The purpose of this study is to elucidate the mechanical factors that lead to restoration of a cartilaginous articular surface, decreased pain, and improved joint function after mechanical distraction of osteoarthritic joints. We propose a randomized controlled trial of distraction with and without motion as treatment for ankle osteoarthritis, and to simultaneously collecting imaging and biological data that we can use to improve our understanding of the pertinent biophysical factors influencing patient outcomes. We will explore several related hypotheses, including 1) Ankle motion during distraction will result in clinically significant improvements in patient-derived outcome measures and increased cartilage thickness distribution over the most heavily loaded portion of the articular surface, as compared to the use of distraction without ankle motion; 2a) Ankles with low geometric surface irregularity and greater range of motion will have better preservation of neo-chondroid tissue (increased normalized cartilage thickness and reduced longitudinal compressive strain distribution over the habitually heavily loaded regions of the articular surface) than those with high surface irregularity; 2b) Ankles with low geometric surface irregularity and greater range of motion have reduced habitual focal or regional contact stress elevation; and 3) Joints that have better improvements in patient derived outcome measures and improved cartilage thickness distribution over habitually heavily loaded portion of the articular surface will have improved normalization of synovial fluid markers of biosynthetic and oxidative activity. The studies we propose involve a multi-disciplinary approach utilizing both laboratory and clinical research to focus on improving our understanding of the pathomechanics and treatment of osteoarthritis. We will bring state-of-the-art techniques for clinical assessment, articular surface imaging, biomechanical modeling, and biochemical testing within the framework of a mutually supportive interaction between basic scientists and clinical investigators. New knowledge of the biophysical determinants of articular repair in OA will lead to improved treatment and reduce the substantial associated morbidity and suffering from OA.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Specialized Center (P50)
Project #
1P50AR048939-01
Application #
6690440
Study Section
Special Emphasis Panel (ZAR1)
Project Start
2002-09-16
Project End
2007-08-31
Budget Start
Budget End
Support Year
1
Fiscal Year
2002
Total Cost
Indirect Cost
Name
University of Iowa
Department
Type
DUNS #
041294109
City
Iowa City
State
IA
Country
United States
Zip Code
52242
Martin, James A; Anderson, Donald D; Goetz, Jessica E et al. (2017) Complementary models reveal cellular responses to contact stresses that contribute to post-traumatic osteoarthritis. J Orthop Res 35:515-523
Kempton, Laurence B; Dibbern, Kevin; Anderson, Donald D et al. (2016) Objective Metric of Energy Absorbed in Tibial Plateau Fractures Corresponds Well to Clinician Assessment of Fracture Severity. J Orthop Trauma 30:551-6
Anderson, Donald D; Kilburg, Anthony T; Thomas, Thaddeus P et al. (2016) Expedited CT-Based Methods for Evaluating Fracture Severity to Assess Risk of Post-Traumatic Osteoarthritis After Articular Fractures. Iowa Orthop J 36:46-52
Anderson, Donald D; Long, Steven; Thomas, Geb W et al. (2016) Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively. Clin Orthop Relat Res 474:874-81
Kern, Andrew M; Anderson, Donald D (2015) Expedited patient-specific assessment of contact stress exposure in the ankle joint following definitive articular fracture reduction. J Biomech 48:3427-32
Nguyen, Mai P; Pedersen, Douglas R; Gao, Yubo et al. (2015) Intermediate-term follow-up after ankle distraction for treatment of end-stage osteoarthritis. J Bone Joint Surg Am 97:590-6
Anderson, Donald D; Thomas, Thaddeus P; Campos Marin, Ana et al. (2014) Computational techniques for the assessment of fracture repair. Injury 45 Suppl 2:S23-31
Buckwalter, Joseph A; Anderson, Donald D; Brown, Thomas D et al. (2013) The Roles of Mechanical Stresses in the Pathogenesis of Osteoarthritis: Implications for Treatment of Joint Injuries. Cartilage 4:286-294
Sauter, Ellen; Buckwalter, Joseph A; McKinley, Todd O et al. (2012) Cytoskeletal dissolution blocks oxidant release and cell death in injured cartilage. J Orthop Res 30:593-8
Saltzman, Charles L; Hillis, Stephen L; Stolley, Mary P et al. (2012) Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial. J Bone Joint Surg Am 94:961-70

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