Contralateral Knee Osteoarthritis Among Older Adults after Primary Total Knee Arthroplasty

项目摘要/摘要 到2030年，每年约有350万老年人接受全膝关节置换术(TKA)。在……里面 此外，近30%接受单侧全膝关节置换术的患者将发展为终末期膝骨性关节炎(OA)。 并要求在首次手术后3年内对侧(非手术侧)行全膝关节置换术。因此， 原发性全膝关节置换术患者的对侧膝关节表现为膝关节加速发展的生物力学模型。 为研究膝骨性关节炎发病的生物力学机制提供了一个独特的机会。一 提出的对侧膝关节骨性关节炎快速进展的机制是异常的运动模式增加 集中负荷在未习服的膝关节软骨上。具体地说，较小的矢状面膝关节偏移，或 更“僵硬”的步态模式和更高的关节负荷--这些加在一起可能会将更大的力分配给 膝关节软骨面积缩小-在膝关节OA和/或TKA患者中都很常见，而且 与膝关节骨性关节炎的严重程度和未来对侧全膝关节置换术有关。先前研究异常的研究 全膝关节置换术后的运动模式和对侧膝关节骨性关节炎有显著的局限性，依赖于诊断 (例如，放射)成像或生物力学分析，但不能两者兼而有之。F32的工作将解决缺陷 在以前的研究中，探讨了与对侧膝关节骨关节炎相关的生物力学机制 严重性和进展，对于了解OA的发病机制并最终设计有效的方案至关重要 干预措施。这个F32奖项的目的是1)确定长期的、异常的运动模式 可能有助于早期的对侧膝关节骨关节炎(在全膝关节置换术前)，以及2)持续的、异常的运动 初次全膝关节置换术后的模式可能进一步有助于加速对侧膝关节骨性关节炎的进展。 将收集150例患者(年龄60-85岁)术前步态的生物力学运动分析。 全膝关节置换术后立即康复。磁共振成像(MRI)将在 基线期和术后2年。目标1将确定较大的膝关节负荷和较小的膝关节偏移量 术前对侧膝关节的损伤与更大的对侧膝关节骨关节炎(即，更高[更差])相关 半定量和定量MRI值)。目标2将确定更大的膝关节负荷和更少的膝盖 TKA术后即刻对侧膝关节的关节移位与对侧相关 初次全膝关节置换术后膝关节骨性关节炎从基线进展到2年。拟议的研究具有重要意义，因为： 1)接受全膝关节置换术的人数庞大且不断增长；2)对侧膝关节骨性关节炎的高发病率 单侧全膝关节置换术后进展，可能是未解决的异常运动模式的直接后果； 3)我们目前对导致骨折发生的生物力学机制认识不足。 对侧膝关节骨性关节炎的进展。这项F32拨款将有助于确定这些机制--一个关键 最终降低对侧全膝关节置换率的初步步骤--并支持申请人的发展 成为致力于优化我们老龄化人口肌肉骨骼健康的独立调查者。

PROJECT SUMMARY/ABSTRACT Approximately 3.5 million older adults will undergo total knee arthroplasty (TKA) annually by the year 2030. In addition, nearly 30% of individuals who undergo unilateral TKA will develop end-stage knee osteoarthritis (OA) and require a TKA on their contralateral (non-operated) side within just 3 years of their initial surgery. As such, the contralateral knee of primary TKA patients represents a biomechanical model of accelerated progression of knee OA, offering a unique opportunity to investigate biomechanical mechanisms of OA pathogenesis. One proposed mechanism for rapid contralateral knee OA progression is aberrant movement patterns that increase and concentrate loading on unhabituated knee cartilage. Specifically, smaller sagittal plane knee excursions, or a more “stiff-knee” gait pattern, and higher joint loading—which together may distribute increased forces on a reduced area of knee cartilage—are both common among individuals with knee OA and/or TKA and are associated with knee OA severity and future contralateral TKA. Previous studies investigating aberrant movement patterns and contralateral knee OA after TKA have notable limitations, relying either on diagnostic (e.g., radiographic) imaging or biomechanical analyses, but not both. The F32 work will address shortcomings in previous research and investigate the biomechanical mechanisms associated with contralateral knee OA severity and progression, critical to understanding OA pathogenesis and ultimately designing effective interventions. The purpose of this F32 award is 1) to determine how longstanding, aberrant movement patterns might contribute to early, contralateral knee OA (before TKA), and 2) how persistent, aberrant movement patterns after primary TKA might further contribute to accelerated contralateral knee OA progression. Biomechanical motion analyses during gait will be collected for 150 patients (age 60-85 years) pre-operatively and immediately after rehabilitation following TKA. Magnetic resonance imaging (MRI) will be performed at baseline and 2 years after TKA. Aim 1 will determine if greater knee joint loading and less knee joint excursion in the contralateral knee preoperatively are associated with greater contralateral knee OA (i.e., higher [worse] semi-quantitative and quantitative MRI values). Aim 2 will determine if greater knee joint loading and less knee joint excursion in the contralateral knee immediately after TKA rehabilitation are associated with contralateral knee OA progression from baseline to 2 years after primary TKA. The proposed study is significant because of: 1) the large and growing population of people undergoing TKA; 2) the high incidence of contralateral knee OA progression after unilateral TKA, potentially a direct consequence of unresolved aberrant movement patterns; and 3) our current, inadequate understanding of the biomechanical mechanisms leading to the development and progression of contralateral knee OA. This F32 grant will help identify these mechanisms—a key preliminary step for ultimately reducing rates of contralateral TKA—and support the Applicant's development into an independent investigator committed to optimizing musculoskeletal health in our aging population.