Effect of Osseointegrated Prostheses on the Pathogenesis of Hip Osteoarthritis in Patients with Lower Limb Loss

骨整合假体对下肢丧失患者髋骨关节炎发病机制的影响

• 批准号: 10662142
• 负责人: Brecca Gaffney
• 金额: $ 13.16万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-03 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662142
• 关键词: 3-Dimensional; Activities of Daily Living; Adopted; Affect; Algorithms; Amputation; Area; Atrophic; Bilateral; Biochemical; Biomechanics; Biomedical Engineering; Cartilage; Cartilage Matrix; Case Series; Chronic; Client satisfaction; Clinical; Collagen; Computer Models; Control Groups; Data; Degenerative polyarthritis; Development; Disease Progression; Distal; Eligibility Determination; Engineering; Ensure; Environment; Etiology; Fascia; Fatty acid glycerol esters; Femur; Geometry; Goals; Health; Hip Osteoarthritis; Hip region structure; Image; Implant; Individual; Infiltration; Intervention; Joints; Link; Longitudinal Studies; Lower Extremity; Magnetic Resonance Imaging; Maps; Mechanics; Medical Imaging; Mentors; Methodology; Modeling; Motion; Movement; Muscle; Muscle Weakness; Musculoskeletal; Orthopedics; Osseointegration; Outcome; Pathogenesis; Pathologic; Pathology; Patients; Pattern; Play; Population; Prosthesis; Rehabilitation therapy; Relaxation; Reporting; Research; Research Design; Role; Secondary pain; Secondary to; Skin; Surgeon; Training; Translating; Ulcer; Vacuum; Walking; Water; arthropathies; articular cartilage; biomechanical model; bone; bone health; career; design; disability; hip bone; improved; improved outcome; in vivo; joint biomechanics; joint injury; joint loading; limb amputation; limb loss; mechanical load; novel; osseointegrated implant; pathomechanics; patient population; physical therapist; prosthetic socket; radiologist; residual limb; skills; tool; transmission process; treatment optimization; treatment strategy

PROJECT SUMMARY The overarching objective of this proposal is to determine if transfemoral osseointegrated prostheses have a positive influence on the etiology of hip osteoarthritis (OA). The two leading causes of disability following transfemoral amputation are chronic skin pathologies due to poor socket fit (e.g., ulceration) and OA due to habitually altered joint loading. Osseointegrated prostheses are a recent clinical intervention to treat socket related pathologies by directly mounting the prosthesis to the residual limb through a bone anchored implant, providing a more normative load transmission from the ground to residual limb. This proposal will determine if this improved load transmission has positive role on the pathogenesis of hip OA differently than socket prostheses. This will be accomplished through a longitudinal study design that will compare the most common biomechanical etiological factors to OA progression at two timepoints (baseline and 12-months) between two groups (patients with osseointegrated prostheses and patients who successfully use a traditional socket prosthesis). In Aim 1, we will quantify bilateral hip muscle quality using fat fraction quantitative magnetic resonance imaging (MRI). Using these images, we will quantify 3D muscle volume and levels of fatty infiltration on the bilateral hip musculature. This will elucidate if the known atrophy and poor composition due to disuse in a socket prosthesis, both of which are known to progress OA, can be reversed following prosthesis osseointegration. In Aim 2, we will quantify dynamic cartilage loading mechanics using motion capture and a subject-specific musculoskeletal contact model. Because altered cartilage loading is a primary instigator and factor in OA onset and progression, these results will determine if cartilage mechanics are normalized during activities of daily living following osseointegration. Although muscle composition and cartilage mechanics are etiological factors to OA development, we seek to assess the role of osseointegration on the clinical progression of OA. Thus, in Aim 3, we will quantify cartilage health using T2 quantitative MRI, which is currently the most sensitive methodology to assess early osteoarthritic changes in-vivo. Ultimately, we seek to use our multi-domain approach to better inform targeted interventions aimed at improving outcomes following osseointegration. The candidate’s overarching career goal is to utilize engineering-based tools to better elucidate the mechanisms to secondary pain conditions that can be used to improve targeted interventions. This proposal builds on the candidate’s current expertise by providing new training in quantitative MRI, advanced imaging post- processing tools, longitudinal research design and implementation, and links between biomechanics and clinical factors of joint disease. The mentoring team consists of physical therapists, radiologists, bioengineers, and orthopaedic surgeons who are experts in imaging, clinical interventions, and OA. This proposal will provide preliminary data for an R01 focused on key factors that affect long-term outcomes with varying prosthesis types.

项目摘要 该提案的首要目标是确定经股骨骨整合假体是否具有 对髋关节骨关节炎（OA）的病因产生积极影响。导致残疾的两大原因是 经股截肢是由于较差的承窝配合引起的慢性皮肤病变（例如，溃疡）和OA， 习惯性改变关节负荷。骨整合假体是治疗接受腔的最新临床干预措施 通过骨锚定植入物将假体直接安装到残肢上， 提供从地面到残肢的更规范的载荷传递。该提案将确定， 这种改善的载荷传递对髋关节OA的发病机制有积极作用， 假体.这将通过纵向研究设计来完成，该设计将比较最常见的 两个月之间两个时间点（基线和12个月）OA进展的生物力学病因因素 组（使用骨整合假体的患者和成功使用传统牙槽的患者 假体）。在目标1中，我们将使用脂肪分数定量磁 磁共振成像（MRI）。使用这些图像，我们将量化3D肌肉体积和脂肪浸润水平 双侧臀部肌肉组织上这将阐明，如果已知的萎缩和不良组成，由于废用， 接受腔假体，这两种假体都已知会进展为OA， 骨整合在目标2中，我们将使用运动捕捉和 受试者特异性肌肉骨骼接触模型。因为改变的软骨负荷是主要的煽动者， OA发病和进展的因素，这些结果将决定软骨力学是否正常化， 骨整合后的日常生活活动。虽然肌肉成分和软骨力学是 的发病因素，我们试图评估骨整合在临床进展中的作用 的OA。因此，在目标3中，我们将使用T2定量MRI来量化软骨健康，这是目前最常见的方法。 敏感的方法来评估早期骨关节炎的变化在体内。最终，我们寻求利用我们的多域 更好地为旨在改善骨整合后结局的有针对性的干预提供信息的方法。 候选人的首要职业目标是利用基于工程的工具，以更好地阐明 这些机制可用于改善针对性干预措施。这项建议 通过提供定量MRI，高级成像后， 处理工具，纵向研究设计和实施，以及生物力学和临床之间的联系 关节疾病的因素。指导小组由物理治疗师、放射科医生、生物工程师和 影像学、临床干预和OA方面的骨科医生。该提案将提供 R01的初步数据集中于影响不同假体类型长期结局的关键因素。