Understanding barriers to clinical adoption of total ankle replacement in the treatment of ankle osteoarthritis to develop future interventions

踝关节骨关节炎影响全球约1-3%的人口，据报道，在英国有超过150万患者。通常，踝关节骨关节炎患者比髋关节或膝关节关节炎患者年轻。踝关节骨关节炎对患者的生活质量和活动能力有巨大的影响。对于一般的骨关节炎，全关节置换手术通常用于治疗晚期关节炎。然而，在英国，每年接受踝关节置换术的患者不到1000人，而且踝关节置换术远不如髋关节或膝关节置换术成功。对于这一患者群体来说，一个功能良好且易于植入的设备是一个巨大的未满足需求。在其他关节置换术中，纯工程方法的植入物设计已被证明有局限性。与所有利益相关者一起确定新设备的关键要求将为优化现有解决方案和方法或开发全新设备的研究提供一个极好的平台。申请人具有医学工程背景，在关节置换性能的工程模拟方面有丰富的经验，并一直在发展一个专注于踝关节生物工程的研究小组。她的目标是提高全踝关节置换术的性能，为更广泛的踝关节关节炎患者提供真正的解决方案。这项学科转换资助将使申请人在临床环境中通过以下活动与利益相关者接触：i)观察门诊诊所和踝关节关节炎患者的治疗决策途径（利兹教堂阿勒顿医院）ii)观察踝关节手术-全踝关节置换和融合，以确定英国三家领先的踝关节置换中心手术技术中的关键挑战。iii)通过尸体培训课程获得全踝关节置换术的实践经验iv)对踝关节外科医生进行全国调查，以扩展从具有不同经验水平的广泛外科医生那里获得的信息v)通过重点访谈小组（位于利兹的Chapel Allerton医院）进行患者参与，并进行更广泛的全国调查。为了支持这些活动，申请人在资助期间提出了一个培训计划，包括良好临床实践，患者参与培训，医疗经济学暑期学校，并将与教堂阿勒顿医院的外科学员一起参加研讨会。最终，这笔资助将使她增加对外科医生和患者对全踝关节置换术需求的了解，使她能够为未来的踝关节置换术设计制定一个强有力的规范，成功地满足更广泛患者的需求。通过学科跳跃与外科医生和患者建立的关系将在未来的合作研究中继续发展。

Osteoarthritis of the ankle affects approximately 1-3% of the global population, and is reported in more than 1.5 million patients in the UK. Typically, patients with ankle osteoarthritis are younger than those that develop hip or knee arthritis. Ankle osteoarthritis has a huge impact on quality of life and patient mobility. For osteoarthritis in general, total joint replacement surgery is often used to treat late stage arthritis. However, less than one thousand patients receive an ankle replacement annually in the UK, and ankle replacement is far less successful than hip or knee replacement. There is a huge unmet need for a well functioning device that is simple to implant for this patient group.A purely engineering approach to implant design has been shown to have limitations in other joint replacements. Engagement with all stakeholders to determine the key requirements of a new device will provide an excellent platform for research to optimise existing solutions and approaches, or to develop an entirely new device. The applicant has a medical engineering background and extensive experience in engineering simulation of joint replacement performance and has been developing a research group focused on bioengineering in the ankle. She is aiming to improve the performance of total ankle replacement, to provide a real solution to a wider range of ankle arthritis patients. This discipline hopping grant would embed the applicant within a clinical environment to engage with the stakeholders through the following activities:i) Observation of out-patient clinics and the treatment-decision pathway for ankle arthritis patients (Chapel Allerton Hospital, Leeds)ii) Observation of ankle surgery - total ankle replacement and fusion, to identify the key challenges within the surgical technique at three leading ankle replacement centres within the UK. iii) Hands-on experience of total ankle replacement through a cadaver training courseiv) Undertaking a national survey of ankle surgeons, to extend the information received from a wide range of surgeons, with different levels of experiencev) Patient engagement through a focused interview group (based at Chapel Allerton Hospital, Leeds), and a broader national survey To support these activities, the applicant has proposed a training programme during the grant including Good Clinical Practice, Patient Engagement Training, a Healthcare Economics summer school and will attend seminars with the surgical trainees at Chapel Allerton Hospital.Ultimately, this grant will allow her to increase her knowledge of the surgeon and patient needs for total ankle replacement enabling her to define a robust specification for future ankle replacement design that successfully meets the needs of a wider range of patients. The relationships with surgeons and patients developed through the discipline hop will continue in collaborative research development in the future.