Foot Bone Motion in End Stage Ankle Arthritis Patients

末期踝关节炎患者的足骨运动

• 批准号: 8548963
• 负责人: Michael E. Hahn
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8548963
• 关键词: Accounting; Address; Affect; Aftercare; Agreement; Ankle; Arthritis; Arthrodesis; Arthroplasty; Articular Range of Motion; Attention; Basic Science; Cadaver; Client satisfaction; Clinical; Clinical Sciences; Complication; Data; Degenerative polyarthritis; Development; Disease Progression; Distal; Failure; Foot joint structure; Foundations; Gait; General Population; Generations; Goals; Gold; Health; Health Status; Healthcare Systems; Hip region structure; Incidence; Individual; Intervention; Ipsilateral; Joints; Kinetics; Knee; Lead; Left; Life; Limb structure; Mechanics; Mental Health; Modeling; Modification; Motion; Operative Surgical Procedures; Pain; Patients; Performance; Phase; Physical Function; Physicians; Population; Positioning Attribute; Prevalence; Procedures; Prognostic Factor; Prosthesis; Relative (related person); Replacement Arthroplasty; Research; Research Project Grants; Reservations; Robotics; Segmented foot model; Simulate; Staging; Stretching; Surgical complication; Symptoms; Talus; Techniques; Time; Veterans; Work; alternative treatment; ankle joint; base; bone; common treatment; design; effective therapy; experience; falls; follow-up; foot; foot bone; improved; insight; kinematics; prospective; social; sound; standard care; tibia; treatment effect

DESCRIPTION (provided by applicant): The purpose of this proposal is to better understand the effects of two common treatments for end stage ankle arthritis (ESAA). Until fairly recently, the "gold standard" for treatment ESAA has been an ankle arthrodesis (i.e., a fusion). However, recent improvements in the long-term viability of ankle arthroplasty (i.e., joint replacement) have increased the treatment options available. Many patients and physicians are now considering ankle arthroplasty, whereas a decade ago, most would only consider arthrodesis. Although arthrodesis can remove the primary symptom of ESAA (i.e., pain), the patient is left with a fused ankle, which results in the distal foot joints (subtalar, midtarsal and tarsometatarsal) being stretched into increased dorsiflexion during the push off phase of the gait cycle. Subsequently, a common secondary complication of arthrodesis is the development of arthritis in the distal joints of the ipsilateral foot. It is thought that joint replacement, which allows for more normal ankle motion, will not lea to aberrant dorsiflexory moments on the distal foot joints. While certainly plausible, a detailed comparison of the motion of the bones of the foot in patients with an arthrodesis vs. an arthroplasty has not been conducted to date. Moreover, while it is known that both treatments for ESAA are susceptible to misalignments of the talus relative to the tibia, the specific effects f poor alignment on the distal joints are not well understood. Finally, the last issue this proposal will address is that while there is general agreement on the "ideal" patients for both procedures (arthrodesis patients tend to be young and more active, while arthroplasty patients are often older and less active), this "clinical wisdom" is not absolute. Moreover, there are many subjects who fall between the ideals and it is not known which treatment they will benefit from most. As such, we propose the following: Specific Aim 1: To determine the foot joint kinematics of subjects treated for ESAA with either an arthrodesis or arthroplasty. We will employ a multi-segment foot model that our group has developed to study 60 subjects (n=30 for each group) pre-surgery and then at 12 and 24 months follow up. Specific Aim 2: To determine the effect of joint alignment on foot joint kinematics with cadaveric feet simulating treatment for ESAA with either an arthrodesis or arthroplasty. Using the Robotic Gait Simulator (RGS), a cadaveric gait simulator that our group has developed, we will systematically vary the alignment and quantify the effect on foot joint kinematics for ankle fusion and total ankle joint replacement in 30 cadavers each (60 total). In the neutral position, we will also be able to directly compare arthrodesis to arthroplasty by quantifying the motion of individual bones in the foot (not possible with living subjects). The secondary aims of this study are to compare the following parameters pre- and post-operatively between ankle arthrodesis and arthroplasty patients: physical function, ankle specific function, pain, general health, overall patient satisfaction, step counts and full body motion analysis, as well as post-surgical complication rates. We aim to quantify differences between the treatment groups and to identify intrinsic and extrinsic prognostic factors that are predictive of improved performance. The results of this research project will directly benefit the portion of the general population that experience ankle OA, which has been estimated as 6-10%. Moreover, an increased incidence of ankle OA has been suggested. Osteoarthritis often limits overall mobility and may not only restrict a patient's activities of daly life, but also negatively impact their social and psychological health status. Therefore, it is imperative to address ankle OA conditions with the goal of designing more effective treatment options and interventions to slow the disease progression.

描述（由申请人提供）： 本提案的目的是更好地了解两种常见治疗终末期踝关节炎（ESAA）的效果。直到最近，治疗ESAA的“黄金标准”一直是踝关节固定术（即，融合）。然而，最近踝关节成形术长期可行性的改善（即，关节置换术）增加了可用的治疗选择。许多患者和医生现在正在考虑踝关节置换术，而十年前，大多数人只考虑关节融合术。虽然关节固定术可以消除ESAA的主要症状（即，疼痛），患者留下融合的踝关节，这导致远端足关节（距下、跗中和跗跖骨）在步态周期的蹬离阶段期间被拉伸成增加的背屈。随后，关节融合术常见的继发性并发症是同侧远端关节炎的发展 脚人们认为，关节置换术，这使得更多的正常踝关节运动，将不会lea莱亚异常背屈力矩的远端足关节。虽然这确实是合理的，但迄今为止还没有对关节固定术与关节成形术患者的足部骨骼运动进行详细比较。此外，虽然已知两种治疗ESAA的方法均易受距骨相对于胫骨的错位影响，但对线不良对远端关节的具体影响尚不清楚。最后，本提案将解决的最后一个问题是，尽管对两种手术的“理想”患者有普遍的共识（关节融合术患者往往年轻且更活跃，而关节成形术患者通常年龄较大且不太活跃），但这种“临床智慧”并不是绝对的。此外，有许多受试者处于理想状态之间，不知道他们将从哪种治疗中受益最多。因此，我们提出以下建议：具体目标1：确定接受关节固定术或关节成形术治疗ESAA的受试者的足关节运动学。我们将采用我们小组开发的多节段足部模型，对60名受试者（每组n=30）进行术前研究，然后进行12个月和24个月随访。具体目标二：确定关节对线对尸体足关节运动学的影响，模拟关节融合术或关节成形术治疗ESAA。使用机器人步态模拟器（RGS），尸体步态模拟器，我们的小组已经开发，我们将系统地改变对齐和量化的踝关节融合和全踝关节置换的足关节运动学的影响，在30具尸体（共60）。在中立位，我们还可以通过量化足部单个骨骼的运动来直接比较关节固定术和关节成形术（不可能 活的主题）。本研究的次要目的是比较踝关节融合术和关节置换术患者术前和术后的以下参数：身体功能、踝关节特定功能、疼痛、一般健康状况、总体患者满意度、步数和全身运动分析，以及术后并发症发生率。我们的目标是量化治疗组之间的差异，并确定内在和外在的预后因素，是预测改善的性能。该研究项目的结果将直接受益于一般人群中经历踝关节OA的部分，估计为6- 10%。此外，踝关节骨性关节炎的发病率也有所增加。骨关节炎常限制患者的整体活动能力，不仅可能限制患者的日常生活活动，还可能对患者的社会和心理健康状况产生负面影响。因此，必须解决踝关节OA疾病，目的是设计更有效的治疗方案和干预措施，以减缓疾病进展。