Efficacy of periacetabular osteotomy followed by progressive resistance training compared to progressive resistance training as non-surgical treatment in patients with hip dysplasia (PreserveHip) - a protocol for a randomised controlled trial

Lisa Cecilie Urup Reimer, Stig Storgaard Jakobsen, Louise Mortensen, Ulrik Dalgas, Julie Sandell Jacobsen, Kjeld Soballe, Tone Bere, Jan Erik Madsen, Lars Nordsletten, May Arna Risberg, Inger Mechlenburg, Lisa Cecilie Urup Reimer, Stig Storgaard Jakobsen, Louise Mortensen, Ulrik Dalgas, Julie Sandell Jacobsen, Kjeld Soballe, Tone Bere, Jan Erik Madsen, Lars Nordsletten, May Arna Risberg, Inger Mechlenburg

Abstract

Introduction: Periacetabular osteotomy (PAO) is an established treatment for adolescent and adult patients with hip dysplasia. However, the efficacy of PAO has not been tested against another surgical intervention or conservative treatment in a randomised controlled trial before. We suggest that progressive resistance training (PRT) could be an alternative to PAO. The primary aim of this trial is therefore to examine the efficacy of PAO followed by 4 months of usual care followed by 8 months of PRT compared to 12 months of solely PRT in patients with hip dysplasia eligible for PAO in terms of patient-reported pain measured by The Copenhagen Hip and Groin Outcome Score (HAGOS).

Methods and analysis: This trial is a single-blinded multicentre randomised controlled clinical trial, where patients with hip dysplasia, who are eligible for PAO, will be randomised to either PAO followed by usual care and PRT or PRT only. Primary outcome is patient-reported pain, measured on the subscale pain on the HAGOS questionnaire 12 months after initiation of PAO or PRT. The key secondary outcomes are the other subscales of the HAGOS, adverse and serious adverse events, usage of painkillers (yes/no) and type of analgesics. Based on the sample size calculation, the trial needs to include 96 patients.

Ethics and dissemination: The trial is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-234-18) and by the Danish Data Protection Agency (Journal No 1-16-02-120-19). The trial is also approved by The Regional Committee for Medical and Health Research Ethics, Region South-East Norway (Ref. 2018/1603). All results from this trial will be published in international peer-reviewed scientific journals regardless of whether the results are positive, negative or inconclusive.

Trial registration number: NCT03941171.

Keywords: PAO; hip; hip dysplasia; osteoarthritis; periacetabular osteotomy; progressive resistance training.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Patient flow through the trial.

References

    1. Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995;77:985–9. 10.2106/00004623-199507000-00002
    1. Jacobsen S, Sonne-Holm S. Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey. Rheumatology 2005;44:211–8. 10.1093/rheumatology/keh436
    1. Wyles CC, Heidenreich MJ, Jeng J, et al. . The John Charnley Award: redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clin Orthop Relat Res 2017;475:336–50. 10.1007/s11999-016-4815-2
    1. Ganz R, Klaue K, Vinh TS, et al. . A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988:26–36. 10.1097/00003086-198807000-00006
    1. Troelsen A, Elmengaard B, Søballe K. A new minimally invasive Transsartorial approach for Periacetabular osteotomy. J Bone Joint Surg Am 2008;90:493–8. 10.2106/JBJS.F.01399
    1. Steppacher SD, Tannast M, Ganz R, et al. . Mean 20-year followup of Bernese Periacetabular osteotomy. Clin Orthop Relat Res 2008;466:1633–44. 10.1007/s11999-008-0242-3
    1. Lerch TD, Steppacher SD, Liechti EF, et al. . One-Third of hips after Periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res 2017;475:1154–68. 10.1007/s11999-016-5169-5
    1. Hartig-Andreasen C, Troelsen A, Thillemann TM, et al. . What factors predict failure 4 to 12 years after Periacetabular osteotomy? Clin Orthop Relat Res 2012;470:2978–87. 10.1007/s11999-012-2386-4
    1. Mechlenburg I, Nyengaard JR, Gelineck J, et al. . Cartilage thickness and cyst volume are unchanged 10 years after Periacetabular osteotomy in patients without hip symptoms. Clin Orthop Relat Res 2015;473:2644–9. 10.1007/s11999-015-4273-2
    1. Mechlenburg I, Nyengaard J, Rømer L, et al. . Changes in load-bearing area after Ganz periacetabular osteotomy evaluated by multislice CT scanning and stereology. Acta Orthop Scand 2004;75:147–53. 10.1080/00016470412331294395
    1. Jacobsen S, Sonne-Holm S, Søballe K, et al. . Joint space width in dysplasia of the hip: a case-control study of 81 adults followed for ten years. J Bone Joint Surg Br 2005;87:471–7. 10.1302/0301-620X.87B4.15522
    1. Morita D, Hasegawa Y, Seki T, et al. . A possible new radiographic predictor of progression of osteoarthritis in developmental dysplasia of the hip. Clin Orthop Relat Res 2018;476:2157–66. 10.1097/CORR.0000000000000458
    1. Troelsen A, Rømer L, Søballe K. [Hip dysplasia: clinical assessment, radiologic evaluation and reference]. Ugeskr Laeger 2007;169:394–6.
    1. Sørensen H, Nielsen DB, Jacobsen JS, et al. . Isokinetic dynamometry and gait analysis reveal different hip joint status in patients with hip dysplasia. Hip Int 2019;29:215–21. 10.1177/1120700018773401
    1. Mortensen L, Schultz J, Elsner A, et al. . Progressive resistance training in patients with hip dysplasia: a feasibility study. J Rehabil Med 2018;50:751–8. 10.2340/16501977-2371
    1. Clohisy JC, Nepple JJ, Ross JR, et al. . Does surgical hip dislocation and Periacetabular osteotomy improve pain in patients with Perthes-like deformities and acetabular dysplasia? Clin Orthop Relat Res 2015;473:1370–7. 10.1007/s11999-014-4115-7
    1. Kanai A, Kiyama T, Genda E, et al. . Biomechanical investigation of ambulatory training in patients with acetabular dysplasia. Gait Posture 2008;28:52–7. 10.1016/j.gaitpost.2007.09.012
    1. Kuroda D, Maeyama A, Naito M, et al. . Dynamic hip stability, strength and pain before and after hip abductor strengthening exercises for patients with dysplastic hips. Isokinet Exerc Sci 2013;21:95–100. 10.3233/IES-130480
    1. Harris-Hayes M, Czuppon S, Van Dillen LR, et al. . Movement-Pattern training to improve function in people with chronic hip joint pain: a feasibility randomized clinical trial. J Orthop Sports Phys Ther 2016;46:452–61. 10.2519/jospt.2016.6279
    1. Bieler T, Siersma V, Magnusson SP, et al. . In hip osteoarthritis, Nordic walking is superior to strength training and home-based exercise for improving function. Scand J Med Sci Sports 2017;27:873–86. 10.1111/sms.12694
    1. Hermann A, Holsgaard-Larsen A, Zerahn B, et al. . Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty – a randomized controlled trial. Osteoarthritis and Cartilage 2016;24:91–8. 10.1016/j.joca.2015.07.030
    1. Wartolowska K, Judge A, Hopewell S, et al. . Use of placebo controls in the evaluation of surgery: systematic review. BMJ 2014;348:g3253 10.1136/bmj.g3253
    1. Wartolowska K, Beard DJ, Carr AJ. Attitudes and beliefs about placebo surgery among orthopedic shoulder surgeons in the United Kingdom. PLoS One 2014;9:e91699 10.1371/journal.pone.0091699
    1. Zurmühle CA, Anwander H, Albers CE, et al. . Periacetabular osteotomy provides higher survivorship than rim trimming for acetabular Retroversion. Clin Orthop Relat Res 2017;475:1138–50. 10.1007/s11999-016-5177-5
    1. Belzile EL, Beaulé PE, Ryu J-J, et al. . Outcomes of joint preservation surgery: comparison of patients with developmental dysplasia of the hip and femoroacetabular impingement. J Hip Preserv Surg 2016;3:hnw033–7. 10.1093/jhps/hnw033
    1. Moher D, Hopewell S, Schulz KF, et al. . CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010;63:e1–37. 10.1016/j.jclinepi.2010.03.004
    1. Thorborg K, Holmich P, Christensen R, et al. . The Copenhagen hip and groin outcome score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 2011;45:478–91. 10.1136/bjsm.2010.080937
    1. Thomeé R, Jónasson P, Thorborg K, et al. . Cross-Cultural adaptation to Swedish and validation of the Copenhagen hip and groin outcome score (HAGOS) for pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement. Knee Surg Sports Traumatol Arthrosc 2014;22:835–42. 10.1007/s00167-013-2721-7
    1. Ageberg E, Cronström A. Agreement between test procedures for the single-leg hop for distance and the single-leg mini squat as measures of lower extremity function. BMC Sports Sci Med Rehabil 2018;10:1–7. 10.1186/s13102-018-0104-6
    1. Kemp JL, Risberg MA, Schache AG, et al. . Patients with Chondrolabral pathology have bilateral functional impairments 12 to 24 months after unilateral hip arthroscopy: a cross-sectional study. J Orthop Sports Phys Ther 2016;46:947–56. 10.2519/jospt.2016.6577
    1. Biedermann R, Donnan L, Gabriel A, et al. . Complications and patient satisfaction after periacetabular pelvic osteotomy. Int Orthop 2008;32:611–7. 10.1007/s00264-007-0372-3
    1. Hawker GA, Mian S, Kendzerska T, et al. . Measures of adult pain: visual analog scale for pain (vas pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CpGs), short Form-36 bodily pain scale (SF. Arthritis Care Res 2011;63:S240–52. 10.1002/acr.20543
    1. Behrend H, Giesinger K, Giesinger JM, et al. . The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 2012;27:430–6. 10.1016/j.arth.2011.06.035
    1. Plisky PJ, Gorman PP, Butler RJ, et al. . The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther 2009;4:92–9.
    1. Herdman M, Gudex C, Lloyd A, et al. . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011;20:1727–36. 10.1007/s11136-011-9903-x
    1. Christensen R, Bliddal H, Henriksen M. Enhancing the reporting and transparency of rheumatology research: a guide to reporting guidelines. Arthritis Res Ther 2013;15:109–4. 10.1186/ar4145

Source: PubMed

3
Prenumerera