Evaluating Disease Progression in Hip Osteoarthritis

摘要 本提案的总体目标是评估髋关节骨关节炎（OA）患者的软骨成分 使用先进的MRI技术，并确定其与软骨病变发展的关系， 功能，以及功能任务期间髋关节运动学和动力学的变化。核心假设是， 软骨生物化学的早期变化和髋关节生物力学的改变与髋关节疾病的进展有关。 OA定义为患者报告的结局恶化和软骨病变评分较高。为了实现这一目标，我们 需要建立这些指标与髋关节OA自然史的横截面关系， 目的I）为了表征髋关节软骨T1ρ和T2弛豫时间， 空间异质性和解剖位置，以及髋关节几何形状（即α角，髋臼 深度等），作为（I. A）KL等级和（I.B）年度随访时间（0-3年）的函数;目的II）确定 髋关节软骨成分（通过MR T1ρ和T2弛豫时间测量，空间 异质性，其解剖位置-目标I结局）和疾病进展（IIA）髋关节测量 关节形态（见图1-半定量MR分级1，根据髋关节几何形状（如α角）进行调整） 和（IIB）患者报告的结局（由HOOS确定15）;以及目的III）确定 髋关节软骨成分（通过MRI T1ρ和T2弛豫时间测量，Aim I结局）与矢状面 在功能性任务（峰值髋关节屈曲角度和峰值髋关节伸展）期间的平面髋关节运动学和动力学 步态、爬楼梯和坐立过程中的时刻）。将纳入各种OA严重度的共144例髋关节 在书房里。每年进行高级定量成像、运动分析和功能测试 3年以上（基线、1、2和3年随访）。这一对协会的全面评价 髋关节软骨松弛时间、病变患病率和生物力学是确定 使用非侵入性评估髋关节OA的自然病史。这一信息构成了所需的关键， 设计并评估保守治疗（步态再训练、肌肉强化）、疾病改善 药物和手术（股骨和骨盆截骨术等）减缓或逆转疾病的干预措施 过程

ABSTRACT The overall goal of this proposal is to evaluate cartilage composition of patients with hip osteoarthritis (OA) using advanced MRI techniques, and determine their relationship to development of cartilage lesions, patient function, and changes in hip kinematics and kinetics during functional tasks. The central hypothesis is that early changes in cartilage biochemistry and altered hip biomechanics are associated with progression of hip OA defined by worsening patient-reported outcomes and higher cartilage lesion scores. To accomplish this we need to establish the cross-sectional relationship of these metrics and natural history of hip OA over three years with the following specific aims: Aim I) To characterize hip cartilage T1ρ and T2 relaxation time, their spatial heterogeneity and anatomical location, and association of hip geometry (i.e. alpha angle, acetabular depth, etc), as a function of (I.A) KL grade and (I.B) annual follow-up time (Years 0-3); Aim II) To determine the relationship between hip cartilage composition (measured by MR T1ρ and T2 relaxation time, spatial heterogeneity, their anatomical location - Aim I outcomes) and disease progression as measured by (IIA) hip joint morphology (see Fig. 1- semi-quantitative MR grading1, adjusted for hip geometry such as alpha angle) and (IIB) patient reported outcomes (as determined by HOOS15); and Aim III) To determine the relationship between hip cartilage composition (measured by MRI T1ρ and T2 relaxation time, Aim I outcomes), and sagittal plane hip kinematics and kinetics during functional tasks (peak hip flexion angle and peak hip extension moments during gait, stairs, and sit-to-stand). A total of 144 hips across a range of OA severity will be included in the study. Advanced quantitative imaging, motion analysis, and functional testing will be performed annually over three years (baseline, 1, 2, and 3 year follow-up). This comprehensive evaluation of the associations of hip cartilage relaxation times, lesion prevalence, and biomechanics is the vital first step to determine the natural history of hip OA using non-invasive assessment. This information forms the crux of what is needed to design and assess the effectiveness of conservative (gait retraining, muscle strengthening), disease modifying drugs, and surgical (femoral and pelvic osteotomy, etc.) interventions at slowing or reversing the disease process.