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PEARLS & PITFALLS – SURGICAL TECHNIQUE
The Pre Osteoarthritic Joint in Hip FAI: Is There a Role for Biomarkers?
Cecilia Pascual-Garrido, MD
Hip Preservation Center, Division of Sport Medicine University of Colorado Boulder, CO, USA
Additional Author:
Omer Mei-Dan, MD
Hip Preservation Center, Sport Medicine University of Colorado
Boulder, CO, USA
Treatment of the pre-osteoarthritic joint disease is a new concept, which emphasizes the need of preventive strategies that will modify the course of a disease. Femoroacetabular impingement (FAI) is one of the most common mechanisms that lead to the development of early cartilage and labral damage in the non-dysplastic hip. Currently, surgical treatment of FAI is an effective, reliable, and safe method to relieve pain and improve function at short- to mid- term follow-up in patients without significant OA (osteoarthritis). However, when the procedure is done many of the joints have already entered the pre-osteoarthritic phase.
Early-stage or pre osteoarthritic disease is clinically silent in that structural changes typically precede clinical signs and symptoms of pain, deformity, functional limitations and disability. Metabolic changes in articular cartilage, synovium and subchondral bone may represent the earliest measurable changes in pre-OA conditions.
As such, identification and validation of biomarkers for pre-OA states at risk joints may have wide application in clinical trials of new intervention strategies. The ability to observe early and reversible cartilage damage supports the development of disease-modifying osteoarthritis drugs (DMOADs) such as P-188 or anticaspases (Fig. 1).
Many biomarkers of inflammation and cartilage turnover have been used to study the progression of OA. Particularly in Hip FAI, biomarkers have been shown to be elevated, suggesting that the cartilage from these patients is already being affected by this condition.
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In the near future, we will stratify patients with regards to clinical, biomechanical, genetic and epigenetic profiles. For example, patients with symptomatic FAI could be stratified using biomarkers of cartilage disease and high-resolution MRI sequences combined with quantitative MR techniques that will provide accurate assessment of the cartilage tissue biochemistry. These patients, if shown to have already developed a “pre- osteoarthritic condition”, could then be offered a surgical treatment, coupled with DMOADs (disease- modifying osteoarthritis drugs) that could potentially reverse their cartilage to a healthy state.
That, in turn, will increase the chances of both post surgical symptomatic improvement and the prevention of future OA, compared with untreated patients with a pre-osteoarthritic condition.
Anti-apoptotic drugs applied immediately following acute injury reduce the development of post-traumatic cartilage degeneration and promote cell survival after a single impact to human ankle cartilage
20 ISAKOS NEWSLETTER 2015: Volume I
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01 Fig 1a
02 Fig 1b
Cartilage explant 7 days post injury. Note the great amount of dead cells (red cells), evident in all superficial, medial and deep layer.
When cartilage was pre-treated with P-188 before trauma, the dead cells are only evident
in the superficial layer, suggesting the potential for prevention of cartilage degeneration after cartilage trauma.