Histological Findings of Bone Marrow Lesions on Magnetic Resonance Images in Patients with Varus Knee Osteoarthritis

Bone marrow lesions (BMLs) on magnetic resonance (MR) images in knee osteoarthritis patients are considered to predict the severity and progression of the disease. We evaluated the histological findings of BMLs on MR images of the subchondral area of the medial femoral condyle in varus osteoarthritic knees. In 24 patients with varus knee osteoarthritis who underwent total knee arthroplasty (TKA), sagittal T1- and T2-weighted MR images of the affected knee were acquired before TKA. During TKA, resected bone pieces from the distal medial femoral condyle were obtained. Sagittal specimens obtained from the center of the bone pieces were histologically examined. Twenty patients had BMLs. Histological findings of BMLs in the subchondral area showed various features, such as fibrovascular tissue, cyst formation, active bone remodeling with bone formation and bone resorption, and hyaline cartilage. BMLs were not found in four patients;histological findings of these patients showed normal bone marrow tissue with normal-thickness trabeculae. Subchondral bony end plate in knees with BMLs was usually thin or destroyed, while that without BMLs was thick or normal. The condition of the subchondral bony end plate would explain the differences in the severity and progression between patients with or without BMLs.

Influence of Psychiatric Problems on Clinical Outcomes during the First 12 Months after Primary Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a useful treatment option for advanced knee osteoarthritis. Excellent clinical outcomes after TKA have been widely recognized, but the influence of psychiatric problems on them has not been focused on until quite recently. This study aimed to assess the influence of psychiatric problems on clinical outcomes after TKA in Japanese patients using two assessment scales developed in Japan because the Japanese cultural lifestyle is specifically characterized by bending to the floor and standing up. Methods: Clinical outcomes and psychiatric problems were evaluated using the Japanese Knee Osteoarthritis Measure (JKOM) and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP), respectively. A total of 115 TKA patients were evaluated preoperatively and at 3, 6, and 12 months after TKA. The patients were classified into four groups (groups A-D) based on the BS-POP score. The JKOM scores were then compared between the two groups (groups A and D) with the worst and least psychiatric problems. The JKOM improvement rate between pre- and postoperative status in both groups A and D was also calculated. Results: The total JKOM score was significantly poorer in group A than in group D preoperatively and at 3, 6, and 12 months after TKA. The improvement rate showed no significant difference between groups A and D. Conclusion: Psychiatric problems influence both the poorer post- and preoperative clinical outcomes. However, a similar improvement rate in both groups A and D has indicated that TKA can be an effective treatment even for patients with psychiatric problems.