Minimal Invasive Surgery in Total Hip Arthroplasty Patients; Short- and Long Term Results

Norwegian University of Science and Technology

Status: Completed

Conditions: Hip Osteoarthritis

Treatments: Procedure: Total hip arthroplasty, anterior approach; Procedure: Total hip arthroplasty posterior approach; Procedure: Total hip arthroplasty direct lateral approach

Study type: Interventional

Funder types: Other

Identifiers

NCT01506024

2011/450

Details and patient eligibility

About

The aim of the present study is to explore the most efficient surgical approach in total hip replacement in short and long term when concerning strength, functionality and postoperative complications.

The objective is to register muscular strength, hip joint functionality/mobilisation and complications after total hip arthroplasty (THA) performed by the direct lateral approach (DLA), the posterior approach (PA) and the anterior approach (AA). The latter is a modified Smith-Petersen approach which follows the principles of minimally invasive surgery (MIS).

The primary working hypothesis is that due to a minimal dissection and reduced trauma in the muscles, patients will tolerate early hospital discharge better after the AA than the PA and the DLA. Patients in the AA group are also thought to be more active and maintain muscular strength and hip joint functionality/mobilisation better than patients in the lateral group.

Full description

With total hip replacement surgery, the orthopaedic surgeon's aim is not only pain relief for the patient, but also restoration of hip joint biomechanics resulting in a minimal functional deficit and maximal longevity of the implant. It is not exceptional that these patients still experience mild to moderate long-term impairments postoperatively. These impairments include pain, muscle weakness of the hip abductors, contracture of the hip, gait disorders, as well as weakness of hip extensors and flexors. These problems may in turn lead to complications such as joint instability and loosening of the implant.

MIS is defined as a surgical approach performed through a short skin and muscle incision to avoid injury to muscles and tendons. Following minimally invasive approach reduced muscle trauma has been found. Moreover clinical outcome improved, as the gluteus medius muscle can be spared more successfully. However, it is debated whether or not the overall results of MIS are superior, or even as good as the traditional hip replacement surgery in terms of component placing and time to revision of the prosthesis.

Enrollment: 60 patients

Sex: All

Ages: Under 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients scheduled for THA
• Diagnosis of primary osteoarthritis as the main cause for elective THA
• American Society of Anesthesiologists (ASA) score I, II, and stable III

Exclusion criteria

• Musculoskeletal diseases
• Current heart/pulmonary- or malignant diseases likely to influence the physical testing performance.

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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60 participants in 3 patient groups

THA Direct lateral

Active Comparator group

Description:

Total hip arthroplasty (THA) carried out by direct lateral approach (DLA)

Treatment:

Procedure: Total hip arthroplasty direct lateral approach

THA Posterior

Experimental group

Description:

Total hip arthroplasty (THA) carried out by posterior approach (DLA)

Treatment:

Procedure: Total hip arthroplasty posterior approach

THA Anterior

Experimental group

Description:

Total hip arthroplasty (THA) carried out by anterior approach (DLA)

Treatment:

Procedure: Total hip arthroplasty, anterior approach