Biomechanics of the Dysplastic Hip

描述(申请人提供)：髋臼发育不良可能是髋关节早产性骨关节炎(OA)的主要原因。然而，与发育不良相关的几何改变与关节内和周围产生的应力之间的关系还知之甚少。这项研究的总体假设是髋臼发育不良会导致髋关节生物力学的改变，从而使关节容易发生软骨退化。将开发和验证特定学科的三维有限元建模技术来研究髋关节生物力学。然后，使用三个患者群体(正常、传统发育不良和逆行发育不良)，特定于患者的有限元模型将被用来确定在模拟行走、爬楼梯和下楼梯时髋关节内和周围的应力。特定于患者的髋关节计算模型也有许多潜在的长期用途和好处，包括针对特定患者的治疗方法，以及基于手术前和术后机制预测矫正手术的长期成功率。这项研究中将要开发和验证的方法可以直接应用于量化手术干预引起的机械负荷的变化，使我们能够根据患者的具体情况评估不同截骨方法的效果。我们还设想使用这些技术进行更长期的前瞻性研究，将手术矫正与机械负荷和长期结果的变化联系起来。目前的现状是，长期的成功是通过避免全髋关节置换术来衡量的，除了在正位X线片上相对粗略的测量之外，与任何术前变量无关。与公共卫生相关：许多骨科医生不知道髋关节发育不良诊断的多个方面及其对关节退变的潜在影响。认识到不同的、通常是微妙的发育不良形式的力学后果，可以更早地识别“有风险的”髋关节，以便更早地开始治疗，有望推迟全髋关节置换术的需要。这项研究将通过使用患者特有的计算模型量化髋关节中的应力转移，立即帮助描绘这种三维病理的真实光谱。

DESCRIPTION (provided by applicant): Acetabular dysplasia may be the leading cause of premature osteoarthritis (OA) of the hip. However, the relationship between the altered geometry associated with dysplasia and the resulting stresses in and around the joint is poorly understood. The overall hypothesis of this study is that acetabular dysplasia causes alterations in hip joint biomechanics, which predispose the joint to cartilage degeneration. Subject-specific, three-dimensional finite element modeling techniques will be developed and validated to study hip joint biomechanics. Then, using three patient populations (normal, traditional dysplastic and retroverted dysplastic), patient-specific finite element models will be used to determine stresses in and around the hip joint during simulated walking, stair-climbing and descending stairs. Patient-specific hip joint computational models also have a number of potential longer-term uses and benefits, including patient-specific approaches to treatment, and prediction of the long-term success rate of corrective surgeries based on pre- and post-operative mechanics. The methods to be developed and validated in this research can be directly applied to quantify changes in mechanical loading due to surgical intervention, allowing us to assess the efficacy of different approaches to osteotomy on a patient-specific basis. We also envision using these techniques for longer-term prospective studies, to correlate surgical correction with changes in mechanical loading and long-term outcome. Currently, the status quo is that long-term success is measured by avoidance of a total hip arthroplasty and is not correlated with any preoperative variable other than the relatively crude measurements made on an anteroposterior radiograph. Relevance to Public Health: Many orthopaedic surgeons are unaware of multiple facets of the hip dysplasia diagnosis and their potential implications for joint degeneration. Recognizing the mechanical consequences of different and often subtle forms of dysplasia allows earlier identification of "at risk' hips so that earlier treatment can be initiated, hopefully delaying the need for total hip athroplasty. This research will immediately help to delineate the true spectrum of this three-dimensional pathology by quantifying stress transfer in the hip joint using patient specific computational models.