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Feasibility study - not able to recruit intended sample size in the desired period. Randomization halted, enrolled patients will be followed to 1 year follow-up
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The aim of the proposed study is to perform a comparative pilot, randomized controlled trial of hip arthroscopy versus definitive total hip arthroplasty (THA) for the treatment of early hip osteoarthritis (Tönnis Grade 1-2) in patients between the ages of 40-60 years.
The purpose of this study is to conduct a randomized trial to compare hip arthroscopy to THR and estimate the long-term cost-effectiveness. Specifically, we aim to:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hip Arthroscopy | Active Comparator | Patients in the Hip Arthroscopy group will undergo arthroscopy in the supine position under general anesthesia, with all procedures performed by two subspecialty-trained hip arthroscopists. An algorithmic surgical approach will be utilized to sequentially address pathology in the central and peripheral compartments of the hip based on both preoperative imaging findings and intraoperative findings. Emphasis will be placed on labral preservation and refixation, with osseous decompression under fluoroscopic guidance. |
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| Total Hip Arthroplasty | Active Comparator | Patients randomized to the Total Hip Replacement (THR) group will undergo THR via a direct anterior approach. A slightly oblique skin incision measuring approximately 8 cm will be used, starting 3 cm distally and laterally to the anterosuperior iliac spine. The intervals between tensor fascia lata (TFL) and sartorius will be developed superficially, and between rectus femoris and gluteus minimus deeper. Capsulotomy will be performed. A double osteotomy of the femoral neck will be performed to facilitate removal of the head followed by traditional preparation of the acetabulum using an offset reamer and the acetabular component will be inserted. Next, the superior capsule will be released to elevate the femur to allow access to the femoral canal, followed by standard preparation by use of an offset broach and the stem will be implanted |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hip Arthroscopy | Procedure | Patients in the Hip Arthroscopy group will undergo arthroscopy in the supine position under general anesthesia, with all procedures performed by two subspecialty-trained hip arthroscopists. An algorithmic surgical approach will be utilized to sequentially address pathology in the central and peripheral compartments of the hip based on both preoperative imaging findings and intraoperative findings. Emphasis will be placed on labral preservation and refixation, with osseous decompression under fluoroscopic guidance. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) | Subscales measuring Pain, Symptoms, Activity limitations daily living and Function in sport and recreation The outcome measure is transformed in a worst to best scale from 0 to 100, with 100 indicating no symptoms and 0 indicating extreme symptoms. | 6 weeks, 3, 6 and 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in International Hip Outcome Tool [iHOT] | The iHOT-33 is a validated, self-administered quality of life assessment tool for young, active patients with hip symptoms. Each question is scored from 0-100 and the average for all questions is calculated, where 100 represents the best possible outcome or highest level of function. | 6 weeks, 3, 6 and 12 months |
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Inclusion criteria:
Exclusion criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ryan Degen, MD, FRCSC | Fowler Kennedy Sport Medicine Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fraser Health | New Westminster | British Columbia | V3L 0E4 | Canada | ||
| Fowler Kennedy Sport Medicine Clinic and University Hospital |
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| ID | Term |
|---|---|
| D015207 | Osteoarthritis, Hip |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D019644 | Arthroplasty, Replacement, Hip |
| ID | Term |
|---|---|
| D019643 | Arthroplasty, Replacement |
| D001178 | Arthroplasty |
| D019637 | Orthopedic Procedures |
| D013514 | Surgical Procedures, Operative |
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| Total Hip Arthroplasty | Procedure | Patients randomized to the Total Hip Replacement (THR) group will undergo THR via a direct anterior approach. A slightly oblique skin incision measuring approximately 8 cm will be used, starting 3 cm distally and laterally to the anterosuperior iliac spine. The intervals between tensor fascia lata (TFL) and sartorius will be developed superficially, and between rectus femoris and gluteus minimus deeper. Capsulotomy will be performed. A double osteotomy of the femoral neck will be performed to facilitate removal of the head followed by traditional preparation of the acetabulum using an offset reamer and the acetabular component will be inserted. Next, the superior capsule will be released to elevate the femur to allow access to the femoral canal, followed by standard preparation by use of an offset broach and the stem will be implanted |
|
| Change in Hip Outcome Score | Validated measure of hip function, includes subscale of ADL (activities of daily living) and Sport will be utilized. Each HOS subscale is calculated from 0 to 100, with 100 being the best score | 6 weeks, 3, 6 and 12 months |
| Change in Modified Harris Hip Score | Min: 0 Max: 100 Scoring of mHHS: Excellent: 90--100 Good: 80--89 Fair: 70--79 Poor: <70 Higher score indicates better hip functionally. | 6 weeks, 3, 6 and 12 months |
| EQ-5D | Health-related quality of life tool to estimate utility scores for the economic analyses (mixed quantitative and qualitative tool with VAS score from 0-100, where 100 represents the 'best imaginable health state') | 6 weeks, 3, 6 and 12 months |
| Cost Utilization | Record all procedural related costs for each intervention and any additional direct and indirect resource use over the study period | 6 weeks, 3, 6 and 12 months |
| Magnetic Resonance Imaging (MRI) | To enable quantification of morphological features of the hip joint (alpha angle - measured on the axial images; lateral center edge angle measured on the coronal images) and chondral degeneration (Outerbridge classification 0-5) | Baseline and 12 months |
| Change in performance on 40 meter fast-paced walk test | Walk as quickly but as safely as possible, without running, along a 10 m (33 ft) walkway and then turn around a cone, return then repeat again for a total distance of 40 m (132 ft) (3 turns). Time is recorded to the nearest 100th second, and speed is then calculated as a value of meters/second. | 6 weeks, 3, 6 and 12 months |
| Change in 6-minute Walk Test | Walking from end to end over a premeasured distance, covering as much ground as possible at a comfortable, safe pace. Distance covered in 6 minutes is recorded to the nearest 10th of a meter. | 6 weeks, 3, 6 and 12 months |
| Change in Timed Up and Go Test | Starting in a seated position in a standard arm chair (height of 44 cm), the time it takes to stand up, walk 3 meters and return to a seated position. Time is recorded to the nearest 100th of a second. | 6 weeks, 3, 6 and 12 months |
| Change in performance on 30-second Chair Stand Test | From the sitting position, stand up completely so hips and knees are fully extended, then completely back down, so that the bottom fully touches the seat. This is repeated as many times as possible in 30 seconds. Score is the total number of completed repetitions. | 6 weeks, 3, 6 and 12 months |
| 3-dimensional gait analysis to provide walking characteristics (gait velocity, step length, stride length), kinematics (hip joint angles, pelvic tilt, lateral trunk lean) and kinetics (hip joint moments) | 12-camera, motion capture system, and a synchronized floor-mounted force platform will be used. Passive-reflective markers are placed on patients using a 22-marker, modified Helen Hayes marker set. Patients will be instructed to walk barefoot across an 8-m walkway at their typical self-selected walking speed, until at least five successful force plates strikes are collected for each limb. Three-dimensional joint angles and moments are calculated from the kinematic and kinetic data using commercial software (Orthotrak 6.6; Motion Analysis Corporation, Santa Rosa, CA) and custom post processing and data reduction techniques | 6 weeks, 3, 6 and 12 months |
| London |
| Ontario |
| N6A 3K7 |
| Canada |
| D012216 |
| Rheumatic Diseases |
| D019651 | Plastic Surgery Procedures |
| D019919 | Prosthesis Implantation |