Differences in synovial fibrosis relative to range of motion in knee osteoarthritis patients

Abstract

This study tests if differences exist in the severity of synovial fibrosis between patients undergoing total knee arthroplasty (TKA) for osteoarthritis (OA) to help explain disparate deficits in pre-and postoperative range of motion (ROM) between patient groups. 117 knee OA patients were grouped by women (n = 74) and men (n = 43) or those who self-reported as Black (n = 48) or White (n = 69). ROM was measured pre-and post-TKA. Condyles and synovium collected during TKA were scored histologically for OA severity and synovitis. Fibrosis was measured from picrosirius-stained sections of the synovium. Data were analyzed using Mann-Whitney, parametric, and Spearman's rho tests with alpha at 0.05. We found no significant differences between patient age, BMI, radiographic scores, or deformity type when grouped by sex or race, or between metrics or OA severity when grouped by sex. Notably, higher synovitis was measured in women (p = .039) than men. White patients had greater ROM before (p = 0.46) and after surgery (p = .021) relative to Black patients. Fibrosis, but not OA severity and synovitis scores, for the total patient sample negatively correlated with preoperative (r s = −0.330; p = .0003) but not postoperative (r s = −0.032; p = .7627) ROM. Black patients manifested more fibrosis than White patients (p = <.0001), without significant differences between sexes. Statement of Clinical Significance: Coupled with histological scoring, measuring perioperative differences in synovial fibrosis against ROM may refine OA classification and justify the in-depth preoperative assessment of the knee as a whole. Such individualized analyses could guide personalized strategies to relieve symptomatic OA when TKA is not readily accessible and promote equitable TKA outcomes.

Risk factors associated with the occurrence of total knee arthroplasty in patients with knee osteoarthritis: a nested case–control study

“…Although the exact reason for this difference remains to be determined, one could speculate on the possibility of a relation to the greater incidence of synovitis in women with knee OA, which is often associated with more severe symptoms and disease progression, known as risk factors linked to TKA. 31,33,34 This study also provides new information on the association, in women, of TKA with ancient trauma. This association may be linked to ligament damage, encountered at the time of injury, 35 which may have led to a greater risk of valgus alignment.…”

“…Although the exact reason for this difference remains to be determined, one could speculate on the possibility of a relation to the greater incidence of synovitis in women with knee OA, which is often associated with more severe symptoms and disease progression, known as risk factors linked to TKA. 31 , 33 , 34 …”

Minoxidil weakens newly synthesized collagen in fibrotic synoviocytes from osteoarthritis patients

“…Synovial fibrosis (SFb) is a hallmark of knee osteoarthritis (KOA) characterized by aberrant type 1 collagen (COL1) deposition in the synovial subintima that constricts the joint capsule to effectively impart painful stiffness and limitations in active range of motion (ROM) [17]. Although the definitive treatment for KOA is total knee arthroplasty (TKA), severe arthrofibrosis in the synovium and other peri‐articular soft tissues can persist post‐operatively [1], potentially hindering patients from maximizing functional gains.…”

“…Although the definitive treatment for KOA is total knee arthroplasty (TKA), severe arthrofibrosis in the synovium and other peri‐articular soft tissues can persist post‐operatively [1], potentially hindering patients from maximizing functional gains. Since pre‐TKA ROM, which is significantly associated with the severity of SFb [17], is the strongest predictor of post‐operative ROM [37], refining strategies to condition articular soft tissues peri‐operatively will likely improve surgical outcomes and lower the risk for arthrofibrosis complication.…”

Macrophages Modulate the Function of MSC- and iPSC-Derived Fibroblasts in the Presence of Polyethylene Particles

“…These biological processes alter the normal biochemical composition and functional state of the stroma. Accordingly, fibrosis and chronic inflammation of the synovium after joint replacement reduces joint motion and adversely affects quality of life [ 4 ].…”