The Cysts of Osteoarthritis of the Hip

Rhaney, K.; Lamb, Dennis

doi:10.1302/0301-620x.37b4.663

Cited by 103 publications

(19 citation statements)

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“…The bone contusion theory seems to explain the absence of a communication. The bony contusion theory postulated by Rhaney and Lamb [15] suggests that impact between opposing surfaces of bone, which have lost its protective cartilage results in microfractures and bone necrosis. Synovial fluid intrudes the bone when the bone attempts to heal by osteoclastic resorption of the necrotic bone.…”

Section: Discussionmentioning

confidence: 99%

“…Estrogen receptors are present in most if not all tissues, suggesting that the pleiotropic actions of estrogen on cartilage and all other tissues may be important in the progression of OA. We postulate that the loss of articular cartilage augmented by hypoestrogenaemia may be a precursor to the formation of subchondral cysts by the pathogenesis suggested by Rhaney and Lamb [15]. Females are also known to have higher body percentage of fat than males.…”

Section: Discussionmentioning

confidence: 99%

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The Truth Behind Subchondral Cysts in Osteoarthritis of the Knee

Audrey¹,

Razak²,

Andrew³

2014

TOORTHJ

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Background:Subchondral cysts have always been taught to be one of the cardinal radiological features of knee osteoarthritis but are not well understood. We aimed to evaluate the radiological prevalence and epidemiology of subchondral cysts in patients with knee osteoarthritis to determine if they are truly a cardinal radiological feature.Methods:All patients of a single surgeon with symptoms of knee osteoarthritis were selected for this study. All patients had failed a trial of conservative therapy and were planned for total knee arthroplasty. Patients with symptoms of and documentary evidence of inflammatory arthritis, other neurological and orthopaedic problems causing functional deficits were excluded from this study. A total of 806 plain radiographs were analyzed with the aid of an atlas for the presence of narrowed joint space, osteophytes, subchondral sclerosis and subchondral cysts. The radiological prevalence of each feature was then calculated. Demographics and pre-operative measurements were compared between patients with and without radiological evidence of subchondral cysts.Results:Subchondral cysts were only present in 30.6% of the study population. Narrowed joint space was present in 99.5%, osteophytes in 98.1% and subchondral sclerosis in 88.3% of all radiographs. The differences in prevalence were statistically significant. There was a higher proportion of females in patients with radiological evidence of subchondral cysts. These patients also had a greater varus deformity preoperatively.Conclusion:With a radiological prevalence of 30.6%, subchondral cysts should not be considered a cardinal radiological feature of osteoarthritis. Subchondral cysts may be associated with the female gender and genu varum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Truth Behind Subchondral Cysts in Osteoarthritis of the Knee

Audrey¹,

Razak²,

Andrew³

2014

TOORTHJ

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“…(4,6) The “bone contusion theory” states that excessive mechanical stress damages trabecular bones, and the area is absorbed and replaced by a cyst. (5,6) In recent studies, Crema et al reported a longitudinal MRI study that showed that bone marrow edema lesions in the subchondral bone eventually changed into a cyst. (10) Durr et al performed finite element analysis and suggested that a subchondral cyst was formed by stress concentration and the subsequent bone resorption.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional analysis of subchondral cysts in hip osteoarthritis: An ex vivo HR-pQCT study

Chiba

Burghardt

Osaki

et al. 2014

Bone

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Introduction Subchondral cysts are deeply related to the pathogenesis of osteoarthritis (OA), but the factors contributing to cyst formation are not well known. A three-dimensional analysis of subchondral cysts at the micro-structural level was conducted using high-resolution peripheral quantitative CT (HR-pQCT), and their relationships with cartilage attrition and subchondral bone microstructure were investigated. Methods Femoral heads extracted from ten female patients with hip OA were scanned using HR-pQCT at a voxel size of 41 μm. The volume fractions, numbers, and sizes of the cysts were measured in the subchondral bone region under the area of cartilage loss. Furthermore, the areas of cartilage loss, as well as the microstructure of the subchondral bones, were also measured, and their correlations with the cysts were analyzed. Results The volume fractions of cysts within subchondral bone regions varied from 2% to 33%, the numbers of cysts varied from 6 to 87, and the sizes varied from 1 mm3 to 657 mm3. There was a positive correlation between the number of cysts and bone volume (r>0.8, p<0.01). Conclusion The degree of cyst formation showed a wide distribution in number and volume, and there was a close relationship between multiple cyst formation and bone sclerosis, which might be caused by reactive bone formation that occurred around each cyst.

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“…Cyst size is typically determined in the image slice with the greatest lesion size [9], via semi-quantitative grading [9, 18, 25–27], or quantitative 2D measurements of maximum diameter [7], or by quantitative 3D volume estimates from three orthogonal slices [8]. Subchondral bone discontinuities, allowing direct communication between the joint space and trabecular bone have been identified [7, 22, 28–30]; however, the extent of such discontinuities and their relationship to bone cysts are unclear. Bone microarchitecture around cysts is sometimes dense at the walls, and then more porous and branched with a relatively normal overall bone volume fraction in surrounding regions, and accompanied by increased porosity of the subchondral bone [19, 31]; however, application of methods developed for regional evaluation of bone [32] to bone cysts have been limited [33].…”

Section: 1 Introductionmentioning

confidence: 99%

Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues

Pallante-Kichura

Cory

Bugbee

et al. 2013

Bone

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The efficacy of osteochondral allografts (OCA) may be affected by osseous support of the articular cartilage, and thus affected by bone healing and remodeling in the OCA and surrounding host. Bone cysts, and their communication pathways, may be present in various locations after OCA insertion and reflect distinct pathogenic mechanisms. Previously, we analyzed the effect of OCA storage (FRESH, 4°C/14d, 4°C/28d, FROZEN) on cartilage quality in fifteen adult goats after 12 months in vivo. The objectives of this study were to further analyze OCA and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral (ScB) and trabecular (TB) bone structure, (2) characterize the location and structure of bone cysts and channels, and (3) assess the relationship between cartilage and bone properties. (1) Overall bone structure after OCA was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCA was lower than Non-Op and other OCA. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCA did not vary compared to Non-Op, but BS/TV was lower. (2) OCA contained “basal” cysts, localized to deeper regions, some “subchondral” cysts, localized near the bone-cartilage interface, and some ScB channels. TB surrounding basal cysts exhibited higher BV/TV than Non-Op. (3) Basal cysts occurred (a) in isolation, (b) with subchondral cysts and ScB channels, (c) with ScB channels, or (d) with subchondral cysts, ScB channels, and ScB erosion. Deterioration of cartilage gross morphology was strongly associated with abnormal μCT bone structure. Evidence of cartilage-bone communication following OCA repair may favor fluid intrusion as a mechanism for subchondral cyst formation, while bone resorption at the graft-host interface without affecting overall bone and cartilage structure may favor bony contusion mechanism for basal cyst formation. These findings suggest that cysts occurring after OCA may result from aberrant mechanobiology due to (1) altered compartmentalization that normally separates overlying cartilage and subchondral bone, either from distinct ScB channels or more general ScB plate deterioration, and (2) bone resorption at the basal graft-host interface.

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The Cysts of Osteoarthritis of the Hip

Cited by 103 publications

References 0 publications

The Truth Behind Subchondral Cysts in Osteoarthritis of the Knee

The Truth Behind Subchondral Cysts in Osteoarthritis of the Knee

Three-dimensional analysis of subchondral cysts in hip osteoarthritis: An ex vivo HR-pQCT study

Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues

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