Legg-Calvé-Perthes disease (LCPD) is a childhood hip disorder of ischemic
osteonecrosis of the femoral head. Hip joint
synovitis is a common feature of LCPD, but the nature and pathophysiology of the
synovitis remain unknown. The purpose of this study was to determine the chronicity of the
synovitis and the inflammatory
cytokines present in the synovial fluid at an active stage of LCPD. Serial MRI was performed on 28 patients. T2-weighted and
gadolinium-enhanced MR images were used to assess synovial effusion and synovial enhancement (
hyperemia) over time. A multiple-
cytokine assay was used to determine the levels of 27 inflammatory
cytokines and related factors present in the synovial fluid from 13 patients. MRI analysis showed fold increases of 5.0 ± 3.3 and 3.1 ± 2.1 in the synovial fluid volume in the affected hip compared to the unaffected hip at the initial and the last follow-up MRI, respectively. The mean duration between the initial and the last MRI was 17.7 ± 8.3 months. The volume of enhanced synovium on the contrast MRI was increased 16.5 ± 8.5 fold and 6.3 ± 5.6 fold in the affected hip compared to the unaffected hip at the initial MRI and the last follow-up MRI, respectively. In the synovial fluid of the affected hips,
IL-6 protein levels were significantly increased (LCPD: 509 ± 519 pg/mL, non-LCPD: 19 ± 22 pg/mL; p = 0.0005) on the multi-
cytokine assay. Interestingly, IL-1β and TNF-α levels were not elevated. In the active stage of LCPD, chronic hip
synovitis and significant elevation of
IL-6 are produced in the synovial fluid. Further studies are warranted to investigate the role of
IL-6 on the pathophysiology of
synovitis in LCPD and how it affects bone healing.