Assessment of cortical thickening in total hip replacement patients

全髋关节置换术（THR）是一种成功的手术，但需要翻修的器械数量持续增加。人口老龄化，越来越多的活跃和肥胖患者，都增加了对设备的要求：他们需要比以往任何时候都更长的时间和承受更高的负载。THR患者翻修前的X线片上经常观察到骨变化（“远端皮质增厚”），但这些变化的特征很少，它们如何与植入物的选择或患者的结局相关。本研究的目的是开发使用自动化图像处理方法客观评价和量化远端皮质增厚的方法，并评估其是否与随后的股骨柄松动相关以及如何相关。主要目标是：[1]开发方法来从X射线证据中识别和量化皮质增厚。[2]通过与（a）临床专业人员使用的手动方法和（B）相同患者/尸体标本的3D CT/MRI成像进行比较，确认方法并定义其准确性。[3]将这些方法应用于更大的数据集，这些数据集由我们在马斯格雷夫公园医院、贝尔法斯特的合作者和通过我们的行业合作伙伴关系访问的其他来源提供，并评估随着时间的推移变化的进展以及与患者结局的关系。[4]为了使用统计形状建模和有限元分析扩展分析方法，以检查初次和翻修股骨柄的不同股骨拟合场景的生物力学效应。这项工作适合EPSRC HealthTech优化治疗的大挑战（循证决策）和物理干预前沿（提高植入的成功率），以及EPSRC交付计划的优先事项，即培训行业相关的博士和增强未来的数字技术。它是与我们的行业合作伙伴共同开发的，由行业和临床需求驱动。这项工作将为骨重建的基础机制提供新的证据，并量化其影响。它将为不同患者的器械选择提供手术建议的证据，并可能提供一种更客观地监测风险病例的途径。

Total hip replacement (THR) is a successful operation but the number of devices requiring revision is continuing to rise. The aging population, growing cohorts of more active and more obese patients, are all increasing the demands on devices: they need to last for longer and withstand higher loads than ever before. Changes in the bone ('distal cortical thickening') are often observed on x-rays of THR patients prior to revision, but there has been little characterisation of these changes, how they relate to the choice of implant or to the outcomes for the patient. The aim of this study is to develop methods to characterise and quantify distal cortical thickening objectively using automated image-processing methods, and assess if and how it relates to subsequent stem loosening. The main objectives are: [1] To develop methods to characterise and quantify cortical thickening from x-ray evidence. [2] To validate the methods and define their accuracy by comparison with (a) manual methods used by clinical professionals, and (b) 3D CT/MRI imaging of the same patients/cadaveric specimens. [3] To apply the methods to larger datasets, provided by our collaborators at Musgrave Park Hospital, Belfast and other sources accessed through our industry partnership, and assess the progression of changes over time and the relationship to patient outcome. [4] To extend the methods of analysis using statistical shape modelling and finite element analysis to examine the biomechanical effects of different femoral fit scenarios, for both primary and revision stems.This work fits to EPSRC HealthTech Grand Challenges on Optimising Treatment (evidence based decision making) and Frontiers of Physical Intervention (improving success rates of implants), as well as EPSRC Delivery Plan priorities of training industry relevant PhDs and enhancing future digital technologies. It has been co-developed with our industry partner and is driven by both industry and clinical need. The work will provide new evidence of the underpinning mechanisms of bone remodelling and quantify its effects. It will provide evidence for surgical recommendations on device selection for different patients and may provide a route to monitor at-risk cases more objectively.