Longitudinal Biomechanics and Patient-Reported Outcomes after Periacetabular Osteotomy for Developmental Dysplasia of the Hip

髋臼周围截骨术治疗髋关节发育不良后的纵向生物力学和患者报告的结果

• 批准号: 10561427
• 负责人: Michael D Harris
• 金额: $ 52.71万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-10 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10561427
• 关键词: Adolescent and Young Adult; Affect; Anterior; Arthritis; Biomechanics; Caring; Cartilage; Data; Deformity; Degenerative polyarthritis; Deterioration; Development; Disease; Dysplasia; Electronics; Femur; Geometry; Goals; Hip Joint; Hip Osteoarthritis; Hip region structure; Intervention; Joints; Magnetic Resonance Imaging; Medial; Modeling; Motion; Musculoskeletal; Operative Surgical Procedures; Osteotomy; Outcome; Outcome Measure; Pain; Patient Monitoring; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Quality of life; Questionnaires; Reaction; Recovery; Rehabilitation therapy; Reporting; Risk; Shapes; Structure; Surgeon; Symptoms; Testing; Treatment Factor; Work; acetabulum; common treatment; expectation; experience; femur head; hip replacement arthroplasty; improved; improved outcome; joint biomechanics; long term recovery; longitudinal analysis; muscle strength; peer; profiles in patients; success; treatment optimization; wearable sensor technology; young adult

PROJECT SUMMARY / ABSTRACT Developmental dysplasia of the hip (DDH) is a life-long disorder that alters joint biomechanics and increases the risk of early osteoarthritis. The most common treatment for DDH is periacetabular osteotomy (PAO), which surgically reorients the abnormally shaped acetabulum to better cover and stabilize the femoral head. After PAO, patient reported outcome measures (PROMs) improve for many, but not all, patients, and PROMs for most patients remain below the levels of their healthy peers. Recent work has shown that aberrant biomechanical variables, including disproportionate joint reaction forces, high acetabular edge loads, and low abductor muscle strength, are related to specific geometric deformities in DDH prior to PAO. These altered biomechanics are also related to worse PROMs. The current project seeks to optimize surgical care for DDH by determining the effects of, and relationships among, PAO-induced changes to hip geometry, biomechanics, and PROMs. Aim 1 will assess how PAO-induced changes in bony geometry alter hip biomechanics. Geometric and biomechanical profiles for patients (N=60) undergoing PAO will be established before surgery using magnetic resonance imaging, motion capture, and musculoskeletal modeling. Changes to patients’ biomechanical profiles resulting from PAO-induced changes to geometry will be determined at 6 and 12 months post-PAO. Aim 2 will establish target ranges for PAO surgical correction based on the sensitivity of biomechanical outcomes to variability in acetabular reorientation. Surgically feasible combinations of changes to patients’ acetabular geometry will be tested using probabilistic analysis, musculoskeletal models, and high-throughput computing to predict the resultant changes to biomechanics. Aim 3 will determine the relationships among PROMs, activity levels, and biomechanics pre-PAO and over the first 12 months post-PAO. Electronic questionnaires and wearable sensors will be used to monitor PROMs and activity changes as patients recover from surgery. From these data, we will demonstrate how hip biomechanics and activity levels differ in patients with improved PROMs compared to those with unresolved symptoms. Results from the project will inform customized surgical plans according to patients’ initial bony geometry and help surgeons and patients focus on modifiable treatment factors that are associated with improved outcomes. Likewise, new information about variables such as post-PAO activity levels and muscle strength will inform rehabilitation to further improve outcomes. Finally, this project will pave the way for long-term longitudinal analyses of PROMs, biomechanics, and joint structure to inform surgical and rehabilitation approaches that predictably mitigate early hip osteoarthritis.

项目摘要 /摘要 髋关节发育不良（DDH）是一种终生疾病，可以改变关节生物力学并增加 早期骨关节炎的风险。 DDH最常见的治疗方法是截骨周期截骨术（PAO），它 通过手术重新修饰绝对形状的髋臼，以更好地覆盖并稳定股骨头。 pao之后， 患者报告的结果指标（PROM）改善了许多但不是全部的患者，大多数患者和舞会改善了 患者保持低于健康同龄人的水平。最近的工作表明异常生物力学 变量，包括不成比例的关节反作用力，高髋臼边缘载荷和低外展肌 强度与PAO之前的DDH的特定几何畸形有关。这些改变的生物力学也是 与较差的舞会有关。当前项目旨在通过确定效果来优化DDH的手术护理 PAO引起的髋关节几何形状，生物力学和舞会的变化的关系。目标1意志 评估PAO诱导的骨几何变化如何改变髋关节生物力学。几何和生物力学 使用磁共振在手术前将建立患者（n = 60）的患者（n = 60）的特征 成像，运动捕获和肌肉骨骼建模。导致患者的生物力学轮廓的变化 通过PAO引起的几何变化将在PAO后6个月和12个月确定。 AIM 2将建立 基于生物力学结果对变异性的敏感性的PAO手术校正的目标范围 髋臼重新定位。对患者髋臼几何变化的外科手术可行组合将是 使用概率分析，肌肉骨骼模型和高通量计算进行了测试，以预测 最终改变生物力学。 AIM 3将确定舞会，活动水平和 生物力学前PAO和PAO后的前12个月。电子问卷和可穿戴传感器 随着患者从手术中恢复，将用于监测舞会和活动的变化。从这些数据，我们将 与那些相比 有未解决的症状。该项目的结果将根据患者的定制手术计划提供信息。 最初的骨几何形状，并帮助外科医生和患者专注于可修改的治疗因素 有改善的结果。同样，有关变量的新信息，例如PAO后活动水平和肌肉 力量将为康复提供信息，以进一步改善结果。最后，这个项目将为长期铺平道路 对舞会，生物力学和联合结构的纵向分析，以告知外科手术和康复 可以预见的可以减轻早期髋骨关节炎的方法。