Reducing variation in hip replacement outcomes: understanding psoas tendon impingement

全髋关节置换术（THR）是一项成功的手术，但需要翻修的装置数量仍在不断增加。高达40%的患者报告手术后持续疼痛，原因之一是软组织撞击（特别是髂腰肌肌腱），这可能发生在约5%的病例中。有效的治疗通常是进一步的手术，包括单独或联合重新定位髋关节置换术杯，释放或切除髂腰肌肌腱，以减少撞击。一些证据表明，罩杯大小和位置、个体患者的骨骼解剖和姿势以及症状性腰肌撞击之间存在联系。本研究的目的是根据个体的解剖结构和姿势，确定如何定位髋臼组件以避免腰肌撞击。该项目由一家主要的植入物制造商共同资助，将解决临床医生和行业相关的问题，以确保所有患者的髋关节置换手术结果最佳。此外，该项目将由一名骨科医生共同监督，以提供临床观点。该项目将包括在一系列受试者中描述与腰肌撞击和姿势相关的骨骼和软组织解剖（使用尸体和成像设备）之间的关系，然后开发一个新的计算模型来定义腰肌肌腱的包裹路径，用于预测撞击。将有机会将特征和模型与髋关节置换术后症状性腰肌撞击患者的现有临床数据集进行比较。该项目的结果将为不同患者的手术组件选择和位置提供证据，以避免腰肌撞击。

Total hip replacement (THR) is a successful operation but the number of devices requiring revision is continuing to rise. Up to 40% of patients report persistent pain after their surgery, and a cause is soft tissue impinging (specifically the iliopsoas tendon) against the replaced joint which can occur in around 5% of cases. Effective treatment is usually further surgery, consisting of release or resection of the iliopsoas tendon, alone or in combination with re-positioning the hip replacement cup to reduce the impingement. Some evidence suggests that there is a link between cup size and position, an individual patient's bony anatomy and posture, and symptomatic psoas impingement.The aims of this study are to determine how an acetabular component can be positioned to avoid psoas impingement, given the anatomy and posture of an individual.This project is co-funded by a major implant manufacturer, and will address an issue of relevance to both clinicians and industry to ensure the outcomes of hip replacement surgery for all patients are optimal. Additionally, the project will be co-supervised by an orthopaedic surgeon to provide a clinical perspective.The project will involve characterising the relationship between bony and soft tissue anatomy (using cadaveric and imaging facilities) relating to psoas impingement and posture in a range of subjects, then developing a new computational model to define the wrapping path of the psoas tendon for use in predicting impingement. There will be opportunities to compare characterisation and modelling with an existing clinical data set of patients with symptomatic psoas impingement after hip replacement.The project outcomes will provide evidence for surgical recommendations on component selection and position for different patients to avoid psoas impingement.