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Rheumatology Advance Access originally published online on September 26, 2006
Rheumatology 2007 46(3):523-528; doi:10.1093/rheumatology/kel302
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Synovial fluid metabolites in osteonecrosis

K. M. Huffman, J. R. Bowers1, Z. Dailiana2, J. L. Huebner3, J. R. Urbaniak1 and V. B. Kraus3

Physical Medicine and Rehabilitation Service, Durham Veterans Affairs Medical Center, 1Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, 2Department of Orthopaedic Surgery, Medical School, University of Thessalia, 41222 Larissa, Greece and 3Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham NC, USA.

Correspondence to: Virginia Byers Kraus, MD, PhD, Box 3416, Duke University Medical Center, Durham, NC 27710, USA. E-mail: vbk{at}duke.edu


  Abstract

Objectives. Osteonecrosis of the femoral head results from interruption of the vascular supply and eventual death of the cellular portion of bone. Effective methods of monitoring response to treatment are needed. Our aim was to evaluate synovial fluid metabolites, glucose and lactate, as biomarkers in a canine model of osteonecrosis.

Methods. Osteonecrosis was cryosurgically induced in the right femoral head while the left hip served as control (n = 31). Animals either underwent no further intervention (n = 10), vascular endothelial growth factor (VEGF) injections (n = 4), placement of a vascularized bone graft (n = 6), a combination of VEGF microinjection and vascularized graft placement (n = 5), or treatment with daily oral alendronate (n = 6). After 12 weeks, synovial fluid from each hip joint was obtained for glucose and lactate concentrations.

Results. Joints with surgically induced osteonecrosis demonstrated decreased synovial fluid concentrations of glucose (P < 0.05) and elevated concentrations of lactate (P < 0.05) relative to contralateral control hips. When animals were treated with VEGF, the vascularized graft placement, or vascularized graft and VEGF, there were no differences in the synovial fluid concentrations of these metabolites between cryoablated and control hips. In contrast, alendronate did not normalize the concentration of these synovial fluid metabolites in the cryoablated hips.

Conclusions. Osteonecrosis of the femoral head is associated with alterations in synovial fluid glucose and lactate, reflecting anaerobic metabolism. These metabolites may serve as useful tools for monitoring response to revascularization therapies.

KEY WORDS: Osteonecrosis, Synovial fluid, Synovial fluid metabolites, Glucose, Lactate, Vascular endothelial growth factor, Vascularized bone graft, Alendronate, Canine model

Submitted 17 April 2006; revised version accepted 18 July 2006.
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