Characterizing and Restoring Joint Motion in Patients with Hallux Rigidus: Human Subject Testing

项目总结/摘要 第一跖趾关节（MTPJ 1）是最常受骨关节炎（OA）影响的部位之一， 一种叫做“拇趾僵硬症”的疾病这是非常普遍的，估计影响到25%的成年人口 并且随着年龄的增长而增加。退伍军人健康管理局（VHA）看到的患者数量 在过去的十年里，人力资源部门的收入增加了一倍多。与髋关节和膝关节的退行性OA相反， 通常采用关节置换关节成形术治疗，严重HR最常见的手术治疗是 关节融合术，消除关节功能。这种方法不允许修改鞋，干扰 对于某些活动（例如，瑜伽，普拉提），并可能导致继发性并发症，如跖骨痛， 流动性限制。迄今为止，已经提出了MTPJ 1关节成形术的各种设计，但没有一种设计是可行的。 特别成功，由于松动和植入物移位的定期报告，失败率很高。这可能 部分原因是跖骨头和近端趾骨中的皮质骨相对较少 区域，使得难以实现假体部件的充分固定。开发新 旨在解决这些问题的植入物受到关于机械性能的定量数据的限制， MTPJ 1的环境。同样，由于技术限制，没有精确的3D运动学数据 可用于描述日常生活活动期间所需的正常MTPJ 1功能的包络。我们最近 工作已经为优化MTPJ 1植入物设计的计算建模工作流程建立了基础， 我们已经初步成功地产生了新的，以证据为基础的植入概念， 部件固定。在这个项目中，我们打算推进这项工作，提高我们改进MTPJ 1的能力 通过计算建模和人类尸体的机器人步态模拟来实现植入技术。这些 性能更好的植入物将最终改善患者的治疗效果。我们打算实现这些目标 通过：1）在不同的日常生活活动中表征病理和健康的MTPJ 1功能; 2）使用 尸体机器人步态模拟器，以测量现有植入物和我们的新型植入物的有效性， 恢复MTPJ 1功能; 3）进一步完善我们的肌肉骨骼和有限元计算模型 MTPJ 1，提高其准确性，并验证其产生临床信息结果的能力。是 我们的工作假设是，成功的MTPJ 1植入物将表现出牢固的初始部件固定， 生理规范的关节生物力学;目前，我们的初步设计工作强调前者， 而[关于膝关节置换术的文献支持]后者。我们相信这项研究有可能 重振MTPJ 1关节成形术的进步，目前主要是由想法驱动，而不是 数据从这项研究中传播的知识将使外科医生和患者做出更好的决定 具体来说，这些数据将帮助临床医生更好地了解这种疾病 HR的过程，并导致更多的生理MTPJ 1替代，最终将导致改善 在流动性和生活质量的退伍军人与人力资源。在完成拟议的研究，我们的小组将有 获得了进行大型临床试验的专业知识，研究HR的手术治疗，目标是 开发更严格的HR分类，并更好地了解MTPJ 1疼痛的各种原因（例如， 背侧第一跖骨骨赘、MTPJ 1软骨损伤或籽骨关节病）。

PROJECT SUMMARY/ABSTRACT The first metatarsophalangeal joint (MTPJ1) is one of the sites most often affected by osteoarthritis (OA), leading to a condition called hallux rigidus (HR). This is very common, estimated to affect 25% of the adult population and increasing in prevalence with age. The number of patients seen by the Veterans Health Administration (VHA) for HR has more than doubled over the last decade. In contrast to degenerative OA at the hip and knee, which is commonly treated with joint replacement arthroplasties, the most common surgical treatment for severe HR is arthrodesis, which eliminates joint function. This approach does not allow modification of footwear, interferes with some activities (e.g., yoga, Pilates) and may lead to secondary complications such as metatarsalgia and mobility restrictions. To date, various designs for MTPJ1 arthroplasties have been proposed, but none have been particularly successful, with high failure rates due to loosening and regular reports of implant migration. This may be in part because of the relatively small amount of cortical bone in the metatarsal head and proximal phalangeal regions, making it difficult to achieve adequate fixation of the prosthetic components. Development of new implants aimed at addressing these problems has been limited by the quantitative data regarding the mechanical environment of the MTPJ1. Similarly, due to technological limitations, there is no precise 3D kinematic data available to describe the envelope of normal MTPJ1 function required during activities of daily living. Our recent work has established the groundwork for a computational modeling workflow to optimize MTPJ1 implant design, and we have had initial success generating novel, evidence-based implant concepts that emphasize strong initial component fixation. In this project, we intend to advance this work, increasing our ability to improve MTPJ1 implant technology through computational modeling and robotic gait simulation of human cadavers. These better-performing implants will ultimately lead to improved patient outcomes. We intend to achieve these aims by: 1) characterizing pathological and healthy MTPJ1 function during different activities of daily living; 2) using a cadaveric robotic gait simulator to measure the effectiveness of existing implants and our novel implants at restoring MTPJ1 function; and 3) further refining our musculoskeletal and finite element computational models of the MTPJ1, improving their accuracy and validating their ability to generate clinically-informative results. It is our working hypothesis that a successful MTPJ1 implant will exhibit both strong initial component fixation and physiologically normative joint biomechanics; presently, our preliminary design work has emphasized the former, while [the literature on knee joint replacements supports] the latter. We believe this research has the potential to reinvigorate the advancement of MTPJ1 arthroplasty, which at present is primarily driven by ideas rather than data. The knowledge disseminated from this research will allow surgeons and patients to make better decisions regarding surgical treatments for HR. Specifically, these data will help clinicians better understand the disease process of HR and lead to more physiologic MTPJ1 replacements that will ultimately result in an improvement in mobility and quality of life of veterans with HR. Upon completion of the proposed study, our group will have obtained the expertise to undertake a large clinical trial investigating surgical treatment of HR with the goals of developing a more rigorous classification of HR, and better insight into the various causes of MTPJ1 pain (e.g., dorsal first metatarsal osteophytes, MTPJ1 cartilage damage, or sesamoid arthropathy).