Personal Surgical Planning to Avoid Hip Dislocation after Total Hip Arthroplasty: Concept of Functional Safe Zone.

项目摘要： 这项建议解决了关于术后髋关节脱位原因的知识缺口， 在美国，相关的年费用超过约5亿美元。 股骨头被挤出髋臼窝。全髋关节置换术后人工股骨头脱位 关节成形术被认为发生在假体的最大活动范围小于功能范围时 进行日常活动所需的髋关节运动。特别是，非最佳髋臼和股骨部件 取向（例如，外展和前倾），这对每个患者来说都是独特的，可能导致这种不匹配。 在日常生活活动期间，髋臼和股骨方向随自然3D骨盆倾斜而变化， 需要倾斜。骨盆倾斜本身也会随着退行性椎间盘疾病的进展而改变 或是因为脊椎手术骨盆倾斜在文献中很少受到关注。目前，双方 传统的和计算机辅助的全髋关节置换术是由二维（2D） 髋臼植入物前倾的安全区;该2D安全区于1978年开发，需要更新。 我的工作假设是，在日常活动中，骨盆在所有三个主平面上的倾斜是主要的原因之一。 影响髋关节脱位率的因素。因此，PI Eslam Pour博士建议开发一种新的个性化 用于整形外科医生的手术计划工具，其将建立最佳植入物组件方向， 每例全髋关节置换术患者。计划工具将针对3D骨盆倾斜范围进行定制 在以下三种常见活动中使用常规腰椎侧位X线片或EOS系统测量 日常生活：站立，坐着和从坐到站的移动。在目标1中，将使用3D计算机模型 开发用于预测任何给定3D骨盆倾斜值的最佳植入物前倾和外展， 在不同的日常活动中所需的运动范围。在Aim 2中，3D创建的新安全区 Aim 1中的计算机模型将使用从患者中收集的图像进行回顾性验证， 全髋关节置换术过程中的EOS成像。一旦经过验证，新工具就可以 用于术前全髋关节置换术手术计划，以降低假体脱位的风险。我们 然后将申请R 01，以在多中心研究中测试这种新的3D安全区模型。埃斯拉姆·普尔博士 在强大的研究环境中组建了一支经验丰富的多学科导师团队。他将 利用这些优秀的资源来满足他的教育需求和职业目标， 教育和辅导包括在这个建议。在一起，培训和研究所支持的， 这项提案将推动他成为一名成功的独立调查员和髋关节置换术的国家领导人 关节成形术研究。

Project Summary: This proposal addresses a knowledge gap concerning the causes of postoperative hip dislocation, a condition with associated annual costs exceeding ~$500 million in the U.S. Hip dislocation occurs when the femoral head is forced out of its acetabular socket. Dislocation of a prosthetic femoral head following total hip arthroplasty is thought to occur when the maximum prosthetic range of motion is less than the functional range of hip motion required to perform daily activities. In particular, non-optimal acetabular and femoral component orientation (e.g., abduction and anteversion), which are unique for each patient, can cause such a mismatch. The acetabular and femoral orientations vary with natural 3D pelvic tilting during activities of daily living that require tilting. The pelvic tilt itself can also change over time with the progression of degenerative disc disease or because of spinal surgeries. The pelvic tilt has received little attention in the literature. Currently, both conventional and computer-assisted total hip arthroplasty are guided by the concept of a 2-dimensional (2D) safe zone for acetabular implant anteversion; this 2D safe zone was developed in 1978 and requires updating. My working hypothesis is that pelvic tilt in all three cardinal planes during daily activities is one of the major factors that affects hip dislocation rate. Thus, PI Dr. Eslam Pour is proposing to develop a new personalized surgical planning tool for orthopedic surgeons that will establish optimal implant component orientations for each total hip arthroplasty patient. The planning tool will be customized for the range of 3D pelvic tilts measured using either regular lateral lumbar radiographs or the EOS system in three common activities of daily living: standing, sitting and moving from sitting-to-standing. In Aim 1, a 3D computer model will be developed to predict the optimal implant anteversion and abduction for any given values of 3D pelvic tilt and the required range of motion in different daily activities. In Aim 2, the new safe zone created by the 3D computer model from Aim 1 will be validated retrospectively using collected images from patients who had pre- and postoperative EOS imaging during their total hip arthroplasty process. Once validated, the new tool can be used for pre-operative total hip arthroplasty surgical planning to reduce the risk for prosthetic dislocation. We will then apply for an R01 to test this new 3D safe zone model in a multicenter study. Dr. Eslam Pour has assembled a highly experienced, multidisciplinary mentorship team in a strong research environment. He will leverage these excellent resources to address his educational needs and career goals by following the detailed educational and mentorship included in this proposal. Together, the training and research supported by this proposal will propel him to become a successful independent investigator and a national leader in hip arthroplasty research.