Osteoarthritis, Hip

ROSEMONT, Ill., Feb. 2, 2024 /PRNewswire/ -- The 2024 Kappa Delta Elizabeth Winston Lanier Award was presented to the Academic Network of Conservative Hip Outcomes Research (ANCHOR) group for 20 years of research to improve the quality of care for adolescent and young adult patients suffering from the three most common pre-arthritic hip conditions: femoroacetabular impingement (FAI), developmental dysplasia of the hip (DDH) and residual Legg-Calve-Perthes Disease (LCPD). Their research helped the orthopaedic community better understand the basic pathophysiology of hip osteoarthritis (OA), disease natural history, diagnosis, surgical treatment and predictors of treatment outcomes for young patients who often live with hip dysfunction for years or even decades with eventual progression to advanced OA. Continue Reading The 2024 Kappa Delta Elizabeth Winston Lanier Award was presented to the Academic Network of Conservative Hip Outcomes Research (ANCHOR) group for 20 years of research to improve the quality of care for adolescent and young adult patients suffering from the three most common pre-arthritic hip conditions. This award recognizes research in musculoskeletal disease or injury with great potential to advance patient care. To read more about the award, please click here. OA is a common condition that affects 27 million Americans with costs that are projected to increase by $185.5 billion per year.i Hip OA is particularly problematic due to the associated disability. Over time, the pre-arthritic conditions of FAI, DDH and LCPD wear down the articular cartilage that covers the hip joint surface and lead to hip OA, which is associated with pain, limited function and reduced quality of life. "In the early 2000s, the orthopaedic community lacked an understanding of pre-arthritic hip disease diagnoses and treatments. Variable patient age at presentation, lack of generalizable surgical treatments and limited clinical outcomes reporting for hip preservation procedures were major challenges," said lead researcher John C. Clohisy, MD, FAAOS, Daniel C. and Betty B. Viehmann Distinguished Professor of Orthopaedic Surgery at Washington University in St. Louis. "Due to a lack of knowledge of pre-arthritic hip disease and a limited number of surgeons to treat these diseases, the average wait time for an accurate pre-arthritic hip diagnosis was three to five years. This was clearly an underserved patient population." Early contributions by Reinhold Ganz, MD, and his colleagues in Switzerland helped transform hip surgery with the introduction of new surgical techniques and refined concepts regarding the causes of hip OA. However, these refined concepts and surgical strategies were initially viewed as untraditional, unproven and technically challenging. "We wanted to understand, investigate and implement Dr. Ganz's concepts to advance the quality of care for these patients, and we established three goals as the basis of our research: improving the individual health care experience of the patient; improving the health of populations; and lowering per capita health care costs for populations," said Dr. Clohisy. The ANCHOR group, coordinated from Washington University, initially enrolled two cohorts (FAI-1 and PAO-1) totaling 3,168 surgical cases to detail population characteristics of FAI and DDH patients, and to investigate the safety and efficacy of surgical treatments. Rigorous, comprehensive data collection of clinical presentation, diagnosis, patient-reported outcome measures (PROMs), radiographic imaging, surgical procedure details and intraoperative disease classification was the foundation for subsequent investigations. This robust dataset enabled the group to study several key performance indicators to provide quantitative measurement of improved patient outcomes. KEY PERFORMANCE INDICATORS AND SUBSEQUENT FINDINGS Timely Diagnosis: Define the patient population and educate orthopaedic surgeons The ANCHOR group performed a series of foundational studies to describe the clinical presentation and epidemiology of patients with FAI, DDH and labral tears. Findings of the studies included: There is a predominance of DDH in young active females, who often present with significant hip dysfunction and symptoms including groin or lateral hip pain. Clinical presentation is accelerated with high activity levels and more severe deformity. Females with FAI have greater symptomatology and milder morphologic abnormalities while males have a higher activity level, larger morphologic abnormalities, and more extensive intra-articular disease. Both groups present with activity-related groin pain, and tend to have restricted hip range of motion and progressive symptoms over time. Patient Satisfaction: Focus on responsiveness to patients' needs The ANCHOR group measured patient-reported satisfaction with standardized methodology to provide feedback on the patient experience associated with surgery for FAI. The findings included: FAI patients self-reported high overall satisfaction rates (>91%) and low rates of dissatisfaction (>9%). Longer-term mean 10-year follow up of the FAI-1 cohort was recently completed (unpublished data) and demonstrated maintenance of these high satisfaction rates (91%). Most patients studied who underwent PAO surgery demonstrated marked clinical improvement and returned to their sport, and only a small percentage had activity limitations from surgical hip symptoms (<11%). Overall patient satisfaction in PAO patients was also consistently over 90%. Treatment Indication: Causes of hip preservation failure and innovations in surgical techniques These studies aimed to identify appropriateness in patient selection and precise surgical technique. The findings included: Hip arthroscopy procedures are best utilized in the treatment of FAI with accessible FAI morphology. Alternatively, outcomes of isolated hip arthroscopy in the setting of acetabular dysplasia or advanced articular disease are not favorable. Complication Risk: Ensuring safety for high-quality care The initial literature on surgical procedures in the young population was not standardized and lacked risk and complication reporting. The group analyzed the safety of PAO, hip arthroscopy and surgical hip dislocation. The findings included: The complication risk is very acceptable and ranges from 1 to 5%, depending on the procedure. Permanent disability related to any of these procedures is less than 1%. Effectiveness: Using PROMs to compare preoperative and follow-up outcomes Early skepticism among the orthopaedic community related to the diagnosis of FAI, its association with hip OA, indications for surgery and efficacy of surgery required critical investigation of these new concepts. The findings included: Preoperative PROM score was a strong, highly significant predictor of all outcomes. More recent analyses have determined that competitive athletes have superior outcomes and lower failure rates compared to non-athletes (after controlling for important covariates). For FAI surgery, a lower risk of clinical failure was associated with participation in competitive athletics (p=0.01) and male gender (p<0.001). Longer chronicity of preoperative symptoms, patients over 40 years old requiring acetabular microfracture, and revision surgery are all independently associated with inferior clinical outcomes. Subgroup analysis of adolescent patients identifies females, mild cam FAI deformities and lack of sports participation to be associated with higher rates of treatment failure. Diagnosis and Length of Stay: Timeliness, accurate evaluation/diagnosis and cost The ANCHOR group developed a consensus document to standardize radiograph evaluation of the young adult hip and more recently have emphasized the important role of 3D imaging. This work included: A comprehensive review of radiographic technique and image interpretation that has served as a cornerstone contribution for surgeons, radiologists, radiology technicians and orthopaedic/radiology trainees. Three-dimensional imaging plays a fundamental role in the evaluation of young adult hip disorders. Low-dose computed tomography (CT) scanning is an excellent tool to precisely determine acetabular and femoral morphology as well as femoral version. "Over the past 20 years, access to quality care for young patients with pre-arthritic hip disease has markedly improved" said Dr. Clohisy. "We now have surgeons and health care teams who can deliver a comprehensive approach to manage the full spectrum of pre-arthritic hip disease. While we've made great strides, we're continuing to improve by better defining and diagnosing the conditions, determining the best indications for surgery and optimizing our surgical techniques." About the Kappa Delta Awards In 1947, at its golden anniversary, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopaedic research. The first annual award, a single stipend of $1,000, was made available to the AAOS in 1949 and presented at the AAOS meeting in 1950. The Kappa Delta Awards have been presented by the AAOS to persons who have performed research in orthopaedic surgery that is of high significance and impact. The sorority has since added two more awards and increased the award amounts to $20,000 each. Two awards are named for the sorority national past presidents who were instrumental in the creation of the awards: Elizabeth Winston Lanier and Ann Doner Vaughn. The third is known as the Young Investigator Award. For more information about the manuscript submission process, please visit aaos.org/kappadelta. Learn more about the Kappa Delta Foundation, here. About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues; and it leads the health care discussion on advancing quality. Follow the AAOS on Facebook, X, LinkedIn and Instagram. Disclosure Funding and Conflicts of Interest 1R13AR061918-01: 2012 AAOS Femoroacetabular Impingement Research Symposium Femoroacetabular impingement (FAI) is at the forefront as a potential precursor to hip osteoarthritis. The symposium emphasized a multidisciplinary, focused approach to summarize current knowledge, develop consensus and identify research strategies for several key issues related to FAI. Focus topics included: The etiology, epidemiology and societal impact of hip OA The role of FAI in hip OA pathophysiology The basic science of FAI FAI disease screening, diagnostics, and disease staging The relative effectiveness and outcomes of different treatment modalities and optimal clinical science methodologies Strategies for future basic and clinical investigations The current ANCHOR study (FAI-1, FAI-2) is funded by the following federal agency: Department of Defense: Contract # W81XWH1920042 (PI: John C. Clohisy, MD) The ongoing RCT (PAO +/- Arthroscopy) is funded by the following agency: Canadian Institute of Health Research: Funding Reference # PJT-178351 (PI: Paul Beaulé, MD) The ANCHOR Study Group has also been supported through the years by the following non-federal entities: Barnes-Jewish Hospital Foundation National Football League Washington Institute of Clinical and Translational Sciences Program North American Hip Society Industry grant programs (Smith and Nephew; Zimmer Biomet; Stryker; Pivot Medical) International Hip Dysplasia Institute NIH/AAOS/OREF/ORS R13 FAI consensus conference grant and proceedings Disclosures: Hip Society: Board or committee member International Hip Society: Board or committee member International Society for Hip Arthroscopy: Board or committee member Microport: IP royalties Microport Orthopedics, Inc.: Paid consultant Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support 2018: Dr. Paul Beaulé (primary author) in year he won the Kappa Delta Award 1993, 2007: Dr. Young-Jo Kim (co-author) in years of Kappa Delta Award i Kotlarz, H., Gunnarsson, C. L., Fang, H. and Rizzo, J. A. 2009. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 60 (12): 3546-3553. SOURCE American Academy of Orthopaedic Surgeons

Updated guideline offers the latest in evidence-based research to reduce pain, expand function and improve quality of life ROSEMONT, Ill. , Jan. 23, 2024 /PRNewswire/ -- The American Academy of Orthopaedic Surgeons (AAOS) issued an update to the Clinical Practice Guideline (CPG) for the Management of Osteoarthritis of the Hip, replacing the previous edition released in 2017. This CPG updated 14 of the 23 evidence-based recommendations for the non-operative treatment of hip osteoarthritis (OA) in adults, resulting in three strong and five moderate recommendations. In addition to providing guidelines for specific surgical techniques and procedures for hip OA, the CPG also offers options surrounding diabetes, BMI and prescription opioid treatment. "The incidence and prevalence of osteoarthritis of the hip have risen over time and are expected to continue to do so, particularly as life expectancy and obesity rates continue to rise," said Charles P. Hannon, MD, MBA, FAAOS, senior associate consultant, Department of Orthopedic Surgery, Mayo Clinic and co-chair of the CPG workgroup. "This updated clinical practice guideline provides orthopaedic surgeons with the most up to date evidence-based practices that they can use to best treat their patients with osteoarthritis of the hip. It outlines both modifiable risk factors as well as surgical techniques and their impact on postoperative outcomes." To access the guideline, click here. Incidence and Prevalence of OA of the Hip OA, sometimes called "wear-and-tear arthritis," is a common condition that many people develop as they age. It can occur in any joint in the body, but most often develops in weight-bearing joints, such as the hip. OA of the hip causes pain and stiffness. It can make it hard to do everyday activities like bending over to tie a shoe, rising from a chair, or taking a short walk. The global prevalence of hip OA is estimated at 7.2%.i The global incidence of hip OA is estimated at 2 million people or 7.8 per 1000 person-years.ii, iii "Osteoarthritis of the hip leads to significant functional impairment interfering with quality of life," added Dr. Hannon. "It limits patients' ability to do the activities they love and in more severe cases activities of daily living. In addition to the physical impact, osteoarthritis influences emotional wellbeing and mental health with a reported 19% of patients who are diagnosed experiencing anxiety and depression." Guideline Recommendations At-A-Glance Since 2017, there has been an abundance of published literature addressing topics within the CPG. In addition, new important topics, such as social determinants of health and the hip-spine relationship, were added to provide evidence-based recommendations. Highlights include: A strong recommendation showing that tranexamic acid (TXA) should be considered for patients with symptomatic OA of the hip who are undergoing total hip arthroplasty (THA) to reduce blood loss and the need for blood transfusions. A strong recommendation showing that oral nonsteroidal anti-inflammatories (NSAIDs) should be used to reduce pain and improve function in the treatment of symptomatic hip OA. A moderate (downgraded) recommendation showing that intraarticular corticosteroids could be considered to improve function and reduce pain in the short-term for patients with symptomatic OA of the hip. A strong recommendation that intraarticular hyaluronic acid should not be considered for treatment of symptomatic OA of the hip as it does not improve function or reduce pain better than placebo. A moderate (downgraded) recommendation for formal postoperative physical therapy or unsupervised home exercise after total hip arthroplasty for symptomatic OA of the hip. It further notes that physical therapy could be considered as a treatment for patients with mild to moderate symptomatic OA of the hip to improve function and reduce pain. A moderate (upgraded) recommendation for the use of cemented femoral stems in patients at risk for fracture such as patients with osteoporosis or elderly females. Additionally, nine options were formulated for the CPG. Options are used when there is little, conflicting, or no evidence on a topic. The new options address the use of oral acetaminophen; adverse events and patient reported outcomes in patients with an elevated BMI or with poorly controlled diabetes undergoing THA; the use of oral opioids for the nonoperative treatment of symptomatic OA of the hip; among others. Clinical Practice Guidelines in Practice The scope of this CPG includes non-surgical treatment and surgical treatment with total hip arthroplasty of symptomatic OA of the hip. It does not provide recommendations for patients diagnosed with rheumatoid arthritis, OA of other joints, hip dysplasia, or other inflammatory arthropathies. It does not provide recommendations for surgical interventions less invasive than total hip arthroplasty. CPGs are not meant to be stand-alone documents, but rather serve as a point of reference and educational tool for both healthcare professionals managing patients hip OA and orthopaedic surgeons. CPGs recommend accepted approaches to treatment and/or diagnosis and are not intended to be a fixed protocol for treatment or diagnosis. Patient care and treatment should always be based on a clinician's independent medical judgment, giving the individual patient's specific clinical circumstances. The guideline is not intended for use as a benefits determination document. The full Clinical Practice Guideline for the Management of Osteoarthritis of the Hip is intended for reference by orthopaedic surgeons and other physicians, and available through AAOS' OrthoGuidelines website and free mobile app. For more information on the development process for AAOS clinical practice guidelines, please view the Clinical Practice Guideline Methodology. About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues; and it leads the health care discussion on advancing quality. Follow the AAOS on Facebook, X, LinkedIn and Instagram. i . Fan, Zijuan, et al. "The prevalence of hip osteoarthritis: a systematic review and meta-analysis." Arthritis Research & Therapy 25.1 (2023): 51. ii James, Spencer L., et al. "Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017." The Lancet 392.10159 (2018): 1789-1858 iii Arslan, Ilgin G., et al. "Estimating incidence and prevalence of hip osteoarthritis using electronic health records: a population-based cohort study." Osteoarthritis and Cartilage 30.6 (2022): 843-851. SOURCE American Academy of Orthopaedic Surgeons

灵长类动物进化史上最深刻的进步或许发生在大约 600 万年前，那时我们的祖先开始用两条腿走路。人们认为，向两足行走的逐渐转变使灵长类动物更能适应不同的环境，并解放了它们的双手，使它们能够使用工具，这反 灵长类动物进化史上最深刻的进步或许发生在大约 600 万年前，那时我们的祖先开始用两条腿走路。人们认为，向两足行走的逐渐转变使灵长类动物更能适应不同的环境，并解放了它们的双手，使它们能够使用工具，这反过来又加速了认知能力的发展。有了这些变化，现代人类的舞台就搭建好了。 在一项新的研究中，来自美国哥伦比亚大学和德克萨斯大学的研究人员发现了使类人猿从以指关节为基础的跳跃转变为人类直立行走的基因变化。他们利用深度学习（人工智能的一种形式）和全基因组关联研究，首次绘制出了灵长类动物骨骼变化导致直立行走的基因组区域图谱。该图谱揭示了化石记录中观察到的解剖结构转变的基因受到了自然选择的强烈影响，并为早期人类带来了进化优势。相关研究结果发表在2023年7月21日的Science期刊上，论文标题为“The genetic architecture and evolution of the human skeletal form”。 论文共同通讯作者、哥伦比亚大学瓦格洛斯内外科医学院计算与统计基因组学（精神病学）助理教授Tarjinder Singh博士说，“在更实际的层面上，我们还发现了与髋关节炎、膝关节炎和背部关节炎相关的基因变异和骨骼特征，这些关节炎是导致美国成年人残疾的主要原因。” 例如，髋关节平均宽高比的轻微偏差与髋关节骨关节炎（hip osteoarthritis）风险的增加有关，而胫骨-股骨角度的轻微偏差与膝关节骨关节炎（knee osteoarthritis）风险的增加有关。这些发现可能有助于科学家们设计出预防和治疗这些使人衰弱的疾病的新方法。 采用新技术 这些作者应用深度学习分析了来自英国生物库的3万多张全身X光片。深度学习是一种模拟大脑神经网络的技术，它可以训练计算机完成人类自然而然会做的事情，比如驾驶汽车或翻译语言。在这项新的研究中，这种技术被用来对X光片进行标准化处理，移除任何有质量问题的图像，然后精确测量数十种骨骼特征，而这些任务原本需要人们花费数月甚至数年的时间才能完成。 接下来，这些作者对人类基因组进行了扫描，以确定与 23 种关键骨骼测量指标（如肩宽、躯干长度和胫骨-股骨角度）的差异有关的染色体区域。（这些扫描被称为全基因组关联研究，包括对一大群人的基因组进行调查，寻找在患有特定疾病或性状的人群中出现频率较高而在没有这种疾病或性状的人群中出现频率较低的基因组变异异）。这一过程发现了 145 个与调控骨骼发育的基因相关的基因组区域。在这些基因位点中，只有少数几个在以前的研究中是已知的。 人类骨骼特征的遗传基础、进化和健康后果。图片来自Science, 2023, doi:10.1126/science.adf8009。 这145个区域中的许多与人类基因组的“加速”区域重叠，与类人猿的相同区域相比，人类基因组的“加速”区域在亿万年中迅速进化。相比之下，与心脏、免疫系统、新陈代谢和其他特征相关的基因很少出现在基因组的“加速”区域。 论文共同通讯作者、德克萨斯大学奥斯汀分校综合生物学助理教授、统计学和数据科学助理教授 Vagheesh M. Narasimhan 博士说，“我们所看到的是第一个基因组证据，表明影响骨骼比例的基因变异存在选择性压力，从而实现了从指关节行走到两足行走的过渡。” 这项新的研究还展示了将大规模生物库数据、机器学习和基因组学结合起来，帮助我们了解人类健康和疾病的力量。Singh目前正在应用这些技术来了解精神疾病的病因。（生物谷 Bioon.com） 参考资料： Eucharist Kun et al. The genetic architecture and evolution of the human skeletal form. Science, 2023, doi:10.1126/science.adf8009.