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.

项目概要 该提案的首要目标是确定经股骨骨整合假体是否具有 对髋骨关节炎（OA）的病因有积极影响。造成残疾的两个主要原因如下 经股截肢术是由于关节窝贴合不良（例如溃疡）和 OA 导致的慢性皮肤病 习惯性改变关节负荷。骨整合假体是最近治疗牙槽窝的临床干预措施 通过骨锚定植入物将假肢直接安装到残肢上，以治疗相关疾病， 提供从地面到残肢的更规范的负载传输。该提案将决定是否 与髋关节窝不同，这种改善的负载传递对髋关节 OA 的发病机制具有积极作用 假肢。这将通过纵向研究设计来完成，该设计将比较最常见的 两次治疗之间两个时间点（基线和 12 个月）导致 OA 进展的生物力学病因 组（使用骨整合假体的患者和成功使用传统接受腔的患者 假肢）。在目标 1 中，我们将使用脂肪分数定量磁性来量化双侧臀部肌肉质量 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 在双侧臀部肌肉组织上。这将阐明已知的萎缩和不良成分是否由于废弃而导致 众所周知，接受腔假体会导致骨关节炎进展，但在假体植入后可以逆转 骨整合。在目标 2 中，我们将使用运动捕捉和 特定主题的肌肉骨骼接触模型。因为改变软骨负荷是主要的诱因 OA 发病和进展的因素，这些结果将决定软骨力学在治疗期间是否正常化 骨整合后的日常生活活动。尽管肌肉成分和软骨力学 OA 发展的病因学因素，我们寻求评估骨整合对临床进展的作用 OA。因此，在目标 3 中，我们将使用 T2 定量 MRI 来量化软骨健康状况，这是目前最先进的技术。 评估体内早期骨关节炎变化的敏感方法。最终，我们寻求使用我们的多域 更好地为旨在改善骨整合后结果的有针对性的干预措施提供信息。 候选人的总体职业目标是利用基于工程的工具更好地阐明 继发性疼痛的机制可用于改善有针对性的干预措施。这个提议 通过提供定量 MRI、高级成像后处理方面的新培训，以候选人当前的专业知识为基础 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。指导团队由物理治疗师、放射科医生、生物工程师和 骨科医生是影像学、临床干预和 OA 方面的专家。该提案将提供 R01 的初步数据侧重于影响不同假体类型长期结果的关键因素。