Measured vs Navigated Techniques in Total Hip Arthroplasty

NCT05393778 | Unknown DMC

• 1 other identifier: 3390
• Study Type: interventional
• Target: 100
• Locations: 0 countries
• Sites: N/A

Brief Summary

Accurate reconstruction of the native hip parameters following total hip arthroplasty is associated with improved outcome. In order to improve ability for optimum reconstruction, 3-D templating software can be utilized that provide detailed information regarding native anatomy. In order to achieve reconstruction within acceptable parameters as per pre-operative plan, some surgeons propose the use of intra-operative devices that measure component orientation and joint reconstruction ("Measured-THA"), whilst others propose the use of navigation tools ("Navigation-THA). Both techniques have shown superiority compared to the most commonly used "freehand" technique, but no prior study has assessed for superiority between these 2 techniques. Furthermore, to-date assessment of post-operative reconstruction has not been tested in detail as post-THA assessments are based on radiographs which provide incomplete, 2-dimensional, assessments and are lacking the important axial plane reconstruction parameters. The aims of this prospective, randomized, trial are to 1. appraise the ability to achieve the pre-operative 3-D plan (as per FormusLab) through a comparison of pre-op plan to post-operative reconstruction; 2. compare ability to accurately reconstruct hip following THA between "navigated-" (IntelliJoint®) and "measured-" techniques; and in doing so it will also 3. assess the accuracy of the intra-operative assessments of reconstruction through a comparison of objective (i.e. measured) intra-operative assessments with the post-operative reconstructions achieved.

Conditions

Osteoarthritis, Hip

Outcome Measures

Primary Outcomes (4)

• Change in Pain Assessment - Oxford Hip Score

  The Oxford Hip Score will be given to patients to assess subjective measures of hip pain. Scores for each question from 0 to 4 with 4 being the best outcome. This method, when summed, produces overall scores running from 0 to 48 with 48 being the best outcome

  once pre-operatively and once one-year post-operatively

• Change in mobility, self-care, usual activities, pain/discomfort and anxiety/depression- EuroQol

  the EuroQol (EQ-5D-5L) will be given to patients to assess subjective measures mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension in the EQ-5D-5L has five response levels: no problems (Level 1); slight; moderate; severe; and extreme problems (Level 5). The maximum score of 1 indicates the best health state, by contrast with the scores of individual questions, where higher scores indicate more severe or frequent problems.

  once pre-operatively and once one-year post-operatively

• Change in physical, mental, and social health- PROMIS Global-10

  the PROMIS Global-10 will be given to patients to assess subjective measures of physical, mental and social health. It is a 10-item patient-reported questionnaire in which the response options are presented as 5-point (as well as a single 11-point) rating scales. The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. Higher scores indicate worse physical and mental health

  once pre-operatively and once one-year post-operatively

• Adverse Events

  Serious adverse events will be monitored. This includes: * Wound complication * Dislocation * Fracture * Infection * Re-operation * Revision surgery

  90 days post-operatively

Secondary Outcomes (4)

• Accuracy of reconstruction (in mm)

  post-operatively (within one week post-operatively)

• Comparison of margin of error

  Through study completion, an average of 1 year

• Accuracy of reconstruction on outcome

  Through study completion, an average of 1 year

• Accuracy of reconstruction (in degrees)

  post-operatively (within one week post-operatively)

Study Arms (2)

Measured Technique

EXPERIMENTAL

Patients in this group will have pre-operative planning done using the measured technique.

Procedure: Measured Technique

Navigated Technique

EXPERIMENTAL

Patients in this group will have pre-operative planning done using the navigated technique.

Procedure: Navigated Technique

Interventions

Measured Technique PROCEDURE

Manual intra-operative checks and tools are used to aid in component placement during surgery.

Measured Technique

Navigated Technique PROCEDURE

IntelliJoint® navigation is an imageless-based navigation system that utilizes a miniature infrared camera and microelectronics to measure hip center of rotation, acetabular inclination and version, leg length, and offset. The device provides accurate real-time data on implant positioning to aid in placement of the components during surgery.

Navigated Technique

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients who are signed for a THA for primary or secondary osteoarthritis without overt deformity that would require revision type implants and with good enough bone quality to be listed for uncemented component implantation.

You may not qualify if:

• Secondary OA due to Dysplasia (Hartofilakidis \>1)
• Avascular necrosis of the hip with destruction of joint structure
• Sequelae of Pediatric deformity with abnormal anatomy
• Cemented fixation of femur or acetabulum
• Previous arthroplasty-type procedure
• Previous septic arthritis of the hip

Sponsors & Collaborators

• Ottawa Hospital Research Institute: lead
• FormusLab: collaborator

Related Publications (39)

• Fang CJ, Shaker JM, Ward DM, Jawa A, Mattingly DA, Smith EL. Financial Burden of Revision Hip and Knee Arthroplasty at an Orthopedic Specialty Hospital: Higher Costs and Unequal Reimbursements. J Arthroplasty. 2021 Aug;36(8):2680-2684. doi: 10.1016/j.arth.2021.03.044. Epub 2021 Mar 23.

  PMID: 33840537 BACKGROUND

• Hu X, Zheng N, Chen Y, Dai K, Dimitriou D, Li H, Tsai TY. Optimizing the Femoral Offset for Restoring Physiological Hip Muscle Function in Patients With Total Hip Arthroplasty. Front Bioeng Biotechnol. 2021 Mar 30;9:645019. doi: 10.3389/fbioe.2021.645019. eCollection 2021.

  PMID: 33869155 BACKGROUND

• Grammatopoulos G, Thomas GE, Pandit H, Beard DJ, Gill HS, Murray DW. The effect of orientation of the acetabular component on outcome following total hip arthroplasty with small diameter hard-on-soft bearings. Bone Joint J. 2015 Feb;97-B(2):164-72. doi: 10.1302/0301-620X.97B2.34294.

  PMID: 25628277 BACKGROUND

• Agarwal S, Eckhard L, Walter WL, Peng A, Hatton A, Donnelly B, de Steiger R. The Use of Computer Navigation in Total Hip Arthroplasty Is Associated with a Reduced Rate of Revision for Dislocation: A Study of 6,912 Navigated THA Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2021 Oct 20;103(20):1900-1905. doi: 10.2106/JBJS.20.00950.

  PMID: 34143758 BACKGROUND

• Shon WY, Baldini T, Peterson MG, Wright TM, Salvati EA. Impingement in total hip arthroplasty a study of retrieved acetabular components. J Arthroplasty. 2005 Jun;20(4):427-35. doi: 10.1016/j.arth.2004.09.058.

  PMID: 16124957 BACKGROUND

• Barrack RL, Krempec JA, Clohisy JC, McDonald DJ, Ricci WM, Ruh EL, Nunley RM. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg Am. 2013 Oct 2;95(19):1760-8. doi: 10.2106/JBJS.L.01704.

  PMID: 24088968 BACKGROUND

• Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011 Feb;469(2):319-29. doi: 10.1007/s11999-010-1487-1.

  PMID: 20717858 BACKGROUND

• Bosker BH, Verheyen CC, Horstmann WG, Tulp NJ. Poor accuracy of freehand cup positioning during total hip arthroplasty. Arch Orthop Trauma Surg. 2007 Jul;127(5):375-9. doi: 10.1007/s00402-007-0294-y. Epub 2007 Feb 13.

  PMID: 17297597 BACKGROUND

• Schwarzkopf R, Muir JM, Paprosky WG, Seymour S, Cross MB, Vigdorchik JM. Quantifying Pelvic Motion During Total Hip Arthroplasty Using a New Surgical Navigation Device. J Arthroplasty. 2017 Oct;32(10):3056-3060. doi: 10.1016/j.arth.2017.04.046. Epub 2017 May 4.

  PMID: 28559196 BACKGROUND

• Pongkunakorn A, Chatmaitri S, Diewwattanawiwat K. Use of smartphone to improve acetabular component positioning in total hip athroplasty: A comparative clinical study. J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019825578. doi: 10.1177/2309499019825578.

  PMID: 30798733 BACKGROUND

• Gupta R, Pathak P, Singh R, Majumdar KP. Double-Stitch Technique: A Simple and Effective Method to Minimize Limb Length Discrepancy after Total Hip Arthroplasty. Indian J Orthop. 2019 Jan-Feb;53(1):169-173. doi: 10.4103/ortho.IJOrtho_188_18.

  PMID: 30905998 BACKGROUND

• Mitsutake R, Tanino H, Nishida Y, Higa M, Ito H. A simple angle-measuring instrument for measuring cemented stem anteversion during total hip arthroplasty. BMC Musculoskelet Disord. 2020 Feb 19;21(1):113. doi: 10.1186/s12891-020-3142-7.

  PMID: 32075628 BACKGROUND

• Steppacher SD, Kowal JH, Murphy SB. Improving cup positioning using a mechanical navigation instrument. Clin Orthop Relat Res. 2011 Feb;469(2):423-8. doi: 10.1007/s11999-010-1553-8.

  PMID: 20852974 BACKGROUND

• Meermans G, Van Doorn WJ, Koenraadt K, Kats J. The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement: a randomised controlled trial. Bone Joint J. 2014 Mar;96-B(3):312-8. doi: 10.1302/0301-620X.96B3.32989.

  PMID: 24589784 BACKGROUND

• Paprosky WG, Muir JM. Intellijoint HIP(R): a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty. Med Devices (Auckl). 2016 Nov 18;9:401-408. doi: 10.2147/MDER.S119161. eCollection 2016.

  PMID: 27920583 BACKGROUND

• Parvizi J, Benson JR, Muir JM. A new mini-navigation tool allows accurate component placement during anterior total hip arthroplasty. Med Devices (Auckl). 2018 Mar 22;11:95-104. doi: 10.2147/MDER.S151835. eCollection 2018.

  PMID: 29606894 BACKGROUND

• Kievit AJ, Dobbe JGG, Mallee WH, Blankevoort L, Streekstra GJ, Schafroth MU. Accuracy of cup placement in total hip arthroplasty by means of a mechanical positioning device: a comprehensive cadaveric 3d analysis of 16 specimens. Hip Int. 2021 Jan;31(1):58-65. doi: 10.1177/1120700019874822. Epub 2019 Sep 11.

  PMID: 31506002 BACKGROUND

• Snijders T, van Gaalen SM, de Gast A. Precision and accuracy of imageless navigation versus freehand implantation of total hip arthroplasty: A systematic review and meta-analysis. Int J Med Robot. 2017 Dec;13(4). doi: 10.1002/rcs.1843. Epub 2017 May 29.

  PMID: 28556582 BACKGROUND

• Singh V, Realyvasquez J, Simcox T, Rozell JC, Schwarzkopf R, Davidovitch RI. Robotics Versus Navigation Versus Conventional Total Hip Arthroplasty: Does the Use of Technology Yield Superior Outcomes? J Arthroplasty. 2021 Aug;36(8):2801-2807. doi: 10.1016/j.arth.2021.02.074. Epub 2021 Mar 5.

  PMID: 33773864 BACKGROUND

• Koper MC, Reijman M, van Es EM, Waarsing JH, Koot HWJ, Keizer SB, Jansen I, van Biezen FC, Verhaar JAN, Bos PK. No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial. BMC Musculoskelet Disord. 2019 Oct 25;20(1):473. doi: 10.1186/s12891-019-2883-7.

  PMID: 31651318 BACKGROUND

• Innmann MM, Maier MW, Streit MR, Grammatopoulos G, Bruckner T, Gotterbarm T, Merle C. Additive Influence of Hip Offset and Leg Length Reconstruction on Postoperative Improvement in Clinical Outcome After Total Hip Arthroplasty. J Arthroplasty. 2018 Jan;33(1):156-161. doi: 10.1016/j.arth.2017.08.007. Epub 2017 Aug 12.

  PMID: 28887022 BACKGROUND

• Schiffner E, Latz D, Jungbluth P, Grassmann JP, Tanner S, Karbowski A, Windolf J, Schneppendahl J. Is computerised 3D templating more accurate than 2D templating to predict size of components in primary total hip arthroplasty? Hip Int. 2019 May;29(3):270-275. doi: 10.1177/1120700018776311. Epub 2018 May 20.

  PMID: 29781288 BACKGROUND

• Minoda Y, Ohzono K, Aihara M, Umeda N, Tomita M, Hayakawa K. Are acetabular component alignment guides for total hip arthroplasty accurate? J Arthroplasty. 2010 Sep;25(6):986-9. doi: 10.1016/j.arth.2009.07.016. Epub 2009 Oct 17.

  PMID: 19837559 BACKGROUND

• Beverland DE, O'Neill CK, Rutherford M, Molloy D, Hill JC. Placement of the acetabular component. Bone Joint J. 2016 Jan;98-B(1 Suppl A):37-43. doi: 10.1302/0301-620X.98B1.36343.

  PMID: 26733639 BACKGROUND

• Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE. Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int. 2012 Jul-Aug;22(4):371-8. doi: 10.5301/HIP.2012.9350.

  PMID: 22865253 BACKGROUND

• Merle C, Innmann MM, Waldstein W, Pegg EC, Aldinger PR, Gill HS, Murray DW, Grammatopoulos G. High Variability of Acetabular Offset in Primary Hip Osteoarthritis Influences Acetabular Reaming-A Computed Tomography-Based Anatomic Study. J Arthroplasty. 2019 Aug;34(8):1808-1814. doi: 10.1016/j.arth.2019.03.065. Epub 2019 Apr 1.

  PMID: 31122846 BACKGROUND

• Meermans G, Goetheer-Smits I, Lim RF, Van Doorn WJ, Kats J. The difference between the radiographic and the operative angle of inclination of the acetabular component in total hip arthroplasty: use of a digital protractor and the circumference of the hip to improve orientation. Bone Joint J. 2015 May;97-B(5):603-10. doi: 10.1302/0301-620X.97B5.34781.

  PMID: 25922452 BACKGROUND

• Lee YK, Kim JW, Kim TY, Ha YC, Koo KH. Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach. Orthop Traumatol Surg Res. 2018 May;104(3):341-346. doi: 10.1016/j.otsr.2017.11.023. Epub 2018 Feb 16.

  PMID: 29458202 BACKGROUND

• Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P. A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 2009 Nov;91(11):2598-604. doi: 10.2106/JBJS.H.01225.

  PMID: 19884433 BACKGROUND

• Blumenfeld TJ. Pearls: Clinical Application of Ranawat's Sign. Clin Orthop Relat Res. 2017 Jul;475(7):1789-1790. doi: 10.1007/s11999-017-5376-8. Epub 2017 May 11. No abstract available.

  PMID: 28497375 BACKGROUND

• Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res. 2009 Jan;467(1):119-27. doi: 10.1007/s11999-008-0598-4. Epub 2008 Nov 1.

  PMID: 18979146 BACKGROUND

• Amuwa C, Dorr LD. The combined anteversion technique for acetabular component anteversion. J Arthroplasty. 2008 Oct;23(7):1068-70. doi: 10.1016/j.arth.2008.04.025. Epub 2008 Jun 4.

  PMID: 18534533 BACKGROUND

• Ogawa T, Takao M, Hamada H, Sakai T, Sugano N. Soft tissue tension is four times lower in the unstable primary total hip arthroplasty. Int Orthop. 2018 Sep;42(9):2059-2065. doi: 10.1007/s00264-018-3908-9. Epub 2018 Mar 27.

  PMID: 29589084 BACKGROUND

• Hill JC, Archbold HA, Diamond OJ, Orr JF, Jaramaz B, Beverland DE. Using a calliper to restore the centre of the femoral head during total hip replacement. J Bone Joint Surg Br. 2012 Nov;94(11):1468-74. doi: 10.1302/0301-620X.94B11.29144.

  PMID: 23109624 BACKGROUND

• Dorr LD, Hishiki Y, Wan Z, Newton D, Yun A. Development of imageless computer navigation for acetabular component position in total hip replacement. Iowa Orthop J. 2005;25:1-9.

  PMID: 16089064 BACKGROUND

• Jacob I, Benson J, Shanaghan K, Gonzalez Della Valle A. Acetabular positioning is more consistent with the use of a novel miniature computer-assisted device. Int Orthop. 2020 Mar;44(3):429-435. doi: 10.1007/s00264-020-04484-2. Epub 2020 Jan 22.

  PMID: 31965312 BACKGROUND

• Christ A, Ponzio D, Pitta M, Carroll K, Muir JM, Sculco PK. Minimal Increase in Total Hip Arthroplasty Surgical Procedural Time with the Use of a Novel Surgical Navigation Tool. Open Orthop J. 2018 Sep 28;12:389-395. doi: 10.2174/1874325001812010389. eCollection 2018.

  PMID: 30416609 BACKGROUND

• Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993 Mar;75(2):228-32. doi: 10.1302/0301-620X.75B2.8444942.

  PMID: 8444942 BACKGROUND

• Gross AE, Safir OA, Kuzyk PRT, Sculco PK, Wolfstadt J, Girardi BL, et al. Optimizing leg length and cup position: A surgical navigation tool. Seminars in Arthroplasty. 2018;29(3):157-60.

  BACKGROUND

MeSH Terms

Conditions

Osteoarthritis, Hip

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Officials

• George Grammatopoulos, MD

  The Ottawa Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Isabel Horton

CONTACT

613-737-8899; ihorton@ohri.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 10, 2021
• First Posted: May 26, 2022
• Study Start: July 1, 2022
• Primary Completion: July 1, 2024
• Study Completion: September 1, 2024
• Last Updated: May 26, 2022

Record last verified: 2022-05