whole joint, but exhibit region-dependent variations, with the weight-bearing region more seriously affected. Biomechanical stress might exert a pivotal impact on subchondral bone homeostasis in hip dysplasia.
The histomorphometric findings in the project indicate an early intervention for the development of hip dysplasia in clinic.
残留性髋关节发育不良是导致继发性髋关节骨关节炎（OA）的最常见潜在病因。对于髋关节发育不良继发骨关节炎（HD - OA）时软骨下骨改变的研究较少。本研究旨在分析HD - OA患者股骨头软骨下骨的微观结构、骨重塑及病理改变。
在髋关节置换手术中，从20例HD - OA患者和20例骨质疏松性股骨颈骨折患者的股骨头负重区和非负重区提取软骨下骨标本。进行显微CT和组织学检查以评估微观结构和组织病理学变化。
与骨质疏松相比，HD - OA患者的负重软骨下骨显示出更明显的硬化微观结构和更高的骨重塑水平。在非负重区，两种疾病具有相似的微观结构特征，但HD - OA患者的骨重塑水平更高。HD - OA患者存在明显的区域差异，而骨质疏松患者的两个区域表现出相似的特征。此外，HD - OA患者表现出更严重的病理改变，包括软骨下骨囊肿、化生软骨组织、骨髓水肿和纤维组织，尤其是在负重区。
髋关节发育不良引起的软骨下骨骨关节炎恶化累及整个关节，但存在区域依赖性差异，负重区受影响更严重。生物力学应力可能对髋关节发育不良时软骨下骨的稳态产生关键影响。
该项目中的组织形态计量学研究结果提示临床上应对髋关节发育不良的发展进行早期干预。
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