Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Osteoarthritis Cartilage. 2022 Jan;30(1):100-109. doi: 10.1016/j.joca.2021.10.005. Epub 2021 Oct 23.
This study aimed to investigate the abnormal subchondral trabecular bone (STB) remodeling in knee osteoarthritis (OA) under the influence of knee alignment [hip-knee-ankle (HKA) angle].
Forty-one patients with knee OA underwent radiographic examination before total knee arthroplasty (TKA) for the measurement of HKA angle. Tibial plateau specimens obtained during TKA were used for histomorphometric analyses to assess STB remodeling and cartilage degradation. Tartrate-resistant acidic phosphatase (TRAP) staining was used to test osteoclast activity. Osterix, osteocalcin, and sclerostin expression in the STB were determined using immunohistochemistry.
The interaction between HKA angle and side (medial vs lateral of tibial plateau) was the main significant influence factor for STB remodeling and microstructure. The STB with the deviation of the knee alignment was accompanied by obvious abnormal bone remodeling and microstructural sclerosis. Bone volume fraction (BV/TV) was the only significant influence factor for OARSI score, the larger the BV/TV of STB, the higher the OARSI score of cartilage. Moreover, the tibial plateau affected by alignment had more TRAP + osteoclasts, Osterix + osteoprogenitors, and osteocalcin + osteoblasts and fewer sclerostin + osteocytes.
The variation of tibial plateau STB remodeling activity and microstructure was associated with HKA angle and cartilage degradation. Knee malalignment may cause abnormal STB remodeling and microstructural sclerosis, which may potentially affect load stress transmission from the cartilage to the STB, thus resulting in accelerated knee OA progression.
本研究旨在探讨膝关节对线（髋膝踝角 [HKA] 角）影响下膝骨关节炎（OA）患者软骨下骨小梁（STB）的异常重塑。
41 例膝关节 OA 患者在接受全膝关节置换术（TKA）前进行放射学检查，以测量 HKA 角。在 TKA 过程中获得的胫骨平台标本用于组织形态计量学分析，以评估 STB 重塑和软骨降解。抗酒石酸酸性磷酸酶（TRAP）染色用于测试破骨细胞活性。用免疫组织化学法检测 STB 中骨钙素、骨桥蛋白和硬化素的表达。
HKA 角与胫骨平台侧（内侧与外侧）的相互作用是 STB 重塑和微观结构的主要显著影响因素。膝关节对线偏差的 STB 伴有明显的异常骨重塑和微结构硬化。骨体积分数（BV/TV）是 OARSI 评分的唯一显著影响因素，STB 的 BV/TV 越大，软骨的 OARSI 评分越高。此外，受对线影响的胫骨平台具有更多的 TRAP+破骨细胞、Osterix+成骨前体细胞和骨钙素+成骨细胞，以及更少的硬化素+成骨细胞。
胫骨平台 STB 重塑活性和微观结构的变化与 HKA 角和软骨降解有关。膝关节对线不良可能导致 STB 重塑异常和微结构硬化，这可能潜在地影响从软骨到 STB 的负荷传递，从而加速膝关节 OA 的进展。
