Optimising knee therapies through improved population stratification and precision of the intervention

我们的愿景是让膝关节疼痛的患者在正确的时间得到正确的治疗。在英国，三分之一的45岁以上的人寻求骨关节炎的治疗，这种疾病每年花费NHS超过50亿英镑。膝盖是骨关节炎最常见的部位，仅在英格兰就有超过400万患者。随着人口老龄化，人们期望更积极的生活方式，加上对年轻和更活跃患者的治疗需求不断增加，对膝关节退行性变的现有治疗提出了挑战。非常需要有效的早期干预，以延迟或防止全膝关节置换手术的要求。患者的膝关节及其功能方式存在很大的差异，在开发治疗方法时考虑到这种差异非常重要，以便正确的治疗方法可以与正确的患者相匹配。通过这项雄心勃勃的研究计划，我们将开发新的测试方法，将联合收割机实验室模拟和计算机建模相结合，以预测膝关节新疗法的机械性能，并优化其设计和使用。重要的是，这些测试将考虑患者解剖结构和膝关节生物力学的变化，以及器械设计和手术技术的变化。这将使不同的治疗方法或不同的设备变体与不同的患者群体相匹配。这些工具将应用于使用临床数据的现有治疗方法，以帮助验证我们的模型预测是正确的。结果将更好地定义哪些患者将从特定干预中受益，并有助于优化其使用。然后，我们将把这些方法应用于新的和新兴的治疗方法，包括再生设备，以便在进行昂贵的临床试验之前对其进行测试和优化。我们将使用这些例子作为案例研究，以展示新的测试方法如何在产品到达患者之前对其进行优化，我们将与行业，标准机构和监管机构合作，促进这些方法在整个行业的采用。该计划将使患者，NHS以及正在开发膝关节新疗法的不断增长的英国工业和科学基础受益。

Our vision is that patients with knee pain receive the right treatment at the right time.In the UK, one third of people aged over 45 have sought treatment for osteoarthritis, and the disease costs the NHS over £5 billion per year. The knee is the most common site for osteoarthritis, with over four million sufferers in England alone. The aging population with expectations of more active lifestyles, coupled with the increasing demand for treatment of younger and more active patients, are challenging the current therapies for knee joint degeneration. There is a major need for effective earlier stage interventions that delay or prevent the requirement for total knee replacement surgery. There are large variations in patients' knees and the way that they function, and it is important that this variation is taken into account when treatments are developed, so that the right treatment can be matched to the right patient. Through this ambitious programme of research we will develop novel testing methods that combine laboratory-based simulation and computer modelling to predict the mechanical performance of new therapies for the knee and enable their design and usage to be optimised. Importantly these tests will take into account the variation in patients' anatomy and knee biomechanics, as well as variations in device design and surgical technique. This will enable different therapies, or different variants of a device, to be matched to different patient groups.The tools will be applied to existing treatments using clinical data to help validate that our model predictions are correct. The outcomes will better define which patients will benefit from a particular intervention and help optimise their usage. We will then apply the methods to new and emerging treatments, including regenerative devices, so that they can be tested and optimised before costly clinical trials take place. We will use these examples as case studies to demonstrate how the new testing methods can optimise the products before they reach the patient, and we will work with industry, standards agencies and regulators to promote the adoption of these methods across the sector. This programme will benefit patients, the NHS and the growing UK industry and science base that are developing new therapies for the knee.