Osteoarthritis of the knee joint as a consequence of hydraulic damage to the synovial and osteochondral barriers

¹Yaroslavl State Medical University, Yaroslavl

²K.D. Ushinsky Yaroslavl State Pedagogical University, Yaroslavl

Osteoarthritis (OA) is a chronic, progressive disease characterized by various etiological causes but similar clinical and morphological manifestations and outcomes, fundamentally involving damage to all joint components. The interplay of mechanical factors, inflammation, and altered intra-articular metabolism significantly reduces the efficacy of most existing treatment methods. Currently, no unified therapeutic approach exists that can completely eliminate the disease. Based on an analysis of literature data, a new theory is proposed for the pathogenesis of knee OA: OA as a consequence of hydraulic damage to the synovial and osteochondral barriers. This theory is substantiated by the fact of the non-inflammatory nature of synovial effusion, the development of intra-articular hypertension, and the irreversible alteration of synovial macrophages and chondrocytes. The main pathological processes identified are excessive proliferative changes in the synovial membrane and bone epiphyses, leading to the development of fibrosis, neoosteogenesis, and hyperalgesia. A classification outlining pathogenetic variants and disease phases has been developed. An analysis on the effectiveness of existing therapeutic methods, surgical interventions, and physical rehabilitation has also been conducted.

Keywords: knee joint osteoarthritis, synovial barrier, osteochondral barrier, hydraulic theory, bone marrow edema, intra-articular barrier.

For citation: Noskov S.M., Bashkina A.S., Shepelyaeva L.S., Kolinko A.A. Osteoarthritis of the knee joint as a consequence of hydraulic damage to the synovial and osteochondral barriers. RMJ. 2025;10:21–27. DOI: 10.32364/2225-2282-2025-10-3