Fish Oil in Total Hip Replacement Randomized Clinical Trial

October 23, 2024 updated by: Jeffrey L Stimac MD

Stopping Fish Oil Supplementation Prior to Total Hip Replacement a Randomized Clinical Trial

The purpose of this study is to determine if continuing fish oil supplementation leads to higher blood loss in patients undergoing total hip arthroplasty (THA). Another purpose is to determine if patients on fish oil have less pain after THA. Fish oil (Omega-3 fatty acid) is commonly used by patients as a natural anti-inflammatory to decrease joint pain from arthritis. Supplements, including fish oil, are typically stopped 1-2 weeks prior to surgery as there is an increased risk of perioperative bleeding. However, there are current methods in joint replacement surgery that decrease the risk of perioperative bleeding. With the risk of excessive bleeding being minimized, fish oil may not need to be stopped prior to surgery and could be continued immediately after surgery. The anti-inflammatory effect of fish oil may also help decrease pain after surgery.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Introduction/Purpose Fish oil (Omega-3 fatty acid) is commonly used by patients as a natural anti-inflammatory to decrease joint pain from arthritis. Furthermore, fish oil has been found to decrease the risk of coronary artery disease, decrease mild hypertension, prevent cardiac arrhythmias and decrease blood triglyceride levels. Supplements, including fish oil, are typically stopped 1-2 weeks prior to surgery as there is an increased risk of perioperative bleeding. With modern blood management techniques in joint replacement surgery, including the use of tranexamic acid, the risk of perioperative bleeding may be minimized. With the risk being minimized fish oil may not need to be stopped prior to surgery and could be continued immediately after surgery. The anti-inflammatory effect of fish oil in the perioperative period may aid in post-operative pain management. The purpose of this study is to determine if continuing fish oil supplementation leads to higher blood loss in patients undergoing unilateral total hip arthroplasty (THA). A secondary analysis is to determine if patients on fish oil have less pain after THA.

Objectives

Primary Outcome Measures:

• Calculated total perioperative blood loss milliliters (mL) using Bourke's, Gross', Camarasa's, and Lopez-Picado's formula based on post-operative (PO) D5 Hemoglobin and Hematocrit

Secondary Outcomes Measures:

  • Incidence of blood transfusion
  • Post-operative day 1 Hemoglobin and Hematocrit
  • Post-operative pain scores
  • Pain medication usage (morphine equivalents)
  • Difference in wound complications (superficial and deep infection, drainage, hematoma)

Study Design Open-label, adaptive randomized clinical trial with a 1:1 randomization

Study arms:

Control: No fish oil supplementation. Interventional: Fish oil supplementation started or continued Fish-Oil naïve subjects will be started on fish oil 4 weeks prior to surgery and continued until the 6 week follow up. Subjects already taking fish oil will be switched to the study fish-oil formulation of two capsules twice daily (3000 mg of EPA and DHA).

All subjects will be asked to stop all non-Fish Oil supplements 2 weeks prior to and 2 weeks after surgery.

Sample size: The primary outcome is blood loss, mean of 1200 mL with a reported standard deviation of 340 mL. A non-inferiority trial to determine if there is no difference in blood loss between subjects taking fish oil and subjects not taking fish-oil will require 50 subjects in each arm with 80% power lower limit of a one-sided 90% confidence two-sided confidence interval that the difference between the two groups is one half the reported standard deviation of 340 mL (170 mL). To allow for drop-outs, 60 subjects will be enrolled in each arm.

Randomization: As patients already taking fish-oil supplements will likely not be willing to discontinue their regimen, an adaptive randomization will be performed. Patients already on fish-oil will be assigned to the Interventional Arm and the subsequent randomization adjusted.

Study Procedures After being deemed eligible, potential study participants will be approached about the study asked to sign an informed consent form that has been approved by the internal review board. Patients that meet the inclusion criteria will be randomized to either the control group or experimental group. Patients in the experimental group will started on 3000 mg of EPA and DHA 4 weeks prior to surgery. The fish oil will be continued in the perioperative period and until their 6 week follow up appointment. Patients will be supplied the fish oil at no cost. Patients will stop all other supplements and herbal medicines 2 weeks prior to surgery and will not restart the supplements until 2 weeks after surgery.

Pre-operative hemoglobin and hematocrit will be obtained on all patients during preadmission testing. All patients must stay one night in the hospital after surgery. A post-day #1 and #5 hemoglobin and hematocrit will be obtained on all patients. Amount of fluid collected in the wound drain will also be collected. Blood loss will be calculated using the Bourke's, Gross', Camarasa's, and Lopez-Picado's formula. Data will be collected on the rates of blood transfusions for each patient. Post-operative day 1 pain scores will be determined for each patient using the visual analog scale. Pain medication use through patient report will be collected and daily morphine equivalents starting on the day of surgery up until the patients 6 week follow up will be calculated. Date and quantity of any narcotic refill will be recorded. Data will also be collected on the rate of wound complications in patients. Enrollment into the study is voluntary and participants can voluntarily withdraw at any time.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
8

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • United States
    • Kentucky
      • Louisville, Kentucky, United States, 40241
        • Norton Healthcare

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 99 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult patients ≥ 18 years old
  • Primary total hip arthroplasty
  • Diagnosis of osteoarthritis
  • Able to consume fish oil
  • Medically cleared for surgery
  • Plan for unilateral total hip arthroplasty
  • Able to consent to surgery and study participation

Exclusion Criteria:

  • Unable to consent for study participation
  • Unable to participate in preoperative testing
  • History of deep vein thrombosis (DVT) or pulmonary embolism (PE)
  • Patient reports of easy bruising
  • Revision total hip replacement
  • Indication for surgery other than osteoarthritis
  • History of surgical wound complication on involved extremity
  • Allergy to fish oil
  • Allergy to Aspirin
  • Patients on Coumadin, Eliquis, Xarelto or other anticoagulants (excluding NSAIDs)
  • Outpatient total hip replacement
  • Bilateral total hip replacement
  • Coagulopathy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Fish Oil
Fish-Oil naïve subjects will be started on fish oil 4 weeks prior to surgery and continued until the 6 week follow up. Subjects already taking fish oil will be switched to the study fish-oil formulation of two capsules twice daily (3000 mg of EPA and DHA).
Dietary supplement: Fish Oil
Fish-oil formulation of two capsules twice daily (3000 mg of EPA and DHA).
No Intervention: Control
No fish oil supplementation

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Total perioperative blood loss
Time Frame: Post-operative day 5
Calculated total perioperative blood loss (mL) using Bourke's, Gross', Camarasa's, and Lopez-Picado's formula based on Post Operative Day 5 (POD5) Hemoglobin and Hematocrit
Post-operative day 5

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Post-operative day 1 Hemoglobin
Time Frame: Post-operative day 1
Post-operative day 1 Hemoglobin
Post-operative day 1
Post-operative day 1 Hematocrit
Time Frame: Post-operative day 1
Post-operative day 1 Hematocrit
Post-operative day 1

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Post-operative pain scores
Time Frame: Post-operative day 1 pain scores will be determined for each patient using the visual analog scale
Post-operative pain scores will be determined for each patient using a numeric rating scales (NRS) with 0 being no pain and 10 being worst pain possible.
Post-operative day 1 pain scores will be determined for each patient using the visual analog scale

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Jeffrey L Stimac MD

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Jeffrey D Stimac, MD, Norton Healthcare

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 1, 2020

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
March 22, 2022

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 10, 2022

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
March 5, 2020

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 22, 2020

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
April 24, 2020

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 26, 2024

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 23, 2024

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2022

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 19-N0364

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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