Characterizing and Restoring Joint Motion in Patients with Hallux Rigidus

项目概要/摘要 第一跖趾关节（MTPJ1）是最常受骨关节炎影响的部位之一，导致骨关节炎。 这种情况称为拇趾僵硬（HR）。这是非常普遍的，估计影响到25%的成年人口， 患病率随着年龄的增长而增加。退伍军人健康管理局（VHA）看到的患者人数 HR在过去十年中翻了一番多。与髋关节和膝关节的退行性骨关节炎相反， 通常通过关节置换关节成形术进行治疗，这是严重患者最常见的手术治疗方法 HR是关节融合术，消除了关节功能。这种方法不允许改变鞋， 干扰某些活动（例如，瑜伽，普拉提），并可能导致继发性并发症，如 跖骨痛和行动不便迄今为止，已经提出了MTPJ1关节成形术的各种设计， 但没有一个是特别成功的，由于松动和定期报告， 植入物移位。这可能部分是因为骨皮质中相对少量的骨皮质。 跖骨头和近节指骨区域，使得难以实现假体的充分固定 件.旨在解决这些问题的新植入物的开发受到限制， 关于MTPJ1机械环境的文献稀疏。同样， 关于日常生活活动期间所需的MTPJ1典型3D运动的详细信息。我们最近 这项工作为基于计算的建模工作流程奠定了基础，该工作流程旨在优化 设计一种新型MTPJ1植入物，我们已经在产生新的，基于证据的 植入概念。在这个项目中，我们打算推进这项工作，增加我们进一步MTPJ1植入的能力。 技术通过计算和机器人步态模拟为基础的测试。这将最终改善 患者结局。我们打算通过以下方式实现这些目标：1）表征病理性和健康MTPJ1 在不同的日常生活活动中的功能; 2）使用机器人步态模拟器来测量 现有的和新型的MTPJ1植入物在恢复关节功能;和3）进一步完善我们的肌肉骨骼和 MTPJ1的有限元模型，以提高其准确性，并进一步验证其生成 有用的结果。我们相信这项工作有可能重振MTPJ1关节成形术的研究， 现在主要是由想法而不是数据驱动的。从这项研究中传播的知识将使 外科医生和患者对HR的手术治疗做出更好的决定。具体来说，这些数据 将有助于更好地了解HR的疾病过程，并导致更多的生理MTPJ1替代， 最终将改善美国人力资源管理人员的流动性和生活质量。完成后， 我们的团队将获得进行大型临床试验的专业知识， 人力资源的目标是制定一个更严格的人力资源分类，并更好地了解各种原因 MTPJ1疼痛（例如，背侧第一跖骨骨赘或MTPJ1软骨损伤或籽骨关节病）。

PROJECT SUMMARY/ABSTRACT The first metatarsophalangeal joint (MTPJ1) is one of the sites most often affected by osteoarthritis, leading to a condition called hallux rigidus (HR). This is very common, estimated to affect 25% of the adult population and increasing in prevalence with age. The number of patients seen by the Veterans Health Administration (VHA) for HR has more than doubled over the last decade. In contrast to degenerative osteoarthritis at the hip and knee, which is commonly treated with joint replacement arthroplasties, the most common surgical treatment for severe HR is arthrodesis, which eliminates joint function. This approach does not allow modification of footwear, interferes with some activities (e.g., yoga, Pilates) and may lead to secondary complications such as metatarsalgia and mobility restrictions. To date, various designs for MTPJ1 arthroplasties have been proposed, but none have been particularly successful, with high failure rates due to loosening and regular reports of migration of the implant. This may be in part because of the relatively small amount of cortical bone in the metatarsal head and proximal phalanx regions, making it difficult to achieve adequate fixation of the prosthetic components. Development of new implants aimed at addressing these problems has been limited by the sparseness of the literature regarding the mechanical environment of the MTPJ1. Similarly, there is very little detailed information on the typical 3D movement of the MTPJ1 required during activities of daily living. Our recent work has established the groundwork for a computational-based modeling workflow that is intended to optimize the design of a novel MTPJ1 implant, and we have had some initial success in generating new, evidence-based implant concepts. In this project, we intend to advance this work, increasing our ability to further MTPJ1 implant technology through computational and robotic gait simulation-based testing. This will ultimately lead to improved patient outcomes. We intend to achieve these aims by: 1) characterizing pathological and healthy MTPJ1 function during different activities of daily living; 2) using a robotic gait simulator to measure the effectiveness of existing and novel MTPJ1 implants at restoring joint function; and 3) further refining our musculoskeletal and finite element models of MTPJ1 to improve their accuracy and provide further validation of their ability to generate useful results. We believe this work has the potential to reinvigorate the study of MTPJ1 arthroplasty, which at present is primarily driven by ideas and not data. The knowledge disseminated from this research will allow surgeons and patients to make better decisions regarding surgical treatments for HR. Specifically, these data will help better understand the disease process of HR and lead to more physiologic MTPJ1 replacements, that will ultimately result in an improvement in mobility and quality of life for Americans with HR. Upon completion, our group will have obtained the expertise to undertake a large clinical trial investigating surgical treatment of HR with the goals of developing a more rigorous classification of HR, and better insight into the various causes of MTPJ1 pain (e.g., dorsal first metatarsal osteophytes or MTPJ1 cartilage damage or sesamoid arthropathy).