Longitudinal Biomechanics and Patient-Reported Outcomes after Periacetabular Osteotomy for Developmental Dysplasia of the Hip

髋臼周围截骨术治疗髋关节发育不良后的纵向生物力学和患者报告的结果

• 批准号: 10561427
• 负责人: Michael D Harris
• 金额: $ 52.71万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-10 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10561427
• 关键词: Adolescent and Young Adult; Affect; Anterior; Arthritis; Biomechanics; Caring; Cartilage; Data; Deformity; Degenerative polyarthritis; Deterioration; Development; Disease; Dysplasia; Electronics; Femur; Geometry; Goals; Hip Joint; Hip Osteoarthritis; Hip region structure; Intervention; Joints; Magnetic Resonance Imaging; Medial; Modeling; Motion; Musculoskeletal; Operative Surgical Procedures; Osteotomy; Outcome; Outcome Measure; Pain; Patient Monitoring; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Quality of life; Questionnaires; Reaction; Recovery; Rehabilitation therapy; Reporting; Risk; Shapes; Structure; Surgeon; Symptoms; Testing; Treatment Factor; Work; acetabulum; common treatment; expectation; experience; femur head; hip replacement arthroplasty; improved; improved outcome; joint biomechanics; long term recovery; longitudinal analysis; muscle strength; peer; profiles in patients; success; treatment optimization; wearable sensor technology; young adult

PROJECT SUMMARY / ABSTRACT Developmental dysplasia of the hip (DDH) is a life-long disorder that alters joint biomechanics and increases the risk of early osteoarthritis. The most common treatment for DDH is periacetabular osteotomy (PAO), which surgically reorients the abnormally shaped acetabulum to better cover and stabilize the femoral head. After PAO, patient reported outcome measures (PROMs) improve for many, but not all, patients, and PROMs for most patients remain below the levels of their healthy peers. Recent work has shown that aberrant biomechanical variables, including disproportionate joint reaction forces, high acetabular edge loads, and low abductor muscle strength, are related to specific geometric deformities in DDH prior to PAO. These altered biomechanics are also related to worse PROMs. The current project seeks to optimize surgical care for DDH by determining the effects of, and relationships among, PAO-induced changes to hip geometry, biomechanics, and PROMs. Aim 1 will assess how PAO-induced changes in bony geometry alter hip biomechanics. Geometric and biomechanical profiles for patients (N=60) undergoing PAO will be established before surgery using magnetic resonance imaging, motion capture, and musculoskeletal modeling. Changes to patients’ biomechanical profiles resulting from PAO-induced changes to geometry will be determined at 6 and 12 months post-PAO. Aim 2 will establish target ranges for PAO surgical correction based on the sensitivity of biomechanical outcomes to variability in acetabular reorientation. Surgically feasible combinations of changes to patients’ acetabular geometry will be tested using probabilistic analysis, musculoskeletal models, and high-throughput computing to predict the resultant changes to biomechanics. Aim 3 will determine the relationships among PROMs, activity levels, and biomechanics pre-PAO and over the first 12 months post-PAO. Electronic questionnaires and wearable sensors will be used to monitor PROMs and activity changes as patients recover from surgery. From these data, we will demonstrate how hip biomechanics and activity levels differ in patients with improved PROMs compared to those with unresolved symptoms. Results from the project will inform customized surgical plans according to patients’ initial bony geometry and help surgeons and patients focus on modifiable treatment factors that are associated with improved outcomes. Likewise, new information about variables such as post-PAO activity levels and muscle strength will inform rehabilitation to further improve outcomes. Finally, this project will pave the way for long-term longitudinal analyses of PROMs, biomechanics, and joint structure to inform surgical and rehabilitation approaches that predictably mitigate early hip osteoarthritis.

项目总结/摘要 发育性髋关节发育不良（DDH）是一种终身疾病，它改变了关节生物力学， 早期骨关节炎的风险。DDH最常见的治疗方法是髋臼周围截骨术（PAO）， 通过外科手术重新定向畸形髋臼，以更好地覆盖和稳定股骨头。在PAO之后， 许多患者（但不是所有患者）的患者报告结局指标（PROM）得到改善，大多数患者的PROM 患者的水平仍低于健康同龄人。最近的研究表明，异常的生物力学 变量，包括不成比例的关节反作用力、高髋臼边缘载荷和低外展肌 强度与PAO前DDH中的特定几何畸形有关。这些改变的生物力学也是 与更糟糕的PROM有关。目前的项目旨在通过确定DDH的影响来优化手术护理 PAO引起的髋关节几何结构、生物力学和PROM变化及其相互关系。目标1将 评估PAO诱导的骨几何结构变化如何改变髋关节生物力学。几何和生物力学 术前将使用磁共振确定接受PAO的患者（N=60）的特征 成像、动作捕捉和肌肉骨骼建模。患者生物力学特征的变化导致 将在PAO后6个月和12个月确定PAO诱导的几何结构变化。目标2将建立 基于生物力学结果对PAO变异性的敏感性， 髋臼重新定向。手术可行的患者髋臼几何结构变化组合将 使用概率分析，肌肉骨骼模型和高通量计算进行测试，以预测 生物力学的变化。目标3将确定方案主管机构、活动水平和 PAO前和PAO后前12个月的生物力学。电子问卷和可穿戴传感器 将用于监测患者手术后恢复时的PROM和活动变化。根据这些数据，我们将 证明了与那些改善的PROM患者相比，改善的PROM患者的髋关节生物力学和活动水平如何不同， 症状尚未解决该项目的结果将根据患者的需求提供定制的手术计划 帮助外科医生和患者专注于相关的可修改的治疗因素， 改善结果。同样，关于变量的新信息，如PAO后活动水平和肌肉 强度将为康复提供信息，以进一步改善结果。最后，该项目将为长期 纵向分析PROM、生物力学和关节结构，为手术和康复提供信息 可预见地减轻早期髋关节骨关节炎的方法。