Enabling Individualised Surgical Treatment of Osteoarthritis

仅在英国，骨关节炎就影响了800多万人，近四分之三的患者报告说有某种形式的持续性疼痛。据估计，英国医疗系统每年花费超过100亿英镑治疗关节炎，损失的工作时间和福利支出带来了显著的额外社会成本。尽管髋关节和膝关节置换手术被认为是成功的，但这些治疗并不适合所有患者，一些设备很早就失败了，需要昂贵且不太成功的翻修手术。仅在英国，每年就有超过1.5万例翻修手术。更年轻、更活跃的患者，以及越来越多的肥胖患者，对这些治疗提出了更高的要求：植入物需要比以往任何时候都更持久，承受更多的极端负荷。有证据表明，个体患者的生物力学和手术选择都会影响这些治疗的结果。改善结果，特别是对于更具挑战性的患者群体，只有更好地将治疗与个别患者的功能需求相匹配才能实现。这项建议将汇集该领域两家世界领先研究机构的互补研究专业知识，以建立必要的证据，使骨性关节炎的治疗更好地适应患者的需求。利兹大学医学和生物工程研究所已经开发出了评估人工关节和自然关节的独特能力和专业知识。其中包括世界上最大的用于实验测试关节置换的学术设施，以及模拟植入物如何在体内发挥作用的计算建模方法。这些能力使植入物的机械性能能够在一系列不同的条件下进行评估，例如研究植入物如何随时间磨损或随着使用而损坏。丹佛大学矫形外科生物力学中心在体内测量患者关节力学方面开发了世界领先的能力，包括在患者进行不同活动时对患者关节成像的方法，以及获得生物力学信息的并行计算方法。这些方法能够得出单个患者髋关节或膝关节上的力和运动，并通过收集许多患者的数据来检查每个人的不同之处。通过将两个小组的专业知识结合起来，这种中心到中心的研究合作将使患者的个体特征(例如，他们的解剖结构和他们如何加载关节)与植入物的机械性能之间的关系得以发展。具体地说，在髋关节方面，我们将结合两个中心开发的方法来评估患者和手术因素如何影响由于设备部件相互挤压或周围骨骼(撞击)或部件对齐方式而导致的髋关节置换早期失败的风险。我们还将研究不同的植入物选择如何影响结果。在膝关节方面，我们将结合方法学来确定患者因素(如膝关节的解剖结构及其在不同活动中的负荷方式)如何影响膝骨性关节炎的早期治疗。我们还将研究更广泛的活动，如蹲下和爬楼梯，对膝关节置换手术结果的影响。这些研究将汇集不同的方法，并为获取和共享数据建立新的途径，这些数据可以被更广泛地采用，并在未来应用于其他肌肉骨骼系统。这项工作将建立改善髋关节和膝关节植入物设计所需的证据，为临床决策提供信息，提高患者的生活质量，减少早期并发症。

Osteoarthritis affects over eight million people in the UK alone, with nearly three quarters of patients reporting some form of constant pain. Treatment for arthritis is estimated to cost the UK healthcare system over £10 billion per year, with significant additional societal costs for lost working hours and welfare payments.Although hip and knee replacement surgeries are considered successful, these treatments are not suitable for all patients and some devices fail early, requiring costly and less successful revision surgery. There are over 15,000 revision surgeries performed in the UK alone each year. Younger and more active patients, as well as rising numbers with obesity, are placing greater demands on these treatments: implants need to last for longer and withstand more extreme loading than ever before. There is evidence that both individual patient biomechanics and surgical choices influence the outcomes of these treatments. Improved outcomes, particularly for more challenging patient groups, can only be achieved by better matching the treatment to the functional requirements of the individual patient.This proposal will bring together complementary research expertise from two of the world's leading research institutes in the field to build the evidence needed to enable treatments for osteoarthritis to be better tailored to individual patient needs. The Institute of Medical and Biological Engineering at the University of Leeds has developed unique capability and expertise to evaluate artificial and natural joints. These include the world's largest academic facility for experimentally testing joint replacements, as well as computational modelling methods to simulate how implants perform in the body. These capabilities enable the mechanical performance of implants to be evaluated under a range of different conditions, for example to study how the implant wears over time or becomes damaged with usage.The Center for Orthopaedic Biomechanics at the University of Denver has developed world-leading capability in measuring patient joint mechanics in vivo, including methods of imaging patient joints as they undertake different activities, and parallel computational methods for deriving biomechanical information. These methods enable the forces and motions on an individual patient's hip or knee joints to be derived and, by collecting data on many patients, examine how these differ from one individual to another. By combining the expertise across both groups, this Centre-to-Centre Research Collaboration will enable relationships to be developed between an individual patient's characteristics (e.g. their anatomy and how they load their joints) and the mechanical performance of the implant. Specifically, in the hip we will combine methodologies developed at the two centres to evaluate how patient and surgical factors affect the risk of early failure in hip replacements due to the device components pushing into each other or the surrounding bone (impingement), or the way the components are aligned. We will also examine how different choices of implant can influence the outcomes. In the knee, we will combine methodologies to identify how patient factors (such as the anatomy of the knee and the way it is loaded during different activities) affect early-stage treatments for knee osteoarthritis. We will also examine the effects of a greater range of activities, such as squatting and stair climbing, on the outcomes of knee replacements. These studies will bring together different methodologies and build new pathways for acquiring and sharing data that can be adopted more widely and applied to other musculoskeletal systems in the future. The work will build the evidence needed to improve hip and knee implant design, inform clinical decision-making, enhance patient quality of life and reduce early complications.