Contralateral Knee Osteoarthritis Among Older Adults after Primary Total Knee Arthroplasty

项目总结/摘要 到2030年，每年将有大约350万老年人接受全膝关节置换术（TKA）。在 此外，近30%接受单侧TKA的个体将发展为终末期膝关节骨关节炎（OA） 并且在初次手术后仅3年内需要在对侧（非手术）进行TKA。因此，在本发明中， 初次TKA患者的对侧膝关节代表了加速进展的生物力学模型， 膝骨关节炎，提供了一个独特的机会，研究OA发病机制的生物力学机制。一 提出的对侧膝关节OA快速进展的机制是异常运动模式， 并将负荷集中在不习惯的膝关节软骨上。具体而言，较小的矢状面膝关节偏移，或 更多的“僵硬的膝盖”步态模式，以及更高的关节负荷--这些加在一起可能会增加 膝关节软骨面积减少-在膝关节OA和/或TKA患者中很常见， 与膝关节OA严重程度和未来对侧TKA相关。既往研究异常 TKA后的运动模式和对侧膝关节OA具有明显的局限性， (e.g.,射线照相）成像或生物力学分析，但不能同时进行。F32的工作将解决缺点 研究对侧膝关节OA相关的生物力学机制 严重程度和进展，对于理解OA发病机制和最终设计有效的 干预措施。这个F32奖项的目的是1）确定长期存在的异常运动模式 可能导致早期对侧膝关节OA（TKA前），以及2）持续异常运动 初次TKA后的模式可能进一步加速对侧膝关节OA进展。 将在术前收集150例患者（年龄60-85岁）步态期间的生物力学运动分析 以及TKA术后康复后即刻。磁共振成像（MRI）将在 基线和TKA后2年。目标1将确定更大的膝关节载荷和更小的膝关节偏移 术前对侧膝关节的损伤与更大的对侧膝关节OA相关（即，更高[更差] 半定量和定量MRI值）。目标2将确定膝关节负荷增加和膝关节负荷减少 TKA康复后即刻对侧膝关节的关节偏移与对侧 从基线至初次TKA后2年，膝关节OA进展。拟议的研究意义重大，因为： 1)接受TKA的人群数量庞大且不断增长; 2）对侧膝关节OA的发生率较高 单侧TKA后进展，可能是未解决的异常运动模式的直接后果; 以及3）我们目前对导致发展的生物力学机制的理解不足 和对侧膝关节OA的进展。这项F32补助金将有助于确定这些机制-一个关键 最终降低对侧TKA发生率的初步步骤-并支持申请人的开发 致力于优化我们老龄化人口的肌肉骨骼健康的独立调查员。

PROJECT SUMMARY/ABSTRACT Approximately 3.5 million older adults will undergo total knee arthroplasty (TKA) annually by the year 2030. In addition, nearly 30% of individuals who undergo unilateral TKA will develop end-stage knee osteoarthritis (OA) and require a TKA on their contralateral (non-operated) side within just 3 years of their initial surgery. As such, the contralateral knee of primary TKA patients represents a biomechanical model of accelerated progression of knee OA, offering a unique opportunity to investigate biomechanical mechanisms of OA pathogenesis. One proposed mechanism for rapid contralateral knee OA progression is aberrant movement patterns that increase and concentrate loading on unhabituated knee cartilage. Specifically, smaller sagittal plane knee excursions, or a more “stiff-knee” gait pattern, and higher joint loading—which together may distribute increased forces on a reduced area of knee cartilage—are both common among individuals with knee OA and/or TKA and are associated with knee OA severity and future contralateral TKA. Previous studies investigating aberrant movement patterns and contralateral knee OA after TKA have notable limitations, relying either on diagnostic (e.g., radiographic) imaging or biomechanical analyses, but not both. The F32 work will address shortcomings in previous research and investigate the biomechanical mechanisms associated with contralateral knee OA severity and progression, critical to understanding OA pathogenesis and ultimately designing effective interventions. The purpose of this F32 award is 1) to determine how longstanding, aberrant movement patterns might contribute to early, contralateral knee OA (before TKA), and 2) how persistent, aberrant movement patterns after primary TKA might further contribute to accelerated contralateral knee OA progression. Biomechanical motion analyses during gait will be collected for 150 patients (age 60-85 years) pre-operatively and immediately after rehabilitation following TKA. Magnetic resonance imaging (MRI) will be performed at baseline and 2 years after TKA. Aim 1 will determine if greater knee joint loading and less knee joint excursion in the contralateral knee preoperatively are associated with greater contralateral knee OA (i.e., higher [worse] semi-quantitative and quantitative MRI values). Aim 2 will determine if greater knee joint loading and less knee joint excursion in the contralateral knee immediately after TKA rehabilitation are associated with contralateral knee OA progression from baseline to 2 years after primary TKA. The proposed study is significant because of: 1) the large and growing population of people undergoing TKA; 2) the high incidence of contralateral knee OA progression after unilateral TKA, potentially a direct consequence of unresolved aberrant movement patterns; and 3) our current, inadequate understanding of the biomechanical mechanisms leading to the development and progression of contralateral knee OA. This F32 grant will help identify these mechanisms—a key preliminary step for ultimately reducing rates of contralateral TKA—and support the Applicant's development into an independent investigator committed to optimizing musculoskeletal health in our aging population.