Kumagai K, Fujimaki H, Yamada S, Nejima S, Matsubara J, Inaba Y
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Osteoarthritis Cartilage. 2021 Jul;29(7):1020-1028. doi: 10.1016/j.joca.2021.03.013. Epub 2021 Mar 25.
The purpose of this study was to evaluate the effects of high tibial osteotomy (HTO) on the biological status of knee osteoarthritis (OA) using joint markers in synovial fluid (SF).
Fifty patients with medial compartmental OA of the knee who underwent opening wedge HTO were enrolled. Paired SF samples from the affected knee and arthroscopic evaluation of articular cartilage were collected at the time of HTO surgery and the time of plate removal (postoperative 17 ± 4 months). The concentrations of the following SF biomarkers were measured: interleukin (IL)-1β, IL-6, IL-8, IL-10, tumour necrosis factor-α, matrix metalloproteinase (MMP)-2, MMP-3, MMP-9, MMP-13, vascular endothelial growth factor (VEGF), and cartilage oligomeric matrix protein (COMP). The Knee Society Score (KSS) and hip-knee-ankle (HKA) angle were assessed before and 2 years after HTO.
The KSS knee and function scores were significantly improved after HTO (mean changes of 36.4 and 23.7, respectively). The mean HKA angle was altered from mechanical varus (-8.6°) to valgus (5.2°). Concentrations of IL-6, IL-8, MMP-2, MMP-3, MMP-13, VEGF, and COMP in SF were significantly decreased after HTO (mean changes of -49.1%, -30.2%, -31.1%, -26.3%, -30.8%, -42.5%, and -13.7% from preoperative baseline, respectively). The cartilage status was improved in 19 cases (38%) after HTO. However, changes of all biomarkers were not significantly different between subjects with and without an improved cartilage status.
SF levels of biochemical markers for cartilage degradation and synovial inflammation were altered after HTO, suggesting an improvement in the OA disease state.
本研究旨在利用滑液（SF）中的关节标志物评估高位胫骨截骨术（HTO）对膝关节骨关节炎（OA）生物学状态的影响。
纳入50例行开放性楔形HTO的膝关节内侧间室OA患者。在HTO手术时及取出钢板时（术后17±4个月），采集患侧膝关节配对的SF样本，并进行关节软骨的关节镜评估。检测以下SF生物标志物的浓度：白细胞介素（IL）-1β、IL-6、IL-8、IL-10、肿瘤坏死因子-α、基质金属蛋白酶（MMP）-2、MMP-3、MMP-9、MMP-13、血管内皮生长因子（VEGF）和软骨寡聚基质蛋白（COMP）。在HTO术前和术后2年评估膝关节协会评分（KSS）和髋-膝-踝（HKA）角。
HTO术后KSS膝关节和功能评分显著改善（平均变化分别为36.4和23.7）。平均HKA角从机械性内翻（-8.6°）变为外翻（5.2°）。HTO术后SF中IL-6、IL-8、MMP-2、MMP-3、MMP-13、VEGF和COMP的浓度显著降低（分别较术前基线平均变化-49.1%、-30.2%、-31.1%、-26.3%、-30.8%、-42.5%和-13.7%）。HTO术后19例（38%）患者的软骨状态得到改善。然而，软骨状态改善和未改善的患者之间，所有生物标志物的变化无显著差异。
HTO术后软骨降解和滑膜炎症的SF生化标志物水平发生改变，提示OA疾病状态有所改善。
