Histomorphometrical features of the ankle synovium in diabetic neuroosteoarthropathy complicated by chronic osteomyelitis

Abstract

The role of the synovium in the pathogenesis of the Charcot foot is not properly studied; there is no information on its histomorphometric features. The aim of the study was to investigate the histomorphometric features of the synovial membrane in patients with diabetic neuroosteoarthropathy complicated by chronic osteomyelitis. Material and methods. Osteochondral fragments and fragments of the articular capsule of the ankle joint obtained from 35 patients were examined. Group 1 included patients with diabetic neuroosteoarthropathy accompanied by chronic osteomyelitis in the acute stage (n=26). Group 2 included patients suffering from diabetic neuroosteoarthropathy with chronic osteomyelitis in remission (n=9). The control group included individuals who did not suffer from diabetes mellitus and diseases of the musculoskeletal system (n = 7); the synovial membrane obtained during their autopsy was used for comparison. Histomorphometry was performed on paraffin and semi-thin sections stained with hematoxylin and eosin, as well as Masson trichrome stain, using an AxioScope.A1 microscope and Zenblue software (Carl Zeiss MicroImaging GmbH, Germany). Results. In patients of group 1, high-grade synovitis and hyperplasia of the integumentary layer were registered. In patients of group 2, mild synovitis and fibrosis of the integumentary layer were noted. In both groups, histological signs of microcirculation disorders were revealed. In the 1st group, there was an increase in the thickness of the covering layer by 1.5 times compared to the control; in the 2nd group, the values of this parameter were 1.7 times lower compared to the control parameters. In both groups, an increase in the numerical density of microvasculature vessels was recorded, being the most pronounced in patients of Group 1. Conclusion. A histomorphometric study of the synovial membrane of the ankle joints in patients with diabetic neuroosteoarthropathy allowed identifying a number of features of its restructuring in the form of reactive and degenerative-inflammatory changes at different inflammatory stages of chronic osteomyelitis.