Enhanced surgical treatments for hip osteoarthritis

全世界有超过8000万患者患有髋关节骨关节炎，并且越来越多的患者需要全髋关节置换手术。这被认为是一种成功的干预措施，然而，随着骨科治疗需求的增加，肥胖和患者期望水平的提高，以及医疗预算和手术培训的减少，老龄化人口正在共同挑战这一成功。年轻患者对手术治疗的需求也越来越大，这将推迟髋关节置换手术的需要，这些干预措施重塑骨骼并修复软组织。自然髋关节和髋关节置换术失败的主要原因之一是撞击，其中股骨侧的骨与髋关节窝或髋关节置换组件之间存在机械邻接。在自然髋关节中，手术重塑骨骼可以减少这种撞击，软组织损伤可以修复;然而，切除的骨量的影响还不清楚，也不是修复软组织的最佳方法。在翻修手术中需要从患者体内取出并更换新髋关节的髋关节置换数量正在增加;通常涉及因撞击造成的髋臼杯边缘损坏。已知的是，如果部件相对于彼此或相对于主体中经历的载荷方向没有很好地对准，则这更有可能。在本提案中，我试图通过消除对撞击的担忧，确保早期干预和髋关节置换手术的长期结果始终是最佳的。为了做到这一点，我将开发一个实验解剖髋关节模拟器。模拟器将向髋关节施加与临床观察到的相似的载荷和运动，并包括模拟自然髋关节的高保真体模，髋关节置换组件也可以植入其中。该解剖学模拟器将用于评估与患者相关的变量（例如，其骨几何结构）、早期介入手术的程度（例如，截骨量）或假体设计以及髋关节在体内的对齐方式将如何影响撞击的可能性。对影响撞击可能性和严重性的因素的更好理解将能够更好地指导如何进行手术以优化提供的结果。我将与整形外科医生合作，将这种改进的理解融入他们的临床实践，并与整形外科公司合作，将研究结果融入新产品开发过程;以便未来的干预措施和设备可以设计为所有患者提供更好的结果。

Over 80 million patients worldwide suffer from hip osteoarthritis, and increasing numbers of patients are requiring total hip replacement surgery. This is considered to be a successful intervention, however, an ageing population with increasing orthopaedic treatment needs, greater levels of obesity and patient expectations, and reducing healthcare budgets and surgical training are conspiring to challenge this success. There is also increasing demand for surgical treatments in younger patients that will delay the need for hip replacement surgery, these interventions reshape bone and repair soft tissue.One of the major causes of failure in the natural hip and in hip replacements is impingement, where there is a mechanical abutment between bone on the femoral side and hip socket or hip replacement components. In the natural hip, surgery reshaping the bone can reduce this impingement and soft tissue damage can be repaired; however, the effects of the amount of bone that is removed is not well understood nor is the best way to repair soft tissue. The number of hip replacements needing to be removed from patients and replaced with a new one in revision surgery is increasing; damage to the cup rim because of impingement is often implicated. It is known that this is more likely if the components are not well aligned relative to each another, or relative to the load direction experienced in the body. In this proposal, I seek to ensure long term outcomes of early intervention and hip replacement surgery are always optimum by negating concerns about impingement. To do this, I will develop an experimental anatomical hip simulator. The simulator will apply loads and motions to the hip similar to those observed clinically, and include high fidelity phantoms that mimic the natural hip, into which hip replacement components can also be implanted. This anatomical simulator will be used to assess how variables such as those associated with the patient (e.g. their bony geometry), the extent of early intervention surgery (e.g. the amount of bone removed) or the design of the prosthesis and how the hip is aligned in the body will affect the likelihood of impingement. This improved understanding of factors affecting the likelihood and severity of impingement will enable better guidance on how the surgery should be performed to optimise outcomes to be provided. I will work with orthopaedic surgeons to integrate this improved understanding into their clinical practice and with an orthopaedic company to integrate the findings into new product development processes; so that future interventions and devices can be designed to provide better outcomes for all patients.