Morphological features of the synovial membrane in patients with osteoarthritis after knee arthroplasty

HERALD of North-Western State Medical University named after I.I. Mechnikov Pub Date : 2024-07-03 DOI:10.17816/mechnikov629870

A. N. Tkachenko, R. Deev, Aleksandr A. Spichko, D. Mansurov, I. L. Urazovskaya, D. Melchenko, E. V. Presnyakov, Stanislav S. Galkov, N. Gladyshev, Vadim V. Magdalinov, Viachaslav D. Savitski

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Abstract

BACKGROUND: Inflammation of the synovial membrane is a common manifestation in osteoarthritis which plays a role in complex pathophysiology of osteoarthritis. Synovitis leads to complications during knee replacement. AIM: To give clinical and morphological characteristics of the knee joint condition by histological assessment of the synovial membrane. MATERIALS AND METHODS: In the clinic of traumatology and orthopedics of North-Western State Medical University named after I.I. Mechnikov in 2022, 187 total knee arthroplasty operations were performed in patients with osteoarthritis. For morphological study of the synovial membrane of the knee joint biopsy specimens were taken from 30 patients (19 women and 11 men) by randomized sampling method. The age of patients: from 40 to 76 years, the average age was 59,3 ± 6,7 years. Immunohistochemical reactions were performed to characterize the cellular composition of the inflammatory infiltrate; antibodies to CD68, CD3, CD20, CD138, Ki-67 were used. Morphometry was performed at ×400 magnification. RESULTS: Only 48 (25.7%) patients had at least one course of inpatient conservative or minimally invasive surgical treatment for osteoarthritis of the knee joint before total knee arthroplasty. 18 (9.6%) patients had intraoperative and postoperative complications. Among 30 morphological studies conducted, 3 (10%) patients had verified stage I osteoarthritis of the knee joint, 8 (26.7%) were diagnosed with stage II osteoarthritis, and 19 (63.3%) — stage III osteoarthritis. Significant correlation was obtained between cells stained with antibodies to CD3 and CD20 (r = 0.69; p 0.05), CD68 and CD138 (r = 0.66; p 0.05). Cluster analysis identified three groups of patients with severe (10%), moderate (30%) and weak/absent infiltration (60%). CONCLUSIONS: To correct the treatment strategy for patients with osteoarthritis of the knee joint, it is advisable to strengthen the role of arthroscopic methods in the diagnostic and treatment processes.

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膝关节置换术后骨关节炎患者滑膜的形态特征

背景：滑膜炎症是骨关节炎的常见表现，在骨关节炎复杂的病理生理学中起着重要作用。滑膜炎会导致膝关节置换术中的并发症。目的：通过滑膜组织学评估，了解膝关节的临床和形态特征。材料与方法：2022 年，以 I.I. Mechnikov 命名的西北国立医科大学创伤骨科诊所为骨关节炎患者实施了 187 例全膝关节置换手术。为了对膝关节滑膜的形态进行研究，采用随机抽样的方法从 30 名患者（19 名女性和 11 名男性）中抽取了活检标本。患者年龄从 40 岁到 76 岁不等，平均年龄为 59.3 ± 6.7 岁。免疫组化反应用于确定炎症浸润的细胞组成特征；使用的抗体包括 CD68、CD3、CD20、CD138 和 Ki-67。以 ×400 倍率进行形态测量。结果：只有 48 例（25.7%）患者在接受全膝关节置换术前至少接受过一次膝关节骨关节炎住院保守或微创手术治疗。18（9.6%）名患者出现了术中和术后并发症。在进行的 30 项形态学研究中，3 例（10%）患者被证实为膝关节骨性关节炎 I 期，8 例（26.7%）被诊断为骨性关节炎 II 期，19 例（63.3%）为骨性关节炎 III 期。用 CD3 和 CD20（r = 0.69；P 0.05）、CD68 和 CD138（r = 0.66；P 0.05）抗体染色的细胞之间存在显著相关性。聚类分析确定了重度（10%）、中度（30%）和弱/无浸润（60%）三组患者。结论：为了纠正膝关节骨性关节炎患者的治疗策略，最好加强关节镜方法在诊断和治疗过程中的作用。

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HERALD of North-Western State Medical University named after I.I. Mechnikov

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