- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04870151
Anterolateral Versus Direct Lateral Approach in Hemiarthroplasty for Hip Fracture
Anterolateral Versus Direct Lateral Approach in Hemiarthroplasty for Hip Fracture: A Randomised Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Dislocated intracapsular hip fractures are usually treated with cemented hemiarthroplasty. In Norway, a direct lateral approach is most often used, as recommended in national guidelines. In total hip arthroplasty, however, minimally invasive approaches are also commonly used, and may improve the clinical results, as compared to posterior or direct lateral approaches.
The aims of the present study are to evaluate the effect of the minimally invasive anterolateral approach (Watson-Jones approach) compared to the direct lateral approach (Hardinge approach) to the hip joint in hemiarthroplasty after dislocated hip fractures.
Patients with dislocated hip fractures who are fit for cemented hemiarthroplasty are randomised to surgery with an anterolateral approach or a direct lateral approach.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Håvard Furunes, PhD
- Phone Number: 0047 99041763
- Email: havardfurunes@gmail.com
Study Contact Backup
- Name: Audun D Bøhn, MD
- Phone Number: 0047 90952322
- Email: audun.bohn@gmail.com
Study Locations
-
-
Innlandet
-
Gjøvik, Innlandet, Norway, 2819
- Recruiting
- Innlandet Hospital Trust
-
Contact:
- Håvard Furunes, PhD
- Phone Number: 0047 99041763
- Email: havardfurunes@gmail.com
-
Contact:
- Audun D Bøhn, MD
- Phone Number: 0047 90952322
- Email: audun.bohn@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- dislocated hip fracture.
- planned cemented hemiarthroplasty.
- able to walk, with or without walking aids, prior to the injury.
Exclusion Criteria:
- young and healthy patients with displaced hip fractures who are recommended total hip arthroplasty or open reduction / internal fixation of the fracture.
- patients with severe comorbidity and high risk of cement-related complications who are recommended uncemented hemiarthroplasty (some, but not all, patients with ASA (American Society of Anesthesiologists) grade 4).
- not able to give informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Anterolateral approach
The minimally invasive anterolateral approach (Watson-Jones approach) is performed with the patient in supine position. An oblique incision is made from just dorsal to the anterior superior iliac spine, and extended distally to the greater trochanter. After the fascia is incised, deep dissection continues in the plane between the tensor fasciae latae and the gluteus medius muscles. The joint capsule is exposed and opened. The femoral head and neck are resected and the femoral canal is reamed according to the preoperative plan. A femoral stem (Link Lubinus SPII) is fixed using bone cement (Heraeus Medical Palacos R+G pro) and connected to a bipolar femoral head (Zimmer Multipolar). After implantation of the prosthesis, the fascia, subcutis and skin is closed in separate layers with sutures. |
Cemented hemiarthroplasty using an anterolateral approach.
|
Active Comparator: Direct lateral approach
The direct lateral approach (Hardinge approach) is performed with the patient in a lateral decubitus position. A straight or curved longitudinal incision is made over the greater trochanter, and the fascia is incised longitudinally. The anterior aspect of the gluteus medius and minimus muscles are separated from the greater trochanter. The joint capsule is exposed and opened. The femoral head and neck are resected and the femoral canal is reamed according to the preoperative plan. A femoral stem (Link Lubinus SPII) is fixed using bone cement (Heraeus Medical Palacos R+G pro) and connected to a bipolar femoral head (Zimmer Multipolar). After implantation of the prosthesis, the gluteus medius and minimus muscles are reinserted using osteosutures. The fascia, subcutis and skin is closed in separate layers with sutures. |
Cemented hemiarthroplasty using a direct lateral approach.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Harris Hip Score (HHS)
Time Frame: 12 months
|
Harris Hip Score (HHS) is an outcome measure for hip-related symptoms.
The score is based on both patient-reported information and clinical examination, and is administered by a qualified health care professional.
It covers four domains: Pain, function, absence of deformity and range of motion.
The score ranges from 0 (worst) to 100 (best).
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
EuroQol questionnaire (EQ-5D)
Time Frame: 12 months
|
Quality of life is measured by the EuroQol questionnaire (EQ-5D).
EQ-5D is a validated generic health-related quality-of-life instrument.
It consists of two parts: EQ-5D descriptive part and EQ-5D visual analogue scale.
The descriptive part includes five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each with three possible answers ("no problems", "some problems", and "major problems").
EQ-5D VAS is a visual analogue scale of self-related overall health, ranging from 0 (worst imaginable health state) to 100 (best imaginable health state).
|
12 months
|
Patient-reported limping
Time Frame: 12 months
|
Patient-reported limping is a sub-score of the Harris Hip Score.
The patients describe their limping as (1) "none", (2) "slight", (3) "moderate" or (4) "severe or unable to walk".
|
12 months
|
Patient-reported use of walking aid
Time Frame: 12 months
|
Patient-reported use of walking aid is a sub-score of the Harris Hip Score.
The patients describe their use of walking aid as (1) "none", (2) "cane/walking stick for long walks", (3) "cane/walking stick most of the time", (4) "one crutch", (5) "two canes/walking sticks" or (6) "two crutches or unable to walk".
|
12 months
|
Trendelenburg test
Time Frame: 12 months
|
Trendelenburg test is a clinical test for the integrity of hip abductor muscle function.
The test is positive when the patient is unable to maintain the pelvis horizontal to the floor when standing on one leg.
|
12 months
|
Timed Up and Go (TUG)
Time Frame: 12 months
|
The Timed Up and Go (TUG) test is a performance-based measure of functional mobility that was initially developed to identify mobility and balance impairments in older adults. The patients start in a seated position, walk 3 meters, turn around, walk back to the chair and sit down. The time starts when the patient is commanded to start and stops when the patient is seated. |
12 months
|
Blood loss
Time Frame: During surgery
|
The peroperative amount of blood loss (milliliters) is registered
|
During surgery
|
Duration of surgery
Time Frame: During surgery
|
The duration of the surgical procedure (minutes) is registered
|
During surgery
|
Length of hospital stay
Time Frame: 12 months
|
The length of hospital stay (days) is registered
|
12 months
|
Adverse events
Time Frame: 12 months
|
Adverse events such as perioperative complications, infections, dislocations and reoperations are registered
|
12 months
|
Mortality
Time Frame: 12 months
|
In patients who die within 12 months follow-up, the time of death is registered
|
12 months
|
Cause of death
Time Frame: 12 months
|
In patients who die within 12 months follow-up, the cause of death is registered
|
12 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Håvard Furunes, PhD, Sykehuset Innlandet HF
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 224045
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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