Magnetic Resonance Imaging as a Biomarker For Adverse Local Tissue Reaction In In

描述(申请人提供)：使用金属-聚乙烯(MOP)支架材料的全髋关节置换术(THA)具有良好的存活率，但假体失败的一个常见原因是磨损碎片的生物反应导致的无菌性松动。替代支承面，如陶瓷和金属，被开发为拖把的替代品，以减少由于聚乙烯磨损造成的骨溶解。最初提倡使用金属对金属(MOM)髋关节表面置换(HRA)植入物是因为它比MOP更有优势；然而，由于局部组织的不良反应，对扩张的囊膜中的MOM磨损碎片的反应已成为植入物过早失败的常见原因。此外，监测植入物的局部反应需要很高的软组织对比度，因为不良反应是由宿主滑膜反应产生的。磁共振成像(MRI)具有优越的软组织对比度，但传统上受到组件产生的伪影的限制。在这项研究中，我们建议开发MRI作为生物标志物来检测THA中所有轴承组合和模块化连接的不良局部组织反应。接受翻修全髋关节手术的患者将被招募进行术前核磁共振检查、术中检查 用于组织学分析的组织取样，以及取回的种植体的术后磨损分析。将进行MRI数据集与组织学和磨损评估之间的相关性，并将其用于开发用于全髋关节置换患者管理的预测性诊断工具。这一预测工具将应用于原发性全髋关节置换术患者的队列，以纵向监测具有不同个体风险因素和种植体支撑面的患者的疾病进展。

DESCRIPTION (provided by applicant): Total hip arthroplasty (THA) with metal-on-polyethylene (MOP) bearing materials have excellent survival rates but a common cause for implant failure is aseptic loosening caused by biologic reaction to wear debris. Alternative bearing surfaces, such as ceramics and metals, were developed as an alternative to MOP to reduce osteolysis due to polyethylene wear. The use of metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) implants was initially advocated due to the perceived advantages over MOP; however, reactions to MOM wear debris in the expanded capsule have become a common cause of premature implant failure due to adverse local tissue reactions. Furthermore, monitoring local response to an implants requires high soft tissue contrast, as the adverse reactions are generated by the host synovial response. Magnetic resonance imaging (MRI) has superior soft tissue contrast but has traditionally been limited by the artifact generated by the components. In this study, we propose to develop MRI as a biomarker to detect adverse local tissue reactions for all bearing combinations and modular connections in THA. Individuals indicated for revision THA surgery will be recruited for pre-operative MRI studies, intra-operative tissue sampling for histologic analysis, and post- operative wear analysis of the retrieved implant. Correlations between the MRI datasets and the histologic and wear assessments will be performed and will be used to develop a predictive diagnostic tool for the management of THA patients. This predictive tool will be applied to cohort of individuals with primary THA to longitudinally monitor disease progression in patients with different individual risk factors and implant bearing surfaces.