Personal Surgical Planning to Avoid Hip Dislocation after Total Hip Arthroplasty: Concept of Functional Safe Zone.

避免全髋关节置换术后髋关节脱位的个人手术计划：功能安全区的概念。

• 批准号: 10626726
• 负责人: Aidin Eslam Pour
• 金额: $ 16.55万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10626726
• 关键词: 3-Dimensional; Activities of Daily Living; Address; Affect; Articular Range of Motion; Attention; Award; Biomechanics; Computer Assisted; Computer Models; Computerized Medical Record; Data; Data Analyses; Dimensions; Dislocations; Education; Environment; Femoral Head Prosthesis; Femur; Goals; Guidelines; Head; Healthcare; Hip Dislocation; Hip Joint; Hip region structure; Human; Image; Implant; Knowledge; Lateral; Literature; Litigation; Measures; Mentorship; Methods; Modeling; Motion; Multicenter Studies; Operative Surgical Procedures; Orthopedics; Patient imaging; Patient-Focused Outcomes; Patients; Pelvis; Positioning Attribute; Postoperative Period; Procedures; Process; Prosthesis; Publishing; Research; Research Activity; Research Personnel; Research Support; Resources; Risk Reduction; Rotation; Safety; Spine surgery; Surgeon; System; Techniques; Testing; Time; Training; Training Support; Treatment Cost; Update; Visual; Work; career; cost; experience; falls; femur head; functional improvement; hip replacement arthroplasty; improved; intervertebral disk degeneration; multidisciplinary; prevent; three-dimensional modeling; tool; two-dimensional

Project Summary: This proposal addresses a knowledge gap concerning the causes of postoperative hip dislocation, a condition with associated annual costs exceeding ~$500 million in the U.S. Hip dislocation occurs when the femoral head is forced out of its acetabular socket. Dislocation of a prosthetic femoral head following total hip arthroplasty is thought to occur when the maximum prosthetic range of motion is less than the functional range of hip motion required to perform daily activities. In particular, non-optimal acetabular and femoral component orientation (e.g., abduction and anteversion), which are unique for each patient, can cause such a mismatch. The acetabular and femoral orientations vary with natural 3D pelvic tilting during activities of daily living that require tilting. The pelvic tilt itself can also change over time with the progression of degenerative disc disease or because of spinal surgeries. The pelvic tilt has received little attention in the literature. Currently, both conventional and computer-assisted total hip arthroplasty are guided by the concept of a 2-dimensional (2D) safe zone for acetabular implant anteversion; this 2D safe zone was developed in 1978 and requires updating. My working hypothesis is that pelvic tilt in all three cardinal planes during daily activities is one of the major factors that affects hip dislocation rate. Thus, PI Dr. Eslam Pour is proposing to develop a new personalized surgical planning tool for orthopedic surgeons that will establish optimal implant component orientations for each total hip arthroplasty patient. The planning tool will be customized for the range of 3D pelvic tilts measured using either regular lateral lumbar radiographs or the EOS system in three common activities of daily living: standing, sitting and moving from sitting-to-standing. In Aim 1, a 3D computer model will be developed to predict the optimal implant anteversion and abduction for any given values of 3D pelvic tilt and the required range of motion in different daily activities. In Aim 2, the new safe zone created by the 3D computer model from Aim 1 will be validated retrospectively using collected images from patients who had pre- and postoperative EOS imaging during their total hip arthroplasty process. Once validated, the new tool can be used for pre-operative total hip arthroplasty surgical planning to reduce the risk for prosthetic dislocation. We will then apply for an R01 to test this new 3D safe zone model in a multicenter study. Dr. Eslam Pour has assembled a highly experienced, multidisciplinary mentorship team in a strong research environment. He will leverage these excellent resources to address his educational needs and career goals by following the detailed educational and mentorship included in this proposal. Together, the training and research supported by this proposal will propel him to become a successful independent investigator and a national leader in hip arthroplasty research.

项目摘要： 该提案解决了有关术后髋关节脱位原因的知识差距 当股骨时，美国的年度费用超过约5亿美元的髋关节脱位 头部被迫离开其髋臼插座。总髋关节后股骨头的脱位 当最大的运动范围小于功能范围时，人们认为关节置换术会发生 进行日常活动所需的髋关节运动。特别是，非最佳髋臼和股骨成分 对于每个患者而言是唯一的，方向（例如，绑架和绑架和前后）可能会导致这种不匹配。 髋臼和股骨方向随着天然3D骨盆倾斜的变化，在日常生活活动中 需要倾斜。随着退行性椎间盘疾病的发展，骨盆倾斜本身也会随着时间的流逝而变化 或由于脊柱手术。骨盆倾斜在文献中很少关注。目前，这两个 传统和计算机辅助的总髋关节置换术受二维（2D）的概念指导 髋臼植入物的安全区；这个2D安全区域于1978年开发，需要更新。 我的工作假设是，在日常活动中，所有三个红衣主教的骨盆倾斜都是主要的之一 影响髋关节位错率的因素。因此，Pi Eslam Pour博士提议开发新的个性化 骨科医生的手术计划工具，这些工具将建立最佳植入物成分方向 每个总髋关节置换术患者。计划工具将针对3D骨盆倾斜的范围定制 使用常规侧腰X光片或EOS系统进行测量 日常生活：站立，坐着和从坐下来移动。在AIM 1中，将是3D计算机模型 为预测任何给定的3D骨盆倾斜和给定值的最佳植入物和绑架而开发 不同日常活动中所需的运动范围。在AIM 2中，由3D创建的新安全区域 来自AIM 1的计算机模型将通过使用前患者的图像进行回顾性验证 以及术后EOS成像在其总髋关节置换过程中。一旦验证，新工具就可以是 用于术前全髋关节置换术手术计划，以降低假肢脱位的风险。我们 然后，将在多中心研究中申请R01来测试这个新的3D安全区模型。 Eslam Pour博士有 在强大的研究环境中组建了一个经验丰富的多学科指导团队。他会的 通过遵循详细信息来利用这些优质的资源来满足他的教育需求和职业目标 该提案中包括教育和指导。共同支持的培训和研究 提案将促使他成为成功的独立调查员和髋关节的国家领导人 关节置换研究。

项目成果

Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion?

• DOI: 10.1016/j.arth.2021.02.017
• 发表时间: 2021-07
• 期刊: The Journal of arthroplasty
• 作者: Pour AE;Schwarzkopf R;Patel KP;Anjaria M;Lazennec JY;Dorr LD
• 通讯作者: Dorr LD

Femoral stem neck geometry determines hip range of motion shape : a computer simulation study.

• DOI: 10.1302/2046-3758.1012.bjr-2021-0273.r1
• 发表时间: 2021-12
• 期刊: Bone & joint research
• 影响因子: 4.6
• 作者: Eslam Pour A;Lazennec JY;Patel KP;Anjaria MP;Beaulé PE;Schwarzkopf R
• 通讯作者: Schwarzkopf R

How much change in pelvic sagittal tilt can result in hip dislocation due to prosthetic impingement? A computer simulation study.

• DOI: 10.1002/jor.25022
• 发表时间: 2021-12
• 期刊: Journal of orthopaedic research : official publication of the Orthopaedic Research Society
• 作者: Pour AE;Schwarzkopf R;Patel KPK;Anjaria MP;Lazennec JY;Dorr LD
• 通讯作者: Dorr LD