Hydraulic theory of pathogenesis of posttraumatic osteoarthritis of knee joints and perspectives of therapeutic measures

Abstract

An original hydraulic theory of the pathogenesis of osteoarthritis of the knee joints is proposed. The hydraulic theory suggests the presence of an initial traumatic or domestic injury to the menisci, cruciate ligaments, and synovial membrane, followed by a post-traumatic increase in the volume of synovial fluid and, accordingly, hydrostatic pressure inside the synovial cavity. Damage to the cell layer of synovial macrophages, which form the basis of the intima and synovial barrier, leads to the leakage of synovial fluid into the subintima with the development of cellular alteration and the subsequent growth of fibrosis and the growth of uncontrolled hyperplasia, cellular hypertrophy and neoplasm of vessels and nerve endings. Later damage to the thick bone and cartilage barrier leads to intrusion of synovial fluid into the bone tissue with the formation of bone cysts and osteoarthritic damage/edema of the bone marrow. Restoration of barriers through the use of repair, including cellular, technologies in the near future is impossible due to the lack of regenerative potential in synovial macrophages and chondrocytes. Damage to the synovial and osteocartilage barrier suggests different medical tactics for the management of patients with osteoarthritis of the knee joints. The authors substantiate the undesirability of any type of analgesic therapy in case of damage to the synovial barrier and preservation of the integrity of the bone-cartilage barrier. The only effective and safe method of treatment at all stages of the disease is therapeutic exercise with an emphasis on exercises that accelerate lymphatic and venous outflow in order to achieve antifibrotic and antihypoxic effects.