Anterior vs Posterior Approach in THA

NCT03673514 | Completed

• 1 other identifier: CÉR : 2009-09-67;2010-415
• Study Type: interventional
• Target: 50
• Locations: 0 countries
• Sites: N/A

Brief Summary

Determining the best approach for a total hip arthroplasty (THA) implies that the procedure is kind on soft tissues, with the lowest complication rates, and easily reproducible. Although there have been several attempts to resolve this issue in the last decade, a definitive answer has not been found. Therefore, the investigators performed a prospective study to compare direct anterior versus posterior approach based on (1) hospital stay, (2) functional outcome, (3) pain, (4) implant position (5) complications and (6) surgical time.

Conditions

Total Hip Arthroplasty

Keywords

Direct anterior approach; posterior approach

Outcome Measures

Primary Outcomes (1)

• Hospital stay

  Length in days of hospital stay

  Between 0 days and 1 month, average of 4 days

Secondary Outcomes (5)

• functional recovery

  2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively

• pain assessment: VAS

  2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively

• implant position

  2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively

• number of patients with per/post surgical complications.

  2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively

• surgical time

  Up to 240 minutes

Study Arms (2)

THA Posterior Approach

ACTIVE COMPARATOR

The posterior approach to the hip has been described by many authors and yields good results. Implants used were Quadra®-H stem and Versacup® hip system, Medacta, Switzerland, with metal on polyethylene bearing. All implants were non-cemented.

Procedure: Total hip arthroplasty

THA Direct anterior approach

ACTIVE COMPARATOR

The modified Hueter approach, based on the Smith-Peterson approach, was performed for the direct anterior minimally invasive surgery. This approach could have some advantages as it is a muscle sparing approach, hence yielding a faster recovery. A traction table was used for DAA as surgeons were trained to use this method. No intra-operative fluoroscopy was used for implant confirmation.Implants used were Quadra®-H stem and Versacup® hip system, Medacta, Switzerland, with metal on polyethylene bearing. All implants were non-cemented.

Procedure: Total hip arthroplasty

Interventions

Total hip arthroplasty PROCEDURE

Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study

THA Direct anterior approach; THA Posterior Approach

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• primary total hip replacement due to osteoarthrosis or osteonecrosis
• patients older than 50 years.

You may not qualify if:

• inflammatory arthritis,
• any previous ipsilateral hip surgery
• suffering from proximal femoral deformity
• BMI over 40
• active infection
• severe contralateral hip disease, muscle contractures or neuromuscular pathology
• requiring structural bone grafts.

Sponsors & Collaborators

• Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal: lead

Related Publications (1)

• Moerenhout K, Derome P, Laflamme GY, Leduc S, Gaspard HS, Benoit B. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Can J Surg. 2020 Sep-Oct;63(5):E412-E417. doi: 10.1503/cjs.012019.

  PMID: 33009898 DERIVED

MeSH Terms

Interventions

Arthroplasty, Replacement, Hip

Intervention Hierarchy (Ancestors)

Arthroplasty, Replacement; Arthroplasty; Orthopedic Procedures; Surgical Procedures, Operative; Plastic Surgery Procedures; Prosthesis Implantation

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: However, the decision to discharge subjects was made by physiotherapists blinded to treatment and based on objective criteria. These criteria were: 1) being autonomous for transfer from bed/chair to upright position 2) being able to walk with walking aid 3) climbing stairs in a safe way 4) having a pain level contained by painkillers. No restrictions were recommended for either group. The same rehabilitation and pain protocols were used for both approaches. In addition, statistical analyses were performed by an independent consultant who remained blinded to treatment group assignment.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Orthopedic Surgeon

Study Record Dates

• First Submitted: September 12, 2018
• First Posted: September 17, 2018
• Study Start: February 1, 2011
• Primary Completion: July 1, 2013
• Study Completion: August 1, 2013
• Last Updated: September 20, 2018

Record last verified: 2018-09

Data Sharing

• IPD Sharing: Will not share