Changes in synovial fluid biochemical markers following arthroscopic surgery in patients with knee osteoarthritis

Abstract

Although arthroscopic surgery (AS) for knee osteoarthritis has been widely employed, scientific evidence is lacking. The purpose of this study was to investigate temporal changes in synovial fluid levels of biochemical markers associated with cartilage metabolism following AS. Twenty-five knees of 24 patients with medial knee osteoarthritis (mean age 70.5 years) were included in this study. Synovial fluids were sampled immediately before surgery and 2, 4, 8, and 12 weeks after AS. Levels of the biochemical markers chondroitin 6-sulfate (C6S), chondroitin 4-sulfate (C4S), and keratan sulfate (KS) were measured and correlations among the biochemical markers were analyzed before and after surgery. C6S, C4S, and total CS levels were the same before and after surgery; however, the KS level decreased significantly at 2 weeks after AS. A strong, positive correlation was detected between C6S and KS levels at 12 weeks, differing from the weaker correlation seen before surgery. Seven of the patients required total or unicompartmental knee arthroplasties in the 2 years following AS. In this study, the significant reduction in KS levels and the strong correlation between C6S and KS levels were shown, which indicates suppressed cartilage turnover after AS. Exploring predictive factors indicating favorable or unfavorable outcomes from AS will be important future studies.

Osteoarthritis year 2013 in review: biomarkers; reflecting before moving forward, one step at a time

“…In this study 35 and another report from the same open trial 89 it was demonstrated that treatment efficacy was reflected by a decrease in uCTX-II as well as Coll2-1, suggesting a decrease in collagen type II degradation and inflammation by (this) visco-supplementation. Arthroscopic surgery of 24 patients with knee arthropathy resulted in a significant and persistent decrease in serum keratan sulphate levels and chondroitin 6 over 4 sulphate levels over a period of 12 weeks 56 . Subjects in whom the efficacy of the surgery was suboptimal requiring arthroplasty within 2 years showed significantly less change in keratin sulphate levels as compared to those with a favourable outcome.…”

If Systems Approach is the Way Forward, What can the Ayurvedic Theory of <i>Tridosha</i> Teach Us?

“…This indicates the relevance of dryness in biology. Interestingly, many of these properties such as dryness, viscosity and adhesion used in ayurveda are increasingly being studied for their physiological roles and clinical relevance [19][20][21][22][23][24][25][26][27][28][29][30] . Just as the functions associated with VPK, these parameters (V1-V7, P1-P7, K1-K7) also exist at all levels of biological organization.…”

“…Other parameters such as lubrication (K3) and viscosity (K4) also have clinical implications. As working examples, consider the following: viscosity of cellular cytoplasm acting on the hydrodynamic forces and affecting macromolecular as well as cellular motion leading to functional changes; viscosity of blood affecting bloodflow; viscoelasticity of synovial fluid in joints influencing movement at the system level 19,20,30 .…”

“…Conventional medicine also opines the same, albeit using different terminologies. It says that alteration of viscoelastic properties of synovial fluid is a possible causative factor for friction between joints resulting in their degeneration 30 . It is pertinent to note that viscoelastic property comes under the ambit of kapha.…”

Research Article Improvement in orthopedic outcome score and reduction in IL-1β, CXCL13, and TNF-α in synovial fluid of osteoarthritis patients following arthroscopic knee surgery.

“…As involves less trauma, quicker recovery, fewer complications, and lower cost compared with conventional surgery, arthroscopic knee surgery has been widely used for KOA diagnosis and treatment (Bellary et al, 2012). Despite the role of immune dysregulation in KOA pathogenesis and the changes in biochemical markers in the synovial fluid of patients with this condition following arthroscopic surgery (Nakajima et al, 2013), the effect of such surgery on the expression of certain immune regulators remains poorly understood. The present study was carried out to investigate the clinical efficacy of arthroscopic knee surgery and its effect on the expression of IL-1β, CXCL13, and TNF-α in the knee joint synovial fluid of patients with osteoarthritis.…”