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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

基本信息

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
项目类别：
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

项目摘要

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.

项目总结