Research ArticleOsteoarthritis

Analysis of spatial osteochondral heterogeneity in advanced knee osteoarthritis exposes influence of joint alignment

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Science Translational Medicine  23 Sep 2020:
Vol. 12, Issue 562, eaba9481
DOI: 10.1126/scitranslmed.aba9481

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Remediating malalignment

Joint alignment affects cartilage and bone degeneration in osteoarthritis. Haberkamp et al. studied site-specific differences in cartilage and bone damage in patients with knee osteoarthritis. They found that varus malalignment (a deviation of axial alignment of the lower leg) caused reduced load on the lateral compartment of the knee, whereas there was a compensatory increase in medial load, particularly in patients with high body mass index. Results help map the spatial structural changes in cartilage and bone that occur during varus knee osteoarthritis and highlight the potential therapeutic utility of load redistribution.


Osteoarthritis (OA) is considerably affected by joint alignment. Here, we investigate the patterns of spatial osteochondral heterogeneity in patients with advanced varus knee OA together with clinical data. We report strong correlations of osteochondral parameters within individual topographical patterns, highlighting their fundamental and location-dependent interactions in OA. We further identify site-specific effects of varus malalignment on the lesser loaded compartment and, conversely, an unresponsive overloaded compartment. Last, we trace compensatory mechanisms to the overloaded subarticular spongiosa in patients with additional high body weight. We therefore propose to consider and to determine axial alignment in clinical trials when selecting the location to assess structural changes in OA. Together, these findings broaden the scientific basis of therapeutic load redistribution and weight loss in varus knee OA.

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