Synovial tissue perivascular edema is associated with altered gait patterns in patients with knee osteoarthritis

H T Philpott; M M Carter; T B Birmingham; R Pinto; C A Primeau; J R Giffin; B A Lanting; C T Appleton

doi:10.1016/j.joca.2021.10.013

Synovial tissue perivascular edema is associated with altered gait patterns in patients with knee osteoarthritis

Osteoarthritis Cartilage. 2022 Jan;30(1):42-51. doi: 10.1016/j.joca.2021.10.013. Epub 2021 Nov 10.

Authors

H T Philpott¹, M M Carter², T B Birmingham³, R Pinto⁴, C A Primeau⁵, J R Giffin⁶, B A Lanting⁷, C T Appleton⁸

Affiliations

¹ Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada. Electronic address: hphilpo2@uwo.ca.
² Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada. Electronic address: mcarte46@uwo.ca.
³ Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada. Electronic address: tbirming@uwo.ca.
⁴ Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada. Electronic address: rpinto7@uwo.ca.
⁵ Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada. Electronic address: cprimea@uwo.ca.
⁶ Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada. Electronic address: rgiffin@uwo.ca.
⁷ Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada. Electronic address: Brent.Lanting@lhsc.on.ca.
⁸ Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada. Electronic address: tom.appleton@sjhc.london.on.ca.

PMID: 34774789
DOI: 10.1016/j.joca.2021.10.013

Abstract

Objective: To explore mechanisms of mechanoinflammation, we investigated the association between the presence of knee synovial perivascular edema and gait biomechanics that serve as surrogate measures of knee load in patients with knee osteoarthritis (OA).

Design: Patients with symptomatic, radiographic knee OA and neutral to varus alignment undergoing total knee arthroplasty or high tibial osteotomy participated in this cross-sectional analysis. All participants underwent 3D gait analysis prior to surgery. Synovial biopsies were obtained during surgery for histopathological assessment. The association between the presence of synovial perivascular edema (predictor) and the external knee moment (outcome) in each orthogonal plane was analyzed using multivariate linear regression and polynomial mixed effects regression models, while adjusting for age, sex, BMI, and gait speed.

Results: Ninety-two patients with complete gait and histopathological data were included. When fitted over 100% of stance, regression models indicated substantial differences between patients with and without synovial perivascular edema for knee moments in frontal, sagittal and transverse planes. The knee adduction moment was higher in patients with edema from 16 to 74% of stance, with the largest difference at 33% of stance (β = 6.87 Nm [95%CI 3.02, 10.72]); whereas the knee flexion-extension moment differed from 15 to 92% of stance, with the largest difference in extension at 60% of stance (β = -10.80 Nm [95%CI -16.20, -5.40]).

Conclusions: In patients with knee OA, the presence of synovial perivascular edema identified by histopathology is associated with aberrant patterns of knee loading throughout stance, supporting the link between biomechanics and synovial inflammation.

Keywords: Gait biomechanics; Inflammation; Osteoarthritis; Perivascular edema; Synovium.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Biomechanical Phenomena
Cross-Sectional Studies
Edema / complications
Edema / physiopathology*
Female
Gait*
Humans
Male
Middle Aged
Osteoarthritis, Knee / complications
Osteoarthritis, Knee / physiopathology*
Synovial Membrane*

Grants and funding

CIHR/Canada