Minimal Invasive Surgery in Total Hip Arthroplasty Patients; Short- and Long Term Results
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.
|Hip Osteoarthritis||Procedure: Total hip arthroplasty direct lateral approach Procedure: Total hip arthroplasty posterior approach Procedure: Total hip arthroplasty, anterior approach|
|Study Design:||Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Treatment
|Official Title:||Minimal Invasive Surgery in Total Hip Arthroplasty Patients; Short- and Long Term Results|
- Muscle strength [ Time Frame: 3 months postoperatively ]Measured by 1 repetition maximum (1 RM)
- Hip joint functionality and mobility [ Time Frame: 3 months postoperatively ]Measured by patient completed questionnaires and clinician reported scores
- activity level [ Time Frame: 6 subsequent days postoperatively ]Measured by an activity monitor
|Study Start Date:||September 2011|
|Study Completion Date:||June 2016|
|Primary Completion Date:||April 2014 (Final data collection date for primary outcome measure)|
Active Comparator: THA Direct lateral
Total hip arthroplasty (THA) carried out by direct lateral approach (DLA)
Procedure: Total hip arthroplasty direct lateral approach
Experimental: THA Posterior
Total hip arthroplasty (THA) carried out by posterior approach (DLA)
Procedure: Total hip arthroplasty posterior approach
Experimental: THA Anterior
Total hip arthroplasty (THA) carried out by anterior approach (DLA)
Procedure: Total hip arthroplasty, anterior approach
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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01506024
|St. Olavs Hospital|
|Study Director:||Lars Jacob Stovner, prof||Norwegian University of Science and Technology|