Effects of Simulated Interventions on Hip Articular Cartilage Loading in Patients with Femoroacetabular Impingement and Developmental Dysplasia of the Hip

模拟干预对股骨髋臼撞击和髋关节发育不良患者髋关节软骨负荷的影响

• 批准号: 9751482
• 负责人: Brecca Gaffney
• 金额: $ 6.42万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751482
• 关键词: 3-Dimensional; Address; Adult; Affect; Architecture; Articular Range of Motion; Cartilage; Clinical; Complex; Computer Simulation; Data; Databases; Deformity; Degenerative polyarthritis; Development; Dysplasia; Effectiveness; Electromyography; Elements; Etiology; Fellowship; Femur; Foundations; Functional disorder; Future; Geometry; Goals; Head; Hip Joint; Hip Osteoarthritis; Hip Pain; Hip region structure; Image; Implant; Intervention; Isometric Exercise; Joints; Knee; Knowledge; Lateral; Lead; Literature; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Methodology; Methods; Modeling; Movement; Muscle; Muscle function; Musculoskeletal; Musculoskeletal Diseases; National Research Service Awards; Operative Surgical Procedures; Orthopedics; Output; Pain; Pathologic; Pathology; Patients; Pattern; Pelvis; Population; Protocols documentation; Publishing; Quality of life; Range of motion exercise; Reaction; Rehabilitation therapy; Research; Research Personnel; Risk; Role; Secondary pain; Structure; Surface; Training; Validation; Walking; articular cartilage; bone; cost; high risk; hip replacement arthroplasty; improved; in vivo; instrument; intervention effect; joint loading; kinematics; muscle strength; preservation; pressure; prevent; strength training; success; treatment planning; treatment strategy

7. PROJECT SUMMARY/ABSTRACT Structural hip deformities, including femoroacetabular impingement (FAI) and developmental dysplasia of the hip (DDH), are orthopaedic conditions that alter the coverage of the femoral head. Specifically, FAI leads to over-coverage and DDH leads to under-coverage of the femoral head, and both are common causes of dysfunction. Without treatment, the altered geometries substantially predispose patients to degenerative joint changes due to increased cartilage loading, including hip osteoarthritis (OA), by upwards of 4.3 fold. Although altered cartilage loading is a primary instigator of the onset of OA, it cannot be measured in vivo. As a result, computational models (e.g. finite or discrete element analysis) are the most widely used surrogates for cartilage contact pressure estimations. However, these models have two primary limitations that impede their clinical utility: 1) the computational burden often remains too large to solve highly dynamic activities and 2) they do not simultaneously integrate the roles of complex patient-specific joint geometry, joint kinematics, and muscle function. The first goal of this proposal is to develop and validate a subject-specific musculoskeletal model that is capable of estimating dynamic cartilage loading contacts in patients with FAI and DDH. To mitigate pain and prevent the development of degenerative secondary pain conditions in patients with DDH, both surgical and nonsurgical approaches exist, yet both have varied success. Surgical intervention aims to provide more uniform distribution of hip loads by correcting bony abnormalities to appear more like healthy (asymptomatic hips) and is specific to pathology type. Although effective at improving short-term pain and function, long-term functional deficits remain (e.g. pain, limping, reduced joint space) that lead to the eventual development of end-stage hip OA and/or total hip arthroplasty. Contrarily, rehabilitation involves general muscle strengthening, movement retraining, and improvements of range of motion. However, it remains not well defined, lacks validation, and is not specific to pathology type. Given the difference in coverage of the femoral head between FAI and DDH, it is likely that cartilage contact pressures are affected differently with the same intervention, yet this effect has not been explored. The second goal of this proposal will be to establish the effects of simulated surgical and non-surgical intervention on hip joint cartilage contact pressure in patients with FAI and DDH. This proposal will be the first to develop a musculoskeletal model capable of estimating hip joint cartilage loading by simultaneously modeling the effect of subject-specific geometry, kinematics, and muscle function (Aim 1) and to assess the effects of simulated intervention on hip joint cartilage loading patterns (Aim 2). Understanding how cartilage contact mechanics change with intervention, and establishing differences specific to pathology types (FAI vs DDH), will inform future treatment strategies that are tailored to the specific pathology in an effort to improve pain and function.

7.项目摘要/摘要 结构性髋关节畸形，包括髋臼撞击和发育性髋关节发育不良 髋关节(DDH)是改变股骨头覆盖范围的骨科疾病。具体地说，FAI导致 过度覆盖和DDH导致股骨头覆盖不足，两者都是常见的原因 功能障碍。在没有治疗的情况下，改变的几何结构极大地使患者容易发生关节退行性变。 由于软骨负荷增加造成的变化，包括髋关节骨关节炎(OA)，增加了4.3倍。 尽管软骨负荷的改变是骨性关节炎发病的主要诱因，但不能在活体内测量。 因此，计算模型(例如有限元或离散元分析)是使用最广泛的替代品 用于软骨接触压力的估算。然而，这些模型有两个主要限制，这阻碍了它们的 临床用途：1)计算负担往往太大，无法解决高度动态的活动；2)它们 不要同时集成复杂的特定于患者的关节几何、关节运动学和肌肉的角色 功能。这项建议的第一个目标是开发和验证特定于对象的肌肉骨骼 该模型能够估计FAI和DDH患者的动态软骨负荷接触。 减轻患者的疼痛和预防退行性继发性疼痛的发展 DDH，手术和非手术方法都有，但两种方法都有不同的成功。手术干预的目的 通过纠正骨骼异常以使其看起来更健康，从而提供更均匀的髋部负荷分布 (无症状髋关节)，并特定于病理类型。虽然在改善短期疼痛和 功能，长期的功能缺陷仍然存在(如疼痛、跛行、关节间隙缩小)，最终导致 发展终末期髋关节骨性关节炎和/或全髋关节置换术。相反，康复涉及全身肌肉。 加强运动再训练，提高活动范围。然而，它仍然没有得到很好的定义， 缺乏有效性，且不针对病理类型。考虑到股骨头覆盖率的不同 在FAI和DDH之间，软骨接触压力可能受到不同的影响 干预，然而，这种影响还没有被探索。这项提案的第二个目标将是建立 模拟手术与非手术干预对兔髋关节软骨接触压力的影响 FAI和DDH患者。 这项提议将是第一个开发能够估计髋关节软骨的肌肉骨骼模型。 通过同时建模特定于受试者的几何、运动学和肌肉功能的效果来加载 (目的1)和评价模拟干预对髋关节软骨负荷模式的影响(目的2)。 了解干预后软骨接触力学的变化，并明确不同之处。 根据病理类型(FAI与DDH)，将提供针对特定病理定制的未来治疗策略 以努力改善疼痛和功能。