Enhanced surgical treatments for hip osteoarthritis

全世界有超过8000万患者患有髋关节骨关节炎，越来越多的患者需要全髋关节置换手术。这被认为是一种成功的干预措施，然而，随着人口老龄化，骨科治疗需求的增加，肥胖水平和患者期望的增加，以及医疗保健预算和手术培训的减少，这一成功正面临挑战。年轻患者对手术治疗的需求也在增加，这将推迟髋关节置换手术的需要，这些干预措施可以重塑骨骼并修复软组织。自然髋关节和髋关节置换术失败的主要原因之一是撞击，在股骨侧的骨头和髋关节窝或髋关节置换术部件之间有一个机械基台。在自然髋关节中，手术重塑骨骼可以减少这种撞击，软组织损伤可以修复；然而，骨移除量的影响尚不清楚，也不是修复软组织的最佳方法。在翻修手术中，需要从患者身上取出并换上新髋关节的数量正在增加；由于撞击造成的杯缘损伤也经常被提及。众所周知，如果组件之间没有很好地相互对齐，或者相对于体内所经历的负载方向，则更有可能发生这种情况。在这个建议中，我试图通过消除对撞击的担忧来确保早期干预和髋关节置换手术的长期结果始终是最佳的。为此，我将开发一个实验性解剖髋关节模拟器。模拟器将对髋关节施加类似于临床观察到的负荷和运动，并包括模仿自然髋关节的高保真模型，其中也可以植入髋关节替代部件。该解剖模拟器将用于评估与患者相关的变量（例如骨骼几何形状）、早期干预手术的程度（例如移除的骨量）或假体的设计以及髋关节在体内的对齐方式等变量如何影响撞击的可能性。这种对影响撞击可能性和严重程度的因素的更好理解将有助于更好地指导如何进行手术，以提供最佳结果。我将与骨科医生合作，将这种改进的理解整合到他们的临床实践中，并与骨科公司合作，将研究结果整合到新产品开发过程中；因此，未来的干预措施和设备可以设计为所有患者提供更好的结果。

Over 80 million patients worldwide suffer from hip osteoarthritis, and increasing numbers of patients are requiring total hip replacement surgery. This is considered to be a successful intervention, however, an ageing population with increasing orthopaedic treatment needs, greater levels of obesity and patient expectations, and reducing healthcare budgets and surgical training are conspiring to challenge this success. There is also increasing demand for surgical treatments in younger patients that will delay the need for hip replacement surgery, these interventions reshape bone and repair soft tissue.One of the major causes of failure in the natural hip and in hip replacements is impingement, where there is a mechanical abutment between bone on the femoral side and hip socket or hip replacement components. In the natural hip, surgery reshaping the bone can reduce this impingement and soft tissue damage can be repaired; however, the effects of the amount of bone that is removed is not well understood nor is the best way to repair soft tissue. The number of hip replacements needing to be removed from patients and replaced with a new one in revision surgery is increasing; damage to the cup rim because of impingement is often implicated. It is known that this is more likely if the components are not well aligned relative to each another, or relative to the load direction experienced in the body. In this proposal, I seek to ensure long term outcomes of early intervention and hip replacement surgery are always optimum by negating concerns about impingement. To do this, I will develop an experimental anatomical hip simulator. The simulator will apply loads and motions to the hip similar to those observed clinically, and include high fidelity phantoms that mimic the natural hip, into which hip replacement components can also be implanted. This anatomical simulator will be used to assess how variables such as those associated with the patient (e.g. their bony geometry), the extent of early intervention surgery (e.g. the amount of bone removed) or the design of the prosthesis and how the hip is aligned in the body will affect the likelihood of impingement. This improved understanding of factors affecting the likelihood and severity of impingement will enable better guidance on how the surgery should be performed to optimise outcomes to be provided. I will work with orthopaedic surgeons to integrate this improved understanding into their clinical practice and with an orthopaedic company to integrate the findings into new product development processes; so that future interventions and devices can be designed to provide better outcomes for all patients.