Factors Affecting Intraosseous Pressure Measurement

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2018 Jul 30

PMID 30055642

Citations 10

Authors

Michael Beverly

David Murray

Affiliations

Soon will be listed here.

Abstract

Background: Although a raised intraosseous pressure (IOP) has been found in osteoarthritis and osteonecrosis, the normal physiology of subchondral circulation is poorly understood. We developed an animal model and explored the physiology of normal subchondral perfusion and IOP.

Methods: In 21 anaesthetised rabbits, 44 intraosseous needles were placed in the subchondral bone of the femoral head (n = 6), femoral condyle (n = 7) or proximal tibia (n = 31). Needles were connected to pressure transducers and a chart recorder. In 14 subjects, the proximal femoral artery and vein were clamped alternately. In five subjects, arterial pressure was measured simultaneously in the opposite femoral artery.

Results: The average IOP at all 44 sites was 24.5 mmHg with variability within SD 6.8 and between subjects SD 11.5. IOP was not significantly influenced by gender, weight, site or size of a needle. Needle clearance by flushing caused a prolonged drop in IOP whereas after clearance by aspiration, recovery was rapid. IOP recordings exhibited wave patterns synchronous with the arterial pulse, with respiration and with drug circulation time. There was a correlation between IOP and blood pressure (13 sites in 5 subjects, Pearson correlation 0.829, p < 0.0005). There was a correlation between IOP and the associated pulse pressure (PP) in 44 sites among 21 subjects (Pearson correlation 0.788, p < 0.001). In 14 subjects (31 sites), arterial occlusion caused a significant reduction in IOP and loss of PP (p < 0.0001). Venous occlusion significantly raised IOP with preservation of the PP (p < 0.012).

Conclusion: Our study shows that subchondral cancellous bone behaves as a perfused tissue and that IOP is mainly a reflection of arterial supply. A single measure of IOP is variable and reflects only perfusion at the needle tip rather than being a measure of venous back pressure. Alternate proximal vessel clamping offers a new means of exploring the physiology of subchondral perfusion. We describe a model that will allow further study of IOP such as during loading.

Citing Articles

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Beverly M, Murray D JBJS Rev. 2023; 11(12).

PMID: 38100622 PMC: 10720793. DOI: 10.2106/JBJS.RVW.23.00040.

Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy.

Huang X, Zheng L, Dai Y, Hu S, Ning W, Li S Front Bioeng Biotechnol. 2023; 11:1056707.

PMID: 36873351 PMC: 9978480. DOI: 10.3389/fbioe.2023.1056707.

Subchondral physiology and vasculo-mechanical factors in load transmission and osteoarthritis.

Beverly M, Murray D Bone Joint Res. 2021; 10(9):571-573.

PMID: 34470462 PMC: 8479564. DOI: 10.1302/2046-3758.109.BJR-2021-0031.R1.

Hypertension meets osteoarthritis - revisiting the vascular aetiology hypothesis.

Ching K, Houard X, Berenbaum F, Wen C Nat Rev Rheumatol. 2021; 17(9):533-549.

PMID: 34316066 DOI: 10.1038/s41584-021-00650-x.

Changes in bone density, intraosseous pressure of distal femoral articular cartilage and subchondral bone after proximal femoral medullary cavity cement filling in rabbits.

Le G, Xi L, Zhang M, Zhao J Exp Ther Med. 2021; 22(2):839.

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References

Uchio Y, Ochi M, Adachi N, Nishikori T, Kawasaki K . Intraosseous hypertension and venous congestion in osteonecrosis of the knee. Clin Orthop Relat Res. 2001; (384):217-23. DOI: 10.1097/00003086-200103000-00025. View

ARNOLDI C, Linderholm H, MUSSBICHLER H . Venous engorgement and intraosseous hypertension in osteoarthritis of the hip. J Bone Joint Surg Br. 1972; 54(3):409-21. View

Green N, Griffin P . Intra-osseous venous pressure in Legg-Perthes disease. J Bone Joint Surg Am. 1982; 64(5):666-71. View

Ficat R . Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 1985; 67(1):3-9. DOI: 10.1302/0301-620X.67B1.3155745. View

Ho K, Hu H, Colletti P, Powers C . Running-induced patellofemoral pain fluctuates with changes in patella water content. Eur J Sport Sci. 2013; 14(6):628-34. DOI: 10.1080/17461391.2013.862872. View

Taylor C, Clarke N . Amputation and intraosseous access in infants. BMJ. 2011; 342:d2778. DOI: 10.1136/bmj.d2778. View

Salzman J, Loken N, Wewerka S, Burnett A, Zagar A, Griffith K . Intraosseous Pressure Monitoring in Healthy Volunteers. Prehosp Emerg Care. 2017; 21(5):567-574. DOI: 10.1080/10903127.2017.1302529. View

Verbruggen S, Vaughan T, McNamara L . Fluid flow in the osteocyte mechanical environment: a fluid-structure interaction approach. Biomech Model Mechanobiol. 2013; 13(1):85-97. DOI: 10.1007/s10237-013-0487-y. View

Wilkes C, VISSCHER M . Some physiological aspects of bone marrow pressure. J Bone Joint Surg Am. 1975; 57(1):49-57. View

10.

Simkin P . Marrow fat may distribute the energy of impact loading throughout subchondral bone. Rheumatology (Oxford). 2017; 57(3):414-418. PMC: 5850356. DOI: 10.1093/rheumatology/kex274. View

11.

Cardoso L, Fritton S, Gailani G, Benalla M, Cowin S . Advances in assessment of bone porosity, permeability and interstitial fluid flow. J Biomech. 2012; 46(2):253-65. PMC: 3735900. DOI: 10.1016/j.jbiomech.2012.10.025. View

12.

Hungerford D, Lennox D . The importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment. Orthop Clin North Am. 1985; 16(4):635-54. View

13.

Pedersen N, Kiaer T, Kristensen K, Starklint H . Intraosseous pressure, oxygenation, and histology in arthrosis and osteonecrosis of the hip. Acta Orthop Scand. 1989; 60(4):415-7. DOI: 10.3109/17453678909149309. View

14.

Miyanishi K, Yamamoto T, Irisa T, Yamashita A, Jingushi S, Noguchi Y . Bone marrow fat cell enlargement and a rise in intraosseous pressure in steroid-treated rabbits with osteonecrosis. Bone. 2002; 30(1):185-90. DOI: 10.1016/s8756-3282(01)00663-9. View

15.

De Lorenzo R, Ward J, Jordan B, Hanson C . Relationships of intraosseous and systemic pressure waveforms in a Swine model. Acad Emerg Med. 2014; 21(8):899-904. DOI: 10.1111/acem.12432. View

16.

Drescher W, Li H, Jensen S, Ingerslev J, Hansen E, Hauge E . The effect of long-term methylprednisolone treatment on the femoral head in growing pigs. J Orthop Res. 2002; 20(4):662-8. DOI: 10.1016/S0736-0266(01)00183-8. View

17.

Azuma H . INTRAOSSEOUS PRESSURE AS A MEASURE OF HEMODYNAMIC CHANGES IN BONE MARROW. Angiology. 1964; 15:396-406. DOI: 10.1177/000331976401500903. View

18.

Frascone R, Salzman J, Adams A, Bliss P, Wewerka S, Dries D . Evaluation of intraosseous pressure in a hypovolemic animal model. J Surg Res. 2014; 193(1):383-90. DOI: 10.1016/j.jss.2014.07.007. View