Horizontal fissuring at the osteochondral interface: a novel and unique pathological feature in patients with obesity-related osteoarthritis
Horizontal fissuring at the osteochondral interface: a novel and unique pathological feature in patients with obesity-related osteoarthritis
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骨软骨界面的水平裂隙：肥胖相关骨关节炎患者的一种新颖而独特的病理特征
DOI：
10.1136/annrheumdis-2020-216942
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发表时间：
2020-06-01
影响因子：
27.4
通讯作者：
Zheng, Minghao
中科院分区：
文献类型：
--
作者：
Chen, Lianzhi;Yao, Felix;Zheng, Minghao
肥胖是骨关节炎（OA）的一个公认的危险因素。我们的目的是表征骨软骨单位中体重指数（BMI）相关的病理变化，并确定肥胖是否是OA患者早期关节置换术的主要原因。方法我们分析了来自澳大利亚骨科协会国家关节置换术登记处的41 023例患者的BMI与患者接受全膝关节置换术（TKR）的年龄之间的相关性。然后，我们研究了BMI对膝关节胫骨平台病理变化的影响。结果澳大利亚TKR患者中有57.58%为肥胖。超重、肥胖I、II级和肥胖III级患者的TKR分别比体重正常患者早1.89、4.48和8.08年。显微镜检查显示，骨软骨界面水平裂是肥胖相关性骨关节炎的主要病理特征。水平裂缝的频率与主要腔室的BMI增加密切相关。体重指数每增加一个单位（1 kg/m(2)），水平裂缝的几率增加14.7%。84.4%的水平裂缝为肥胖所致。软骨退化减少和软骨下骨微观结构改变也与BMI升高有关。结论骨性关节炎合并肥胖患者的主要病理特征是骨软骨单位界面水平裂。肥胖与较年轻的首次TKR密切相关，这可能是水平裂缝的结果。
Objectives Obesity is a well-recognised risk factor for osteoarthritis (OA). Our aim is to characterise body mass index (BMI)-associated pathological changes in the osteochondral unit and determine if obesity is the major causal antecedent of early joint replacement in patients with OA.Methods We analysed the correlation between BMI and the age at which patients undergo total knee replacement (TKR) in 41 023 patients from the Australian Orthopaedic Association National Joint Replacement Registry. We then investigated the effect of BMI on pathological changes of the tibia plateau of knee joint in a representative subset of the registry.Results 57.58% of patients in Australia who had TKR were obese. Patients with overweight, obese class I & II or obese class III received a TKR 1.89, 4.48 and 8.08 years earlier than patients with normal weight, respectively. Microscopic examination revealed that horizontal fissuring at the osteochondral interface was the major pathological feature of obesity-related OA. The frequency of horizontal fissure was strongly associated with increased BMI in the predominant compartment. An increase in one unit of BMI (1 kg/m(2)) increased the odds of horizontal fissures by 14.7%. 84.4% of the horizontal fissures were attributable to obesity. Reduced cartilage degradation and alteration of subchondral bone microstructure were also associated with increased BMI.Conclusions The key pathological feature in OA patients with obesity is horizontal fissuring at the osteochondral unit interface. Obesity is strongly associated with a younger age of first TKR, which may be a result of horizontal fissures.