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

项目概要： 该提案解决了有关术后髋关节脱位（一种病症）原因的知识差距 在美国，每年相关费用超过 5 亿美元 当股骨发生髋关节脱位时 头部被迫脱离髋臼窝。全髋关节假体股骨头脱位 当最大假肢运动范围小于功能范围时，认为会发生关节置换术 进行日常活动所需的髋部运动。特别是髋臼和股骨组件非最佳 每个患者的方向（例如外展和前倾）都是独特的，可能会导致这种不匹配。 在日常生活活动中，髋臼和股骨的方向会随着自然 3D 骨盆倾斜而变化。 需要倾斜。随着退行性椎间盘疾病的进展，骨盆倾斜本身也会随着时间而改变 或由于脊柱手术。骨盆倾斜在文献中很少受到关注。目前，双方 传统和计算机辅助全髋关节置换术均以二维 (2D) 概念为指导 髋臼植入物前倾的安全区；该二维安全区于 1978 年开发，需要更新。 我的工作假设是，日常活动期间所有三个基本平面的骨盆倾斜是主要的影响之一 影响髋关节脱位率的因素。因此，PI 博士 Eslam Pour 建议开发一种新的个性化方法 为骨科医生提供的手术规划工具，可为患者建立最佳的植入部件方向 每个全髋关节置换术患者。规划工具将针对 3D 骨盆倾斜范围进行定制 使用常规侧腰椎X光片或EOS系统在以下三种常见活动中进行测量 日常生活：站立、坐着以及从坐到站的移动。在目标 1 中，3D 计算机模型将是 开发用于预测 3D 骨盆倾斜和任何给定值的最佳植入物前倾和外展 不同日常活动中所需的运动范围。在目标 2 中，3D 创建的新安全区 目标 1 的计算机模型将使用从预先接受过治疗的患者收集的图像进行回顾性验证。 以及全髋关节置换术过程中的术后 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，以减少假体脱位的风险。我们 然后将申请 R01 在多中心研究中测试这个新的 3D 安全区模型。 Eslam Pour 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。他会 通过遵循详细的说明，利用这些优秀的资源来满足他的教育需求和职业目标 该提案中包括教育和指导。共同支持的培训和研究 该提案将促使他成为一名成功的独立调查员和髋关节领域的国家领导者 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.