Minimal Invasive Anterior Approach Versus Trans-gluteal Approach for Hemi-arthroplasty in Femoral Neck Fractures (MIS-CLAS)
|Femoral Neck Fracture||Procedure: Trans-gluteal approach, CLAS Procedure: Anterior minimal invasive approach, AMIS||Phase 4|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Outcomes Assessor
Primary Purpose: Treatment
|Official Title:||Minimal Invasive Anterior Approach Versus Trans-gluteal Approach for Hemi-arthroplasty in Femoral Neck Fractures - A Prospective Randomized Trial|
- Timed up and go test (TUG) [ Time Frame: 3 weeks postoperatively +/- 3 days ]TUG: Time in seconds a person needs to stand up from a chair, walk a distance of 3 meters, turn around a flag, come back and sit down again (with or without walking aids).
- Functional Independence measure (FIM) [ Time Frame: preoperative (retrospective assessment), day 5 postoperatively, 3 and 6 weeks postoperatively, 3 months and 1 year postoperatively (apart from measurement on day 5 postoperative each +/- 3 days ) ]FIM is a widely used method of assessing quality of daily life and the amount of assistance required for a person with a disability to perform basic activities safely and effectively. It includes 18 items focusing on a minimum set of skills related to self-care, sphincter control, transfers, locomotion, communication, and social cognition. Possible scores range from 18 to 126.
- Postoperative complications [ Time Frame: duration from surgery until 1 year postoperatively ]Postoperative complications (proximal femoral fracture, nerve palsy, postoperative surgical site infection, aseptic loosening, peri-prosthetic fracture, re-operation, non-surgical complications etc.) as a secondary outcome variable will be continuously recorded using the Clavien-Dindo classification of surgical complications
- Peri-operative delirium [ Time Frame: duration from admission to day 3, an expected average period of 3-5 days ]To assess delirium, patients will be screened 3 times a day by the responsible nurse using a modified Delirium Observation Screening scale (DOS). DOS is a 13-item scale for early recognition of delirium. If DOS results in equal or more than 3 points, the Confusion Assessment Method (CAM) will be additionally applied. The CAM instrument consists of 4 respectively 5 operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
- One year mortality [ Time Frame: one year ]
- Length of hospitalization [ Time Frame: duration of the hospital stay, an expected average of 10 days ]
- Subgroup effect of patients with normal Mental-state Questionnaire (MSQ) versus patients with abnormal (MSQ) [ Time Frame: one year ]Corresponding to the results of the mental state questionnaire at the admission patients are evaluated able to judge or not able to judge. An analysis of subgroup-effect for the other outcome variables will be done.
- Peri-operative factors [ Time Frame: Peri-operative period, i.e. time between admission until day 5 postoperative, expected average period of 5-8 days ]Blood loss (estimated by anesthesiologist and surgeon) and blood transfusion (amount) Duration of surgery (skin-incision - skin closure)
- Timed up and go test (TUG) [ Time Frame: day 5, 6 weeks, 3 month and 1 year postoperatively (each +/- 3 days) ]see primary outcome measure
|Study Start Date:||August 2011|
|Estimated Study Completion Date:||July 2017|
|Primary Completion Date:||April 2015 (Final data collection date for primary outcome measure)|
Active Comparator: Anterior minimal invasive approach, AMIS
AMIS in 95 randomized patients.
Procedure: Anterior minimal invasive approach, AMIS
Minimal invasive Hueter anterior approach. Device: Cemented unipolar hip hemiarthroplasty for the treatment of femoral neck fractures
Other Name: Medacta, Mathys, Switzerland
Active Comparator: Trans-gluteal approach, CLAS
CLAS in 95 randomized patients.
Procedure: Trans-gluteal approach, CLAS
Classic lateral, trans-gluteal approach. Device: Cemented unipolar hip hemiarthroplasty for the treatment of femoral neck fractures
Other Name: Mecacta, Mathys, Switzerland
HA via various well established approaches is the typical treatment for displaced femoral neck fractures in elderly patients. In the last decade, so called minimal-invasive surgery (MIS) for the implantation of total hip arthroplasty (THA) has become popular and studies have demonstrated that MIS is as safe as conventional approaches. Our hypothesis is that femoral neck fracture patients may especially benefit from MIS. To date, no published data exist comparing a Hueter minimal-invasive anterior (AMIS) with a conventional trans-gluteal Hardinge approach (CLAS) for HA.
Geriatric patients presenting at the University hospital Basel (UHBS) with a femoral neck fracture eligible for HA are randomly assigned to the minimal-invasive or conventional group. In both groups HA will be performed using the same implants. Postoperatively patients will be followed-up continuously until discharge from our hospital (with 7 days as expected average duration of postoperative hospital stay) with a first functional status assessment on day 5. Further follow-up is planned at week 3 and 6, 3 months and one year postoperatively.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01408693
|Department of Traumatology, University Hospital|
|Basel, Switzerland, 4031|
|Principal Investigator:||Marcel Jakob, Professor||Department of Traumatology, University hospital Basel|
|Principal Investigator:||Patrick Studer, MD||Department of Traumatology, UHBS|