Characterizing and Restoring Joint Motion in Patients with Hallux Rigidus

项目摘要/摘要 第一跖趾关节(MTPJ1)是骨性关节炎最常见的部位之一，导致 这种情况称为拇指僵硬(HR)。这是非常常见的，估计会影响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)为 人力资源在过去十年中翻了一番以上。与髋部和膝部退行性骨关节炎形成对比的是， 它通常用关节置换成形术治疗，这是最常见的重症 HR是关节融合术，它消除了关节功能。该方法不允许修改鞋类， 干扰某些活动(如瑜伽、普拉提)，并可能导致继发性并发症，如 踝关节痛和行动不便。到目前为止，已经提出了各种MTPJ1关节成形术的设计， 但没有一个是特别成功的，由于松动和定期报告 植入物的迁移。这可能部分是因为大脑皮质骨量相对较少。 跖头和近节指骨区域，使假体难以充分固定 组件。旨在解决这些问题的新植入物的开发一直受到 关于MTPJ1机械环境的文献很少。同样，也很少有 关于MTPJ1在日常生活活动中所需的典型3D运动的详细信息。我们最近 工作已经为基于计算的建模工作流奠定了基础，该工作流旨在优化 设计了一种新型的MTPJ1植入物，我们在产生新的循证证据方面取得了一些初步成功 植入概念。在这个项目中，我们打算推进这项工作，提高我们进一步植入MTPJ1的能力 技术通过基于计算和机器人步态模拟的测试。这最终将导致改进 病人的结果。我们打算通过以下方式实现这些目标：1)确定病理和健康的MTPJ1的特征 在日常生活的不同活动中的功能；2)使用机器人步态模拟器来测量 现有的和新的MTPJ1植入物可以恢复关节功能；以及3)进一步完善我们的肌肉骨骼和 MTPJ1的有限元模型，以提高其精度并进一步验证其生成能力 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，该成形术在 目前主要是由想法驱动的，而不是数据。这项研究传播的知识将使 外科医生和患者对HR的外科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，并导致更多生理性的MTPJ1替换，即 最终将改善人力资源美国人的流动性和生活质量。完成后， 我们的团队将获得专业知识，进行一项大型临床试验，调查外科手术治疗 人力资源，目标是制定更严格的人力资源分类，并更好地洞察各种原因 MTPJ1疼痛(例如，第一跖骨背侧骨赘或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).