Abstract
The lubrication of the cartilaginous structures in human joints is provided by a fluid from a specialized layer of cells at the surface of a delicate tissue called the synovial lining. Little is known about the characteristics of the fluids produced after a joint arthroplasty procedure. A literature review was carried out to identify papers that characterized the synovial lining and the synovial fluids formed after total hip or knee arthroplasty. Five papers about synovial lining histology and six papers about the lubricating properties of the fluids were identified. The cells making up the re-formed synovial lining, as well as the lining of interface membranes, were similar to the typical Type A and B synoviocytes of normal joints. The synovial fluids around joint replacement devices were typically lower in viscosity than pre-arthroplasty fluids but the protein concentration and phospholipid concentrations tended to be comparable, suggesting that the lining tissue function was preserved after arthroplasty. The widespread, long-term success of joint arthroplasty suggests that the lubricant formed from implanted joint synovium is adequate for good clinical performance in the majority of joints. The role the fluid plays in component wear or failure is a topic for future study.
Highlights
For the normal cartilage-capped articular joint, lubrication of the bony, cartilaginous, ligamentous, and fibrous tissue structures is provided by a fluid produced from a specialized layer of cells found at the surface of a delicate tissue called the synovial lining
The study by Goldring et al [17] was the first which characterized the new membrane that formed at the bone-cement interface into three distinct histological zones: (1) a synovial-like layer of lining cells at the cement surface; (2) sheets of histiocytes and giant cells in the subintima; and (3) a fibrous layer that blended into the bone and becomes continuous with the adjacent bone marrow
There was a surprising lack of studies on implanted synovial tissue and the lubricating fluid it produces, that tissue presumably plays an important role in the tribology and success of joint arthroplasty
Summary
For the normal cartilage-capped articular joint, lubrication of the bony, cartilaginous, ligamentous, and fibrous tissue structures is provided by a fluid produced from a specialized layer of cells found at the surface of a delicate tissue called the synovial lining (from ovum or egg, because of the similarity with egg white). This synovial tissue is composed of specialized layers of cells starting at the outermost (joint-facing) level with the intima, which overlies a vascular subintimal layer, and is supported by a fibrous stroma forming the joint capsule [1,2,3]. The synovial tissue of an aged individual with osteoarthritis will look very different grossly and microscopically from that of a healthy young individual
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