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

项目总结： 这项建议解决了关于术后髋关节脱位的原因的知识空白，这是一种情况 相关的年费用在美国超过5亿美元。当股骨脱位时 头部被迫离开髋臼窝。全髋关节术后假体股骨头脱位 当假体的最大活动范围小于功能范围时，就可以进行关节成形术。 进行日常活动所需的髋关节运动。特别是，非最佳髋臼和股骨假体 方位(例如，外展和前倾)对于每个患者来说都是独特的，可能会导致这种不匹配。 在日常生活活动中，髋臼和股骨方向随自然3D骨盆倾斜而变化 需要倾斜。随着退行性间盘疾病的进展，骨盆倾斜本身也会随着时间的推移而改变 或者是因为脊椎手术。骨盆倾斜在文献中很少受到关注。目前，两者 传统的和计算机辅助的全髋关节置换术是由二维(2D)的概念指导的。 髋臼假体前倾安全区这个2D安全区是1978年开发的，需要更新。 我的工作假设是，在日常活动中，骨盆在所有三个基本平面上的倾斜是主要的 影响髋关节脱位率的因素。因此，派博士埃斯兰·普尔建议开发一种新的个性化 骨科医生的外科计划工具，将建立最佳的植入部件方向 每位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 在以下三种常见活动中使用常规腰椎侧位X线片或EOS系统进行测量 日常生活：站着，坐着，从坐着到站着。在目标1中，3D计算机模型将是 开发用于预测任何给定值的3D骨盆倾斜度和外展的最佳种植体前倾和外展 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 来自AIM 1的计算机模型将使用从患者那里收集的图像进行回顾性验证 以及术后全髋关节置换术中的EOS成像。一旦经过验证，新工具就可以 用于全髋关节置换术前的手术计划，以降低假体脱位的风险。我们 然后将申请R01，以在多中心研究中测试这种新的3D安全区模型。埃斯兰·普尔博士已经 在强大的研究环境中组建了一支经验丰富的多学科指导团队。他会的 利用这些优秀的资源来满足他的教育需求和职业目标 这项建议中包括教育和指导。总而言之，由这一项目支持的培训和研究 这项提议将推动他成为一名成功的独立调查员和HIP领域的全国领导者 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.