Characterizing and Restoring Joint Motion in Patients with Hallux Rigidus

拇强直患者的关节运动特征和恢复

• 批准号: 10058638
• 负责人: William R. Ledoux
• 金额: $ 34.43万
• 依托单位: SEATTLE INST FOR BIOMEDICAL/CLINICAL RES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10058638
• 关键词: 3-Dimensional; Activities of Daily Living; Address; Adult; Affect; Age; American; Ankle; Arthritis; Arthrodesis; Articular Range of Motion; Biomechanics; Body Weight; Bone Spur; Cadaver; Cartilage; Classification; Clinical; Clinical Trials; Complication; Data; Degenerative polyarthritis; Development; Device Designs; Devices; Disease; Dorsal; Effectiveness; Elderly; Elements; Environment; Failure; Female; Fluoroscopy; Foundations; Gait; Goals; Guidelines; Hallux Rigidus; Head; Hip region structure; Hour; Implant; Incidence; Individual; Interphalangeal joint of toe; Intervention; Joints; Kinetics; Knee; Knowledge; Lead; Literature; Locomotion; Mechanics; Metatarsal bone structure; Metatarsalgia; Metatarsophalangeal joint structure; Methods; Modeling; Modification; Motion; Movement; Musculoskeletal; Musculoskeletal Development; Operative Surgical Procedures; Osteotomy; Outcome; Pain; Partner in relationship; Pathologic; Patient-Focused Outcomes; Patients; Performance; Phalanx; Physiological; Population; Positioning Attribute; Preservation Technique; Prevalence; Process; Property; Prosthesis; Public Health; Quality of life; Randomized Controlled Trials; Replacement Arthroplasty; Reporting; Research; Resources; Robotics; Sampling; Secondary to; Shapes; Shoes; Site; Surface; Surgeon; Technology; Testing; United States; Ursidae Family; Validation; Veterans; Visit; Walking; Work; Yoga; arthropathies; base; bone; clinically significant; cortical bone; design; effectiveness measure; evidence base; experience; foot; gait examination; health administration; hip replacement arthroplasty; implant design; improved; ineffective therapies; insight; instrument; iterative design; joint function; joint loading; kinematics; knee replacement arthroplasty; male; migration; novel; pathomechanics; pilates exercise; preservation; sample fixation; simulation; success; systematic review; tool; treatment choice; treatment strategy

PROJECT SUMMARY/ABSTRACT The first metatarsophalangeal joint (MTPJ1) is one of the sites most often affected by osteoarthritis, 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 osteoarthritis 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 migration of the implant. This may be in part because of the relatively small amount of cortical bone in the metatarsal head and proximal phalanx 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 sparseness of the literature regarding the mechanical environment of the MTPJ1. Similarly, there is very little detailed information on the typical 3D movement of the MTPJ1 required during activities of daily living. Our recent work has established the groundwork for a computational-based modeling workflow that is intended to optimize the design of a novel MTPJ1 implant, and we have had some initial success in generating new, evidence-based implant concepts. In this project, we intend to advance this work, increasing our ability to further MTPJ1 implant technology through computational and robotic gait simulation-based testing. This 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 robotic gait simulator to measure the effectiveness of existing and novel MTPJ1 implants at restoring joint function; and 3) further refining our musculoskeletal and finite element models of MTPJ1 to improve their accuracy and provide further validation of their ability to generate useful results. We believe this work has the potential to reinvigorate the study of MTPJ1 arthroplasty, which at present is primarily driven by ideas and not 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 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 for Americans with HR. Upon completion, 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 or MTPJ1 cartilage damage or sesamoid arthropathy).

项目摘要/摘要 第一个MetaThophangeal关节（MTPJ1）是最常受骨关节炎影响的部位之一，导致 条件称为Hallux rigidus（HR）。这很常见，估计会影响25％的成年人口和 随着年龄的增长而增加。退伍军人卫生管理局（VHA）看到的患者人数 在过去的十年中，人力资源率翻了一番。与臀部和膝盖的退化性骨关节炎相反， 通常用关节置换术治疗，这是严重的最常见手术治疗 人力资源是关节固定术，它消除了关节功能。这种方法不允许修改鞋类， 干扰某些活动（例如，瑜伽，普拉提），可能导致次要并发症，例如 metatarsalgia和流动性限制。迄今为止，已经提出了MTPJ1节肢动物的各种设计， 但是，没有一个特别成功，由于放松和定期报告，其失败率很高 植入物的迁移。这可能部分是因为在 meta骨头和近端卵形区域，使得很难实现假肢的足够固定 成分。旨在解决这些问题的新植入物的开发受到了 关于MTPJ1机械环境的文献的稀疏性。同样，很少 关于日常生活活动中需要的MTPJ1典型3D运动的详细信息。我们最近 工作已经为基于计算的建模工作流提供了基础，该工作流旨在优化 新型MTPJ1植入物的设计，我们在产生新的，基于证据的新的方面取得了一些成功 植入概念。在这个项目中，我们打算推进这项工作，增强我们进一步的MTPJ1植入物的能力 通过基于计算和机器人步态模拟的测试技术。这最终将导致改善 患者的结果。我们打算通过以下方式实现这些目标：1）表征病理和健康的MTPJ1 在日常生活的不同活动中的功能； 2）使用机器人步态模拟器来测量 现有和新颖的MTPJ1植入物恢复关节功能； 3）进一步完善我们的肌肉骨骼和 MTPJ1的有限元模型，以提高其准确性并进一步验证其生成能力 有用的结果。我们认为，这项工作有可能振兴对MTPJ1关节置换术的研究，该研究 现在主要是由想法而非数据驱动的。从这项研究中传播的知识将允许 外科医生和患者就HR的手术治疗做出更好的决定。具体来说，这些数据 将有助于更好地了解人力资源的疾病过程，并导致更多的生理MTPJ1替代品，以便 最终将改善人力资源部美国人的流动性和生活质量。完成后， 我们的小组将获得专业知识，以进行大型临床试验，调查外科手术治疗 人力资源的目标是对人力资源进行更严格的分类，并更好地了解各种原因 MTPJ1疼痛（例如，背部第一质子骨植物或MTPJ1软骨损伤或芝麻节关节病）。