Synovial, articular cartilage and bone changes in rapidly destructive arthropathy (osteoarthritis) of the hip

Abstract

We studied ten femoral heads from eight patients suffering from rapidly destructive arthropathy (RDA) of the hip. At surgery, 1-3.5 ml of synovial fluid, ranging from citrous to hemorrhagic, was aspirated from six joints. This fluid was viscous, pauci-cellular and did not contain calcium pyrophosphate dihydrate (CaPPD) crystals, although significant amounts of alizarin S-positive material was found in three joints. Significant synovial hyperplasia was found in four joints and moderate hyperplasia in two. Synovium was hypertrophic, hypercellular and slightly to moderately fibrotic. It lacked evidence of perivascular inflammatory infiltrates. Synovium often contained amyloid micro-deposits and alizarin S-positive osteocartilagenous debris surrounded by macrophages. Synovial hyperplasia had a good correlation with osteocartilagenous debris and a poor correlation with amyloid infiltration. Femoral heads were usually flattened and exhibited large areas of exposed bone spotted by plugs of fibro-cartilagenous tissue. Subchondral bone contained large ischemic and necrotic areas, bone marrow atrophy and fibrosis, and intense bone remodeling. Subchondral bone necrosis and ischemia were the most significant findings of this study and their role in the development of RDA is discussed.

Significant increases in serum and plasma concentrations of matrix metalloproteinases 3 and 9 in patients with rapidly destructive osteoarthritis of the hip

“…MMP-9 can also be produced by activated osteoclasts (34). A number of osteoclasts in rapidly destructive hip OA, which are one source of MMP-9, have been observed around necrotic bone in subchondral areas (23,24). A recent study also demonstrated that MMP-9 was strongly expressed in the subchondral region in RA patients (35).…”

“…In addition, MMP-3 could be released from chondrocytes into the synovial fluid by rapid degeneration of articular cartilage. In rapidly destructive hip OA, articular cartilage is extensively lost, and subchondral bone is invaded by synovial and fibrous connective tissue (24,25). Thus, large amounts of MMP-3 produced and released as described above could be drained into the bloodstream directly by the subchondral intramedullary microcirculation, or it could be drained from the synovial fluid via the blood-synovium barrier.…”

Rapidly destructive arthrosis of the hip joint in a young adult with systemic lupus erythematosus

“…In the joint fluid, a high level of tartrate-resistant acid phosphatase 5b (4190 mU/ dl) was confirmed, indicating high bone resorption within the hip joint [6]. These findings are characteristic of RDA [6][7][8].…”

Rapid destructive arthritis of the hip revisited

“…Some authors reported significantly greater counts of osteoclasts in active areas of rapid destructive arthritis as compared to ordinary hip arthritis, in addition to vascular-rich granulation, indicating that vascularity may be an important factor in the process of lysis and destruction of bone [14][15][16]. Recent reports have shown the existence of subchondral insufficiency fracture in rapid destructive arthritis of the hip joint [14][15][16][17][18][19].…”

“…Recent reports have shown the existence of subchondral insufficiency fracture in rapid destructive arthritis of the hip joint [14][15][16][17][18][19]. Subchondral bone ischemia and cell necrosis have been considered major factors in the development of rapid destructive arthritis of the hip [14,15]. Some researchers supported the hypothesis that an insufficiency fracture of the femoral head precedes the occurrence of the disease [16][17][18].…”