Enhanced surgical treatments for hip osteoarthritis

Lead Research Organisation: University of Leeds
Department Name: Mechanical Engineering

Abstract

Over 80 million patients worldwide suffer from hip osteoarthritis, and increasing numbers of patients are requiring total hip replacement surgery. This is considered to be a successful intervention, however, an ageing population with increasing orthopaedic treatment needs, greater levels of obesity and patient expectations, and reducing healthcare budgets and surgical training are conspiring to challenge this success. There is also increasing demand for surgical treatments in younger patients that will delay the need for hip replacement surgery, these interventions reshape bone and repair soft tissue.

One of the major causes of failure in the natural hip and in hip replacements is impingement, where there is a mechanical abutment between bone on the femoral side and hip socket or hip replacement components. In the natural hip, surgery reshaping the bone can reduce this impingement and soft tissue damage can be repaired; however, the effects of the amount of bone that is removed is not well understood nor is the best way to repair soft tissue. The number of hip replacements needing to be removed from patients and replaced with a new one in revision surgery is increasing; damage to the cup rim because of impingement is often implicated. It is known that this is more likely if the components are not well aligned relative to each another, or relative to the load direction experienced in the body.

In this proposal, I seek to ensure long term outcomes of early intervention and hip replacement surgery are always optimum by negating concerns about impingement. To do this, I will develop an experimental anatomical hip simulator. The simulator will apply loads and motions to the hip similar to those observed clinically, and include high fidelity phantoms that mimic the natural hip, into which hip replacement components can also be implanted.

This anatomical simulator will be used to assess how variables such as those associated with the patient (e.g. their bony geometry), the extent of early intervention surgery (e.g. the amount of bone removed) or the design of the prosthesis and how the hip is aligned in the body will affect the likelihood of impingement. This improved understanding of factors affecting the likelihood and severity of impingement will enable better guidance on how the surgery should be performed to optimise outcomes to be provided.

I will work with orthopaedic surgeons to integrate this improved understanding into their clinical practice and with an orthopaedic company to integrate the findings into new product development processes; so that future interventions and devices can be designed to provide better outcomes for all patients.

Planned Impact

Over 80 million people worldwide suffer from hip osteoarthritis and it presents an increasing burden on healthcare systems. There are growing clinical and economic needs to develop more robust surgical interventions that provide optimum outcomes that do not fail due to impingement in all patients irrespective of surgeon experience and deliver longer lasting interventions to meet the demands of an ageing, active population and reduce the rising cost of revision surgery. The longer term impacts of this research will provide optimised surgical hip interventions, benefiting patients, healthcare providers and the orthopaedic industry. In the shorter term, this research will impact on clinicians in providing guidance on important parameters to consider in early intervention surgery and optimum component placement in hip replacement, industry will benefit from new methodologies for pre-clinical testing; regulatory and standard agencies in developing methods that enable surgical and patient variation to be incorporated into pre-clinical testing, and academia in developing new methodologies and highly skilled researchers, as well as promoting medical engineering to potential engineers of the future.

More specifically, this proposal will provide:
- Improved understanding of the factors affecting early intervention surgery. Proper patient selection and precise surgical technique are critical to successful outcomes, yet evidence is limited. This research will provide underpinning science on the effects of contact conditions in the hip on likelihood of damage.
- Improved definition of design, surgical and patient factors on mechanical failure of hip replacements. Early failure is often directly or indirectly associated with impingement and mechanical failure, yet how surgeon, patient and design variables interact to cause this is not well defined. Evidence will be provided to give surgeons clear guidance on component positioning in stratified (based on patient imaging) patient groups, to ensure optimum outcomes.
- More reliable patient outcomes, enhancing quality of life. Research from this proposal will inform tools and understanding that clinicians have at the planning stage (and in training) of an intervention, to better understand the interaction of variables on outcome. This will be used to ensure the right patient, gets the right treatment at the right time delivered optimally. Thus reducing the need for further interventions and/or revision surgery, which are economically and socially costly.
- Increased competitiveness of commercial partners, and wider community, a platform to pre-clinically assess innovations in hip surgery that goes significantly beyond what is currently available will be developed and demonstrated. Project Partner Simulation Solutions will benefit following the co-development of a novel simulator that they can sell commercially across the world. DePuy Synthes and industry more widely, will benefit from enhanced methodologies to evaluate interventions and opportunity to incorporate better definition of the tolerances needed for success into surgical delivery. In terms of early intervention surgery, the regenerative medicine and medical device community will benefit from such capabilities providing exciting scope to innovate new repair strategies that there are currently no in vitro methods available to assess.
- Improved pre-clinical testing processes, that reflect clinical failure modes (in particularly, with reference to hip replacements). These will be proposed to standards and regulatory agencies and I will advocate for improved methods that consider surgical and patient variation.
- Skilled researchers, this proposal will provide multi-disciplinary training for researchers working with industry and clinicians to optimise clinical outcomes. I will be supported to maximise my leadership potential, rapidly accelerating my long-term research vision.

Publications

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Casper-Taylor ME (2020) Initiating factors for the onset of OA: A systematic review of animal bone and cartilage pathology in OA. in Journal of orthopaedic research : official publication of the Orthopaedic Research Society

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Shuttleworth MP (2023) Inertial Tracking System for Monitoring Dual Mobility Hip Implants In Vitro. in Sensors (Basel, Switzerland)

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Pryce GM (2022) Impingement in total hip arthroplasty: A geometric model. in Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine

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Partridge S (2018) A novel method to measure rim deformation in UHMWPE acetabular liners in Medical Engineering & Physics

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Smeeton M (2023) A geometric assessment method for estimating dimensional change of retrieved dual mobility liners for total hip arthroplasty. in Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine

 
Title Mechanics of Life 
Description With support from "Enhanced surgical treatments for hip osteoarthritis" and Royal Academy of Engineering Ingenious grat, the short film, is a result of a collaboration led by Dr Briony Thomas between the University of Leeds, NOrthern Ballet and Batley High School to co-develop a workshop that led to the creation of an artistic piece communicating overlap in mechanics of life in allet and engineering. 
Type Of Art Film/Video/Animation 
Year Produced 2024 
Impact Successful collaboration between educators, engineering and creatives - all reporting a better understanding of the co-development process Full evaluation of impact is on-going 
URL https://vimeo.com/901190432/160df9af20
 
Description Research funded as part of this award has achieved the following:
-Development of a novel in vitro (experimental) hip joint simulator, that can apply physiological loading to the natural hip joint to assess mechanical conditions in the hip and as such investigate the impact of surgical interventions in the natural hip joint.
-Investigation of hip replacement function, and in particular dual mobility hip replacements. This has included developing sensor systems to track polyethylene liner motion, developing computational tools to assess impingement and examination of retrieved dual mobility hip replacements.
Exploitation Route Adoption of methods / collaboration to use our methods to assess an intervention they have developed
Further assessment of hip replacement function (especially with respect to impingement)
Development of in vitro simulation in other joints (using the know how developed in this project)
Sectors Healthcare

 
Description Increased knowhow in relation to impingement in hip replacements, influencing clinical/surgeon understanding. First reported at the British Hip Society 2022. Research outputs fed into co-created workshop and creative film with Northern Ballet https://vimeo.com/901190432/160df9af20
First Year Of Impact 2022
Sector Healthcare
Impact Types Cultural

Societal

 
Description Impact Accelerator Award
Amount £63,000 (GBP)
Organisation University of Leeds 
Sector Academic/University
Country United Kingdom
Start 05/2023 
End 05/2024
 
Description The Mechanics of Life: Movement, Mobility and Me
Amount £29,500 (GBP)
Funding ID ING2223\17\128 
Organisation Royal Academy of Engineering 
Sector Charity/Non Profit
Country United Kingdom
Start 05/2023 
End 06/2024
 
Title Dataset associated with "Impingement in total hip arthroplasty: a geometric model" 
Description Total Hip Arthroplasty (THA) is one of the most common and successful surgical interventions. The survivorship at 10 years for the most commonly used systems is over 95%. However, the incidence of revision is usually much higher in the 0-1 year time period following the intervention. The most common reason for revision in this early time period is dislocation and subluxation, which may be defined as complete and permanent or partial and temporary loss of contact between the bearing surfaces respectively.This study comprises the development of a geometric model of bone and an in-situ total hip replacement, to predict the occurrence and location of bone and component impingement for a wide range of acetabular cup positions and for a series of frequently practiced activities of daily living. The model developed predicts that antero-superior component impingement is associated with activities that result in posterior dislocation. The incidence may be reduced by increased cup anteversion and increased inclination. Postero-inferior component impingement is associated with anterior dislocation activities. Its incidence may be reduced by decreased anteversion and reduced inclination. A component impingement-free range was identified running from when the cup was positioned with 45° inclination and 25° cup anteversion to 70° inclination and 15°-20° anteversion. 
Type Of Material Model of mechanisms or symptoms - in vitro 
Year Produced 2022 
Provided To Others? Yes  
Impact Method for other users analysing hip retrieved hip replacements to assess geometric changes related to in vivo use 
URL https://archive.researchdata.leeds.ac.uk/930/
 
Title In vitro natural hip simulation 
Description Different hip pathologies can cause geometric variation of the acetabulum and femoral head. These variations have been considered as an underlying mechanism that affects the tribology of the natural hip joint and changes the stress distribution on the articular surface, potentially leading to joint degradation. To improve understanding of the damage mechanisms and abnormal mechanics of the hip joint, a reliable in-vitro methodology that represents the in vivo mechanical environment is needed where the position of the joint, the congruency of the bones and the loading and motion conditions are clinically relevant and can be modified in a controlled environment. An in vitro simulation methodology was developed and used to assess the effect of loading on a natural hip joint. Porcine hips were dissected and mounted in a single station hip simulator and tested under different loading scenarios. The loading and motion cycle consisted of a simplified gait cycle and three peak axial loading conditions were assessed (Normal, Overload and Overload Plus). Joints were lubricated with Ringer's solution and tests were conducted for 4 hours. Photographs were taken and compared to characterise cartilage surface and labral tissue pre, during and post simulation. The results showed no evidence of damage to samples tested under normal loading conditions, whereas the samples tested under overload and overload plus conditions exhibited different severities of tears and detachment of the labrum at the antero-superior region. The location and severity of damage was consistent for samples tested under the same conditions; supporting the use of this methodology to investigate further effects of altered loading and motion on natural tissue. 
Type Of Material Model of mechanisms or symptoms - in vitro 
Year Produced 2022 
Provided To Others? Yes  
Impact In vitro assessment of the mechanical environment of the natural hip, ability to consider effects of loading, surgical resection and alignment in an in vitro simulation. 
URL https://pubmed.ncbi.nlm.nih.gov/35980907/
 
Title Dataset associated with "Impingement in total hip arthroplasty: a geometric model" 
Description Total Hip Arthroplasty (THA) is one of the most common and successful surgical interventions. The survivorship at 10 years for the most commonly used systems is over 95%. However, the incidence of revision is usually much higher in the 0-1 year time period following the intervention. The most common reason for revision in this early time period is dislocation and subluxation, which may be defined as complete and permanent or partial and temporary loss of contact between the bearing surfaces respectively.This study comprises the development of a geometric model of bone and an in-situ total hip replacement, to predict the occurrence and location of bone and component impingement for a wide range of acetabular cup positions and for a series of frequently practiced activities of daily living. The model developed predicts that antero-superior component impingement is associated with activities that result in posterior dislocation. The incidence may be reduced by increased cup anteversion and increased inclination. Postero-inferior component impingement is associated with anterior dislocation activities. Its incidence may be reduced by decreased anteversion and reduced inclination. A component impingement-free range was identified running from when the cup was positioned with 45° inclination and 25° cup anteversion to 70° inclination and 15°-20° anteversion. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact Data to support paper https://doi.org/10.1177/09544119211069472 
URL https://archive.researchdata.leeds.ac.uk/930/
 
Title Dataset associated with 'A geometric method for estimating dimensional change of retrieved dual mobility liners for total hip replacement' 
Description Dataset associated with 'A geometric method for estimating dimensional change of retrieved dual mobility liners for total hip replacement.' This includes data associated with the repeatability analysis (i.e., raw outputs relating to the geometric variance of each repeated measure) and verification study (i.e., associated heatmap and surface images for three of the five samples assessed). 
Type Of Material Database/Collection of data 
Year Produced 2023 
Provided To Others? Yes  
Impact Ability to semi-quantitatively assess geometric change in dual mobility hip replacements. 
URL https://archive.researchdata.leeds.ac.uk/1231/
 
Title Dual-Mobility Hip Implant Liner Tracker Validation Data 
Description Dual mobility (DM) implants are being increasingly used for total hip arthroplasties due to additional range of motion and joint stability they afford over more traditional implant types. Currently there are no reported methods for monitoring their motions under realistic operating conditions and therefore, it is challenging to predict how they will function under clinically relevant conditions and what failure modes may exist. This repository contains the validation data and required post-processing scripts for a novel inertial tracking system that directly mounts to the mobile liner of DM implants. The tracker was custom built and based on a low-cost, off-the-shelf inertial measurement unit (IMU) and employed a gradient-decent sensor fusion algorithm for amalgamating nine degree-of-freedom IMU readings into three-axis orientation estimates. Additionally, a novel approach to magnetic interference mitigation using a fixed solenoid and magnetic field simulation was evaluated. 
Type Of Material Database/Collection of data 
Year Produced 2023 
Provided To Others? Yes  
Impact Ability to record in vitro motion of floating liner in a dual mobility hip replacement, allowing increased understanding of liner motion in vivo 
URL https://archive.researchdata.leeds.ac.uk/1088/
 
Title Input data and photographs from the experimental simulation on the natural hip joint 
Description The mechanical environment of the natural hip joint is related to hip geometry. Despite evidence from clinical and in silico studies that mechanical environment contributes to degradation in the hip, in vitro studies assessing this are limited. Data associated to this document comprise the conditions to run the simulations of a normal gait motion corresponding to three different loading conditions on a hip joint. In addition, the data obtained from the simulator after completing the test and the photographs used to assess the conditions of the articular surfaces of the hip joint at different stages of the tests. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact Data supporting findings in paper Jimenez-Cruz D, Dubey M, Board T, Williams S (2022) An in vitro methodology for experimental simulation on the natural hip joint. PLoS ONE 17(8): e0272264. https://doi.org/10.1371/journal.pone.0272264 
URL https://archive.researchdata.leeds.ac.uk/1002/
 
Description Collaboration with Dr Doug Van Citters, Thayer School of Engineering at Dartmouth 
Organisation Dartmouth College
Country United States 
Sector Academic/University 
PI Contribution Provision of in vitro tests parts to validate methodology Exchange of research ideas
Collaborator Contribution Provision of components for in vitro testing Loan of retrieved dual mobility hip replacements to assess in vivo wear mechanisms
Impact On-going (to date, co-authored conference abstracts, and journal papers planned)
Start Year 2018
 
Description Interview for radio 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact • Radio interview on materials used in the body and specifically hip replacements [Naked Scientists 18/8/18 and online and 5 Live - Science 1/9/19]. https://www.bbc.co.uk/programmes/p05l64qw#playt=45m5s
Year(s) Of Engagement Activity 2019
URL https://www.bbc.co.uk/programmes/p05l64qw#playt=45m5s
 
Description Mechanics of Life 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact The Mechanics of Life: Movement, Mobility and Me is a collaboration from the University of Leeds and creatives at Northern Ballet collaborate to showcase the mechanics of movement through dance. The project was also supported by a Royal Academy of Engineering Ingenious award. This ingenious collaboration brought together engineers at the University of Leeds and creatives at Northern Ballet engage a diverse audience with the mechanics of movement through dance. Through creative exploration of motion, this project aims to inspire an understanding of medical engineering and its impact on health and wellbeing in society.

The project will culminated in an experience day for high school students (35 students in year 8) where they co-designed an engineering-inspired performance, which was choreographed and performed by Northern Ballet, and digitally captured in film (https://vimeo.com/901190432/160df9af20). Through this unique collaboration, the project seeks to create lasting relationships across arts, science, and engineering.
Year(s) Of Engagement Activity 2023,2024
URL https://vimeo.com/901190432/160df9af20
 
Description The Engineering Experience: Women in engineering day (MB) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Run a "fixing bones workshop" for young women at a school, generated lots of questions and subject interest
Year(s) Of Engagement Activity 2020
 
Description • "Operation Ouch" at the Science and Media Museum, Bradford. 16-24 February 2019. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact • "Operation Ouch" at the Science and Media Museum, Bradford. 16-24 February 2019. https://www.scienceandmediamuseum.org.uk/about-us/press-office/operation-ouch-half-term-national-science-and-media-museum
Year(s) Of Engagement Activity 2019
URL https://www.scienceandmediamuseum.org.uk/about-us/press-office/operation-ouch-half-term-national-sci...
 
Description • Cheltenham Science festival (4-9 June 2019) (https://www.cheltenhamfestivals.com/science) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact • Cheltenham Science festival (4-9 June 2019) (https://www.cheltenhamfestivals.com/science)
Exhibit showcasing research undertaken in institute with specific content related to this grant
Year(s) Of Engagement Activity 2019
URL https://www.cheltenhamfestivals.com/science