Evaluating Disease Progression in Hip Osteoarthritis

摘要 这项建议的总体目标是评估髋关节骨关节炎患者的软骨成分。 使用先进的MRI技术，并确定它们与软骨病变发展的关系，患者 功能，以及在功能任务中髋关节运动学和动力学的变化。中心假设是 早期软骨生化改变和髋关节生物力学改变与髋关节的进展有关 OA的定义是患者报告的预后恶化和软骨损伤评分较高。为了实现这一目标，我们 需要建立这些指标和三年以上髋关节骨性关节炎自然病史的横断面关系 目标I)表征髋关节软骨T1ρ和T2松弛时间，其 空间异质性和解剖位置，以及髋关节几何形状(即Alpha角、髋臼)的关联 深度等)，作为(I.A)KL等级和(I.B)年度随访时间(0-3年)的函数；目标II)以确定 髋关节软骨成分(MR T1ρ测量)与T2松弛时间、空间分布的关系 异质性，其解剖位置-目标I结果)和(IIA)髋关节测量的疾病进展 关节形态(参见图1-半定量MR分级1，根据髋关节几何形状进行调整，如Alpha角) 和(IIB)患者报告的结果(由HOOS15确定)；以及目标III)以确定关系 髋关节软骨成分(通过磁共振T1ρ和T2松弛时间测量，目标I结果)和矢状面之间的关系 功能任务(最大髋关节屈曲角度和最大髋关节伸展角度)时的平面髋关节运动学和动力学 步态、楼梯和从坐到站的瞬间)。总共144个髋关节将被包括在一系列的OA严重程度中 在书房里。将每年执行高级定量成像、运动分析和功能测试 三年以上(基线、1年、2年和3年随访)。这是对以下协会的全面评估 确定髋关节软骨松弛时间、病变发生率和生物力学是至关重要的第一步。 无创性评估髋关节骨性关节炎的自然病史。这些信息构成了所需信息的关键 设计和评估保守疗法(步态再训练、肌肉强化)、疾病矫正的有效性 药物和外科手术(股骨和骨盆截骨术等)减缓或逆转疾病的干预措施 进程。

ABSTRACT The overall goal of this proposal is to evaluate cartilage composition of patients with hip osteoarthritis (OA) using advanced MRI techniques, and determine their relationship to development of cartilage lesions, patient function, and changes in hip kinematics and kinetics during functional tasks. The central hypothesis is that early changes in cartilage biochemistry and altered hip biomechanics are associated with progression of hip OA defined by worsening patient-reported outcomes and higher cartilage lesion scores. To accomplish this we need to establish the cross-sectional relationship of these metrics and natural history of hip OA over three years with the following specific aims: Aim I) To characterize hip cartilage T1ρ and T2 relaxation time, their spatial heterogeneity and anatomical location, and association of hip geometry (i.e. alpha angle, acetabular depth, etc), as a function of (I.A) KL grade and (I.B) annual follow-up time (Years 0-3); Aim II) To determine the relationship between hip cartilage composition (measured by MR T1ρ and T2 relaxation time, spatial heterogeneity, their anatomical location - Aim I outcomes) and disease progression as measured by (IIA) hip joint morphology (see Fig. 1- semi-quantitative MR grading1, adjusted for hip geometry such as alpha angle) and (IIB) patient reported outcomes (as determined by HOOS15); and Aim III) To determine the relationship between hip cartilage composition (measured by MRI T1ρ and T2 relaxation time, Aim I outcomes), and sagittal plane hip kinematics and kinetics during functional tasks (peak hip flexion angle and peak hip extension moments during gait, stairs, and sit-to-stand). A total of 144 hips across a range of OA severity will be included in the study. Advanced quantitative imaging, motion analysis, and functional testing will be performed annually over three years (baseline, 1, 2, and 3 year follow-up). This comprehensive evaluation of the associations of hip cartilage relaxation times, lesion prevalence, and biomechanics is the vital first step to determine the natural history of hip OA using non-invasive assessment. This information forms the crux of what is needed to design and assess the effectiveness of conservative (gait retraining, muscle strengthening), disease modifying drugs, and surgical (femoral and pelvic osteotomy, etc.) interventions at slowing or reversing the disease process.