Abstract
PurposeThere are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC.MethodsA systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included.ResultsA total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78–1000) and 954 knees (range 408–1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA.ConclusionThe presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty.Level of evidenceIV.
Highlights
Chondrocalcinosis (CC) refers to calcifications of hyaline cartilage and/or fibrocartilage, detected by imaging and/ or histological examination, most frequently caused by the formation of calcium pyrophosphate (CPP) crystals in the pericellular matrix of the chondrocytes as seen in calcium pyrophosphate deposition (CPPD) disease [1, 2].There is a strong association of chondrocalcinosis with age [3, 4]
Chondrocyte apoptosis, associated with age, contributes to cartilage matrix degradation and OA and to an increase in substrate production required for the formation of CPP crystals [11,12,13]
The major findings of this systematic review showed that chondrocalcinosis does not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA in the other compartments after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA)
Summary
Chondrocalcinosis (CC) refers to calcifications of hyaline cartilage and/or fibrocartilage, detected by imaging and/ or histological examination, most frequently caused by the formation of calcium pyrophosphate (CPP) crystals in the pericellular matrix of the chondrocytes as seen in calcium pyrophosphate deposition (CPPD) disease [1, 2]. There is a strong association of chondrocalcinosis with age [3, 4]. In patients with end-stage osteoarthritis (OA), the prevalence of histological and/or radiological chondrocalcinosis varies from 30% up to 53% [5, 6]. Chondrocyte apoptosis, associated with age, contributes to cartilage matrix degradation and OA and to an increase in substrate production required for the formation of CPP crystals [11,12,13]. The chondrocytes present in the OA knee are more prone to generate CPP crystals and to cause chondrocalcinosis
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