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. 2019 Jan 5;20(1):14.
doi: 10.1186/s12891-018-2388-9.

Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

Wadena D Burnett  1 , Saija A Kontulainen  1 , Christine E McLennan  2 , Diane Hazel  2 , Carl Talmo  2 , David R Wilson  3 , David J Hunter  4 , James D Johnston  5
Affiliations

Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

Wadena D Burnett et al. BMC Musculoskelet Disord. .

Abstract

Background: Subchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. The objective of this study was to use QCT-based image-processing techniques to characterize subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA.

Methods: The preoperative knee of 42 knee arthroplasty patients was scanned using QCT. Patient characteristics were obtained, including OA severity, knee pain, JSN, and alignment. We used 3D image processing techniques to obtain cyst parameters including: cyst number, cyst number per proximal tibial volume, cyst volume per proximal tibial volume, as well as maximum and average cyst volume across the proximal tibia, as well as regional bone mineral density (BMD) excluding cysts. We used Spearman's correlation coefficients to explore associations between patient characteristics and cyst parameters.

Results: At both the medial and lateral compartments of the proximal tibia, greater cyst number and volume were associated with higher BMD. At the lateral region, cyst number and volume were also associated with lateral OA severity, lateral JSN, alignment and sex. Pain was not associated with any cyst parameters at any region.

Conclusion: Cyst number and volume were associated with BMD at both the medial and lateral compartments. Lateral cyst number and volume were also associated with joint alignment, OA severity, JSN and sex. This is the first study to use clinical QCT to explore subchondral tibial cysts in patients with knee OA and provides further evidence of the relationships between subchondral cysts and clinical OA characteristics.

Keywords: Bone mineral density; Computed tomography; Osteoarthritis; Tibia.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Research Board of the New England Baptist Hospital. Informed written consent was obtained from all study participants.

Consent for publication

Not applicable

Competing interests

JDJ is a member of the Editorial Board of BMC Musculoskeletal Disorders. The other authors have nothing to declare. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Process for identifying, isolating, and measuring cysts included isolating the subchondral region of 7.5 mm from the subchondral surface (a), cyst identification on CT images (b), and segmenting individual cysts using semi-automatic region growing for larger cysts manual segmentation for smaller cysts (c). Segmented image volumes were then used to measure cyst parameters, and regional BMD excluding cysts which included total, lateral, and medial regions (d)
See this image and copyright information in PMC

References

    1. Javaid MK, Kiran A, Guermazi A, Kwoh CK, Zaim S, Carbone L, et al. Individual magentic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain. Arthritis Rheum. 2012;64(10):3246–3255. doi: 10.1002/art.34594. - DOI - PMC - PubMed
    1. Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Hunter DJ, et al. Knee osteoarthritis patients with severe nocturnal pain have altered proximal tibial subchondral bone mineral density. Osteoarthr Cartil. 2015;23(9):1483–1490. doi: 10.1016/j.joca.2015.04.012. - DOI - PubMed
    1. Burnett W, Kontulainen S, McLennan C, Hazel D, Talmo C, Hunter D, et al. Response to letter to the editor: 'Is subchondral bone mineral density associated with nocturnal pain in knee osteoarthritis patients?'. Osteoarthr Cartil. 2015;23(12):2299–2301. doi: 10.1016/j.joca.2015.06.015. - DOI - PubMed
    1. McErlain DD, Milner JS, Ivanov TG, Jencikova-Celerin L, Pollmann SI, Holdsworth DW. Subchondral cysts create increased intra-osseous stress in early knee OA: a finite element analysis using simulated lesions. Bone. 2011;48(3):639–646. doi: 10.1016/j.bone.2010.11.010. - DOI - PubMed
    1. Chiba K, Burghardt AJ, Osaki M, Majumdar S. Three-dimensional analysis of subchondral cysts in hip osteoarthritis: an ex vivo HR-pQCT study. Bone. 2014;66:140–145. doi: 10.1016/j.bone.2014.06.001. - DOI - PMC - PubMed

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