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PRESENATION FOR GRANT-IN-AID RESEARCH PROJECT, ICMR

This research project aims to gain a deeper understanding of the role of hip and knee alignment in tibiofemoral osteoarthritis. The study will evaluate hip and knee geometric variations using computerized tomography scanogram and determine the association between hip and knee geometry in subjects with and without knee osteoarthritis. The research will also analyze the anatomic variations in the hip and knee related to gender in the Indian population. The findings will contribute to early identification of osteoarthritis, targeted treatment, and improved surgical outcomes.

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PRESENATION FOR GRANT-IN-AID RESEARCH PROJECT, ICMR

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  1. PRESENATION FOR GRANT-IN-AID RESEARCH PROJECT, ICMR

  2. Principal Investigator & Email: VeenaPais, PhD candidate, Yenepoya University. veenapais@yenepoya.edu.in

  3. Co-Investigator(s) & Email: Dr. DevadasAcharya K acharyadevdas@gmail.com Dr. Imthiazahammed k.drimthiaz@icloud.com Mr.SudeepPais, sudeep_pais@hotmail.com

  4. Duration of Research Project • Period which may be needed for collecting the data: 2018-2019 ii) Period that may be required for analyzing the data : 2020-2021

  5. Institution responsible for the research project Name: Yenepoya University. POSTAL ADDRESS: Nityananda Nagar, Derelakatte, Mangalore 575018 Telephone: +91 824 2206000 Fax: +91 824 2204667 email:reachus@yenepoya.org

  6. Contents • Title of project • Introduction • Aim and objectives • Hypothesis • Methodology • Expected outcomes • Budget table • Time line chart • References

  7. Title: A deeper understanding on the role of hip and knee alignment in tibiofemoral Osteoarthritis.

  8. Introduction • Osteoarthritis (OA) is a “chronic degenerative disorder”. • The recent prevalence of knee OA in India is 28.7%.(2) • The main risk factors for OA are; ageing, obesity, overuse, malalignment and joint trauma.(1) • OA usually affects individuals aged 55 years and above, leading to joint pain, stiffness, and physical disability and poor quality of life.

  9. Currently, there is no effective cure for OA and treatments are mainly focused on relieving pain and improving function.(3) • The natural history of this disease still remains unexplored. A better understanding of this chronic disease may help develop more effective treatments in the future.

  10. What is known: Malalignment is a strong risk factor for the progression and incidence of OA.

  11. When the proximal and the distal sides of the joint fit together normally, load is distributed physiologically. • When one of the bones is misshapen either due to developmental abnormality or as a result of injury, this can introduce increased level of load stress on the joint (4).

  12. A study revealed that treatments which correct the pathomechanics have long lasting favorable effects on pain and joint function compared with treatments that suppress inflammation alone, which is temporary. Osteoarthritis as a disease of mechanics Osteoarthritis Cartilage.2013 Jan; 21(1): 10–15.

  13. Alignment, is also important for a good surgical outcome. Improper correction of the hip geometry like (FO, NSA etc can lead to complications and early wear and tear of the prosthesis)

  14. Several studies are done on Knee malalignment like varus and valgus causing medial and lateral joint OA respectively. • Since the hip, knee and ankle form a kinematic chain. Can changes in the proximal femur translate into abnormal kinematics and lead to knee OA??

  15. Hence, the knowledge regarding the geometry of proximal femur is important to understand the biomechanics of the hip and its biomechanical influence on the distal joints. This will not only be useful in the early diagnosis, management of knee OA but also help improve the surgical outcome.

  16. Social relevance • Global statistics reveal over 100 million people worldwide suffer from OA, which is one of the most common causes of disability. • As per a recent report published in the Times of India (2010) regarding OA, over 40% of the Indian population in the age group of 70 years or above suffer from OA. • Nearly 2% of these undergo severe knee pain and disability.

  17. The traditional protocol mainly addresses issues of pain and reduced muscle strength around the knee but rarely gives much importance to alignment. • Thus understanding the role of hip and knee alignment will help in early identification of OA, target the causative factor during treatment of OA and also improve surgical outcomes. • Thus contributing a great deal to society.

  18. Objectives 1) To evaluate the hip and knee geometric variations in subjects with and without knee OA using computerized tomography scanogram. 2) To find an association between the hip and knee geometry in subjects with and without knee OA. 3) To determine the anatomic variations in the hip and knee related to male and female gender in the Indian population.

  19. Hypothesis Research hypothesis: 1) Hip geometry will have a significant association with knee osteoarthritis. 2) Hip morphology will differ significantly between males and females with and without knee osteoarthritis. Null hypothesis: 1) Hip geometry will not have a significant association with knee osteoarthritis. 2) Hip morphology will not differ significantly between males and females with and without knee osteoarthritis.

  20. Methodology • Study setting: Department of Orthopaedics, Yenepoya University. Department of Radiodiagnosis, Yenepoya University. • Study duration: From July 2017 to 2020 • Study design Cross sectional study

  21. Sample size • Based on the 28.7% prevalence rate in India 4% precision 95% confidence level sample size is estimated to 491, which will be rounded off to 500.

  22. Method: An age match control group with no knee OA Study Group all subjects who full the criteria will be included . full limb length CT scan in supine position geometry around the hip & knee will be calculated Recorded, Analysed, Interepreted

  23. Phases of methodology

  24. Expected outcomes: The study is expected to provide a vital information regarding the influence of various malalignment around the hip and knee associated with knee osteoarthritis. 1) This could help in early identification of this chronic disease. 2) Also understanding the influence of the angle in knee OA can help in early correction of the malaligment thus slow down the progress of this disabiling disease. Thus contributing a great deal to society.

  25. Budget:

  26. Proposed timeline:

  27. References Silman AJ, Hochberg MC. 2nd ed. Oxford: Oxford University Press; Indian J Orthop. 2016 Sep; 50(5): 518–522. Chandra Prakash Pal, Pulkesh Singh,1Sanjay Chaturvedi,2Kaushal Kumar Pruthi, and Ashok Vij3 Epidemiology of knee osteoarthritis in India and related factors. Epidemiology of the Rheumatic Diseases. 2001 .Wei-Nan Zeng, Fu-You Wang, Cheng Chen et al. Investigation of association between hip morphology and prevalence of osteoarthritis. Scientific Reports 6, Article number: 23477 (2016) Marc C. Hochberg, Alan J. Silman, Josef S. Smolen, Michael E. Weinblatt, Michael H. Weisma. Rheumatology; pg no:1439-1440 Boissonneault A, Lynch JA, Wise BL, Segal NA, Gross KD, Murray DW, Nevitt MC, Pandit HG. Association of hip and pelvic geometry with tibiofemoral osteoarthritis: multicenter osteoarthritis study (MOST). Osteoarthritis Cartilage. 2014 Aug;22(8):1129-35. CoskunBenlidayi I, Guzel R, Basaran S, Aksungur EH, Seydaoglu G. Is coxavalga a predictor for the severity of knee osteoarthritis? A cross-sectional study.SurgRadiol Anat. 2015 May;37(4):369-76. Dudda M, Kim YJ, Zhang Y, Nevitt MC, Xu L, Niu J, et al. Morphological differences between Chinese and Caucasian female hips: Could they account for the ethnic difference in hip osteoarthritis? Arthritis Rheum. 2011  Dinesh Bhatia, Tatiana Bejarano, Mario Novo1 Current interventions in the management of knee osteoarthritis. J PharmBioallied Sci. 2013 Jan-Mar; 5(1): 30–38

  28. Thank you

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