Relationship of plasma and synovial fluid vascular endothelial growth factor with radiographic severity in primary knee osteoarthritis

Purpose

Recent evidence suggests that angiogenesis and inflammation contribute to the development and progression of osteoarthritis (OA). The purpose of this study was to investigate vascular endothelial growth factor (VEGF) levels in plasma and synovial fluid of patients with knee OA and to determine the relationship of VEGF levels with disease severity in knee OA.

Methods

A total of 100 subjects were enrolled in this study (80 knee OA patients and 20 healthy controls). Plasma and synovial fluid VEGF levels were analysed using enzyme-linked immunosorbent assay. VEGF expressions in synovial membrane and articular cartilage samples were assessed using immunohistochemistry.

Results

VEGF level in synovial fluid of knee OA patients was tenfold higher than that in paired plasma (P < 0.001). Both plasma and synovial fluid VEGF exhibited a positive correlation with radiographic severity (r = 0.454 and r = 0.727, P < 0.001, respectively). VEGF expression was highly detectable in synovial lining cells and articular chondrocytes of knee OA patients.

Conclusions

VEGF levels in both plasma and synovial fluid were positively correlated with the severity of knee OA. Therefore, VEGF may be useful for monitoring OA severity and could play a substantial role in the development and progression of knee OA.     

重度膝关节外翻畸形的全膝关节置换术

 目的 探讨重度膝关节外翻畸形全膝关节置换术的手术方法及临床效果。方法 对2007年1月至2012年12月采用全膝关节置换治疗的重度膝关节外翻畸形患者22例（23膝）进行回顾性分析。男7例,女15例;年龄41~78岁,平均65岁。股胫角（股骨和胫骨解剖轴线的夹角）22°~50°,平均为34.6°。骨关节炎17例,类风湿关节炎5例。髌骨完全脱位3例3膝,内侧不稳定1例1膝,屈曲挛缩畸形3例4膝。21例22膝采用后稳定型假体,1例1膝采用限制型假体。髌旁内侧入路、常规截骨及单纯外侧软组织松解,术中行髌骨置换5例。以膝关节活动度、X线股胫角及美国特种外科医院（Hospital for Special Surgery,HSS）膝关节评分评价术后疗效。结果 全部病例随访时间1~5年,平均2.5年。膝关节活动度由术前平均43.7°±5.8°（0°~80°）提高至末次随访时110.6°±7.5°（80°~130°）,HSS膝关节评分由术前平均（19.6±4.7）分（6~34分）提高至末次随访时（89.7±3.6）分（84~96分）,手术前后的差异有统计学意义。外翻畸形基本得到矫正,末次随访时股胫角平均为8.6°±0.8°（0°~12°）,较术前34.6°±2.4°（22°~50°）明显改善,手术前后的差异有统计学意义。术后2例2膝有膝关节内侧不稳症状,给予膝关节支具保护;1例1膝术前严重髌骨脱位患者术后存在半脱位,未予特殊处理;2例2膝术后出现腓总神经麻痹,未予特殊处理。随访期间未发生感染、松动及深静脉血栓形成等并发症。结论 对重度膝关节外翻畸形患者可采用常规截骨、单纯外侧软组织松解及后稳定型假体植入,能较好地矫正外翻畸形,近期疗效满意。     

膝关节骨关节炎关节镜术及透明质酸关节内注射的疗效观察

目的：通过对35例膝关节骨关节炎（OA）病人的治疗，对疗效及预后进行评估。方法：1998年5月－2000年12月35例膝关节OA论断明确的病人，术前分别进行Kellgren-Lawrence放射学分级及Lysholm膝关节评分，关节镜术及透明质酸关节内注射治疗，术后随访。结果：本组病人疗效优良率为68．57％。绪论：Kellgren-Lawrence放射学诊断标准对于膝关节镜术指征的把握有一定意义。Lysholm膝关节评分在本组病人中相符性较好。提倡对于膝关节骨关节炎病人，尽早进行膝关节镜手术，以阻断骨关节炎的恶性循环，但对于X线片分级Ⅲ-Ⅳ级的病人（特别是Ⅳ级），疗效不佳。     

Clinical importance of impingement deformities for hip osteoarthritis progression in a Japanese population

Purpose

Femoroacetabular impingement is a new disease concept for hip disorders in young adults suggested as a major cause of primary hip osteoarthritis in Western countries. However, significant controversy exists regarding the prevalence and contribution of impingement deformities to osteoarthritis in Japan, owing to the higher prevalence of developmental dysplasia of the hip. Therefore, the aims of this study were to: (1) determine the prevalence of structural abnormalities associated with hip disorders in patients undergoing total hip replacement and (2) analyse the contribution of impingement deformities to osteoarthritis.

Methods

We analysed 250 patients from two different medical centres who underwent primary total hip replacement except those which were due to femoral head necrosis, posttraumatic osteoarthritis and systemic inflammatory disease. The average patient age at surgery was 64 years (range, 40–89 years), with 35 men and 215 women.

Results

Radiographic abnormality related to developmental dysplasia of the hip was associated with the majority of osteoarthritic hips (62 %). Hips with femoroacetabular impingement deformities were present within the cases categorized as unknown etiology. Cam impingement deformity was present in 22 % of unknown aetiology cases when cases with reactive osteophytes were excluded from all cam deformity cases (pistol grip deformity and aspherical femoral heads).

Conclusions

The prevalence of femoroacetabular impingement within primary osteoarthritis cases and gender predominance of impingement deformities are relatively similar to those reported previously in Western populations. This finding indicates that femoroacetabular impingement deformities are associated with osteoarthritis in the Japanese population, although it has a lower frequency among all hip failure patients.