Periarticular changes in association with osteoarthritis in the hip, knee or shoulder

Abstract

The aim of this thesis was to evaluate the presence of degenerative changes in the periarticular tendons in association with osteoarthritis (OA) in the hip, knee or shoulder. Moreover, changes in bone mineral density (BMD) in the hip, spine and calcanei were investigated after total hip arthroplasty (THA). Study I is a case control study comprising 26 patients, in which the macroscopic, histological, morphological and ultrastructural changes in tissue samples from the long head of the biceps and subscapularis tendons of the shoulder were examined. The tendon fibril diameter and histological total degeneration score (TDS) were assessed. The biceps tendon in patients with OA of the shoulder revealed more macroscopic and morphological degenerative changes compared with the control group. This indicates that OA in the shoulder might be associated with tendinopathy in the periarticular tendons. Study II is a case control study comprising 41 patients, in which the histological, morphological and ultrastructural changes in tissue samples from the semitendinosus tendon were examined. The tendon fibril diameter and histological total degeneration score (TDS) were assessed. The semitendinosus tendon in patients with OA of the knee revealed no more degenerative changes compared with the control group. No association was found between the presence of degenerative tendon changes and OA of the knee. Study III is a case control study comprising 100 patients, in which the histological and ultrastructural changes in tissue samples from the gluteus medius (GMED) tendon were examined. The GMED tendon revealed more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients. Furthermore, patients who had previously undergone primary THA through a direct lateral approach revealed more ultrastructural GMED tendon degeneration than patients who had previously undergone THA through a posterior approach. The direct lateral revision group had a higher total degeneration score (TDS) histologically compared with the primary hip OA group. An association was found between the presence of GMED degenerative changes and previous THA but not between GMED degenerative changes and OA of the hip. Study IV is a prospective study comprising 42 patients. BMD was measured in the spine, hip and calcanei before and after THA. BMD decreased postoperatively in both calcanei, in both male and female patients, despite an improvement in physical activity and quality of life as measured with the Tegner activity score and EQ-5D.