Hip Replacement in a High Volume Community Hospital: Effect on Length of Stay and Hospital Cost

Introduction of the Direct Anterior Approach to Hip Replacement Into a High Volume Community Hospital: Effect on Length of Stay and Hospital Cost

The investigators propose to evaluate and compare the percentage of patients who are able to be discharged in less than 3 days after undergoing total hip arthroscopy through either a direct anterior or posterior approach, utilizing the identical post operative protocol. The investigators also propose to evaluate the costs associated with the two different approaches to hip replacement in the same group of patients. Post operative resource utilization, discharge disposition, and pain medicine requirement will also be evaluated.

Study Overview

• Status: Withdrawn
• Conditions: Hip Osteoarthritis

Detailed Description

The investigators hypothesize that a higher proportion of patients treated with the direct anterior approach for hip replacement will be able to leave the hospital in less than 3 days when compared with a less invasive posterior approach. Secondly, decreased length of stay associated with the procedure may reduce hospital costs.

• Study Type: Observational

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Annapolis, Maryland, United States, 21401
      • Anne Arundel Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients who have undergone primary uncemented hip replacement at our institution (Anne Arundel Medical Center) through either a posterior approach or direct anterior approach on a fracture table utilizing the identical post operative protocol.

Description

Inclusion Criteria:

1. Consecutive single surgeon series of patients who have undergone primary uncemented hip replacement at our institution through either a posterior approach or direct anterior approach on a fracture table. Posterior approach patient - most recent patient prior to March, 2010, compared with consecutive recent anterior approach patients with minimum of 6 month follow-up.
2. Diagnosis of osteoarthritis, inflammatory arthritis, or avascular necrosis.
3. No previous surgery on affected hip.
4. Age 40-90 at time of surgery

Exclusion Criteria:

1. Patient not permitted to bear full weight after the procedure, per post operative instructions
2. Hip replacement performed for acute fracture.
3. Previous hip surgery.

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Retrospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Direct Anterior Approach hip replacement; Single surgeon series of 105 consecutive patients who underwent hip replacement via the direct anterior approach on a fracture table
Posterior Approach Hip Replacement; 105 consecutive patients previously operated on by a less invasive posterior approach at the same institution. These surgeries occurred prior to March, 2010.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of Hospital Stay	The length of stay and proportion of patients who went home in less than 3 days will be determined for each group. To evaluate and compare the percentage of patients who are able to be discharged in less than 3 days after undergoing total hip arthroscopy through either a direct anterior or posterior approach, utilizing the identical post operative protocol.	Retrospective review of hospital discharge records
Hospital cost	Hospital cost analysis will be undertaken for each group.	Retrospective review of utilization records

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post Operative Pain Medication Utilization	Analysis of post operative pain medicine requirement will be compared for the two groups.	After retrospective chart review is complete -- approximately 6 months
Utilization of inpatient physical therapy resources	Utilization of inpatient physical therapy resources and post hospital discharge disposition will be compared for the two groups.	Retrospective review -- of hospital discharge

Collaborators and Investigators

• Sponsor: Anne Arundel Health System Research Institute
• Collaborators: DePuy Orthopaedics
• Investigators: Principal Investigator: Paul King, M.D., Anne Arundel Medical Center / Anne Arundel Orthopedic Surgeons

Publications and helpful links

General Publications

• Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL. Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplasty. 2000 Jun;15(4):448-52. doi: 10.1054/arth.2000.4346.
• Vorhies JS, Wang Y, Herndon J, Maloney WJ, Huddleston JI. Readmission and length of stay after total hip arthroplasty in a national Medicare sample. J Arthroplasty. 2011 Sep;26(6 Suppl):119-23. doi: 10.1016/j.arth.2011.04.036. Epub 2011 Jul 1.
• Duwelius PJ, Moller HS, Burkhart RL, Waller F, Wu Y, Grunkemeier GL. The economic impact of minimally invasive total hip arthroplasty. J Arthroplasty. 2011 Sep;26(6):883-5. doi: 10.1016/j.arth.2010.09.011. Epub 2010 Nov 3.
• Matta JM, Ferguson TA. The anterior approach for hip replacement. Orthopedics. 2005 Sep;28(9):927-8. doi: 10.3928/0147-7447-20050901-11. No abstract available.
• Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005 Dec;441:115-24. doi: 10.1097/01.blo.0000194309.70518.cb.

Study record dates

Study Major Dates

• Primary Completion (Actual): January 1, 2014

Study Registration Dates

• First Submitted: May 10, 2013
• First Submitted That Met QC Criteria: May 17, 2013
• First Posted (Estimate): May 20, 2013

Study Record Updates

• Last Update Posted (Estimate): December 18, 2014
• Last Update Submitted That Met QC Criteria: December 17, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: Total Hip replacement; Fracture table; DePuySynthes; Direct anterior approach hip replacement; Posterior approach hip replacement
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Hip
• Other Study ID Numbers: IIS-000158