Outcomes Following Anterior Approach to Total Hip Arthroplasty (AAP)
Osteoarthritis disables approximately 10% of people who are 60 years or older and compromises the quality of life of more than 20 million Americans every year. Osteoarthritis is caused by the breakdown of cartilage that lines the bones at your joints from daily wear and tear and results in pain and restricted function. Total hip arthroplasty (THA) or total hip replacement, is currently one of the most successful and cost-effective treatments used to eliminate pain and restore function in those suffering from osteoarthritis. There are multiple ways to perform a THA. The main difference between each type is the point of incision in relation to a muscle on the outer surface of your hip bone: gluteus medius. The incision performed can be anterior (in front of the muscle), anterolateral (in front and to the side of the muscle), or posterior (from the back). Each of these approaches has its own advantages and disadvantages, but there is no evidence available that makes one better than the other. The purpose of this study is to determine which of the three approaches to THA is the most effective. The main outcome that will determine the most effective approach is the functional ability of the patients included in this study at 52 weeks. The investigators will also compare whether the patient's: length of hospital stay, use of assistive devices, need for revision surgery, ability to return to work, ability to relieve pain, complication rate, and quality of life. The investigators hypothesize that the anterior approach will be the most effective approach in reducing the rate of post-operative complications after THA.
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Outcomes Following Anterior Approach to Total Hip Arthroplasty: A Multi-Centre Observational Cohort Study|
- Patient Functional Ability [ Time Frame: 52 Weeks ] [ Designated as safety issue: No ]Measured by the Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire.
- Technical Parameters [ Time Frame: 1 day - measured during and post-operatively ] [ Designated as safety issue: No ]Length of Incision (cm), Blood Loss (mL), Fluoroscopy Time (s), Operative Time (Min)
- Length of Hospital Stay [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]Duration of time patient is in hospital post-operatively.
- Use of Assistive Device [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]Presence of an assistive device(s) provided to patients at discharge and the length of time it takes the patient to discard the assistive device(s).
- Revision Surgery [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]Occurrence and type of revision surgery required (if any)
- Ability to participate in sports activities [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]Subjectively reported.
- Return to Work [ Time Frame: 52 Weeks ] [ Designated as safety issue: No ]Measured by the Work Limitations Questionnaire (WLQ)- short form format
- Complication Rate [ Time Frame: 52 Weeks ] [ Designated as safety issue: No ]We will define complications in patients as a constellation of clinical symptoms and laboratory examinations. These will include (but are not limited to) both intraoperative and postoperative complications; More specifically, musculoskeletal, cardiovascular, psychological, neurological, genitourinary, and wound-related complications.
- Pain [ Time Frame: 52 Weeks ] [ Designated as safety issue: No ]Measured by the EuroQol-5d (EQ-5D) and Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaires.
- Quality of Life [ Time Frame: 52 Weeks ] [ Designated as safety issue: No ]Measured by the EuroQol-5d (EQ-5D) and Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaires.
|Study Start Date:||February 2013|
|Study Completion Date:||October 2013|
|Primary Completion Date:||October 2013 (Final data collection date for primary outcome measure)|
Anterior Approach THA
500 Patients will be included who have received a total hip arthroplasty using the Anterior Approach. The anterior approach to total hip arthroplasty refers to an internervous approach to the hip, where the incision is made from the middle of the iliac crest, then curved distally and laterally to the anterior superior iliac spine (Kelmanovich et al., 2003). To optimize feasibility and applicability of our results, we will not standardize the use of cemented components, the implant manufacturer, or the femoral head size. Surgeons will use the manufacturer specific guides for insertion of the total hip arthroplasty.
Posterior Approach THA
100 patients will be enrolled who have received a total hip arthroplasty using the posterior approach. The posterior approach is performed by making a curved incision posteriorly on the greater trochanter (Jolles & Bogoch, 2004). The fascia lata is then incised and the fibers of the gluteus maximus split using dissection (Jolles & Bogoch, 2004). To ensure the feasibility and applicability of our findings, we will not standardize the use of cemented components, the implant manufacturer, or the femoral head size used in the posterior approach.
Anterolateral Approach THA
100 patients will be enrolled who have had a total hip arthroplasty using the anterolateral approach. An anterolateral approach to THA utilizes an intermuscular approach by incising the patient posteriorly and distally to the anterior superior iliac spine, extending distally to the greater trochanter along the shaft of the femur (Kelmanovich et al., 2003). To optimize the feasibility and applicability of our results, the implant manufacturer, femoral head size or the use of cemented components will not be standardized in this study.
|Hamilton, Ontario, Canada, L8L 8E7|
|Principal Investigator:||Mohit Bhandari, MD, PhD, FRCSC||McMaster University|
|Principal Investigator:||Joel Matta, MD||St. Joseph's Health Centre|