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Percutaneous Assisted Approach for Total Hip Replacement and it's Effect on Functional Rehabilitation.

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ClinicalTrials.gov Identifier: NCT02032017
Recruitment Status : Unknown
Verified January 2014 by Claudia Hendrickx, Universiteit Antwerpen.
Recruitment status was:  Recruiting
First Posted : January 9, 2014
Last Update Posted : January 9, 2014
Sponsor:
Collaborator:
Stöpler Belgium nv
Information provided by (Responsible Party):
Claudia Hendrickx, Universiteit Antwerpen

Brief Summary:
The purpose of this study is to investigate whether revalidation following total hip replacement through the percutaneous approach is faster or better than following the anterolateral approach. We assume this would be the case since it is possible to spare a large part of the gluteus medius muscle with the percutaneous approach.

Condition or disease Intervention/treatment Phase
Total Hip Arthroplasty Procedure: Ceramic on ceramic couple Procedure: Percutaneous assisted approach Procedure: Anterolateral approach Other: Usual care Not Applicable

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Percutaneous Assisted Approach for Total Hip Replacement and it's Effect on Functional Rehabilitation Compared to the Anterolateral Approach.
Study Start Date : October 2013
Estimated Primary Completion Date : December 2014

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Percutaneous assisted approach
In this technique, a second small incision (1 cm) at the anterior border of the femur is made. A canulla is placed underneath the muscle and used to pass the reamers in the direction of the acetabulum. There's no need to enlarge the skin incision or to release more muscle insertion to achieve good working access to the acetabulum. Two advantages can be defined: sparing of the gluteus medius muscle and safe access to the acetabulum to obtain perfect positioning of the implants.
Procedure: Ceramic on ceramic couple
All patients will get a standard total hip replacement (cementless hydroxyapatite coated cup and a titanium plasmasprayed stem) with a ceramic on ceramic (third generation biolox delta) couple. Preoperative leg length and offset are marked to reconstruct the preoperative leg length and to obtain the optimal offset.

Procedure: Percutaneous assisted approach
Other: Usual care
Both groups will receive usual care (UC) after surgery. This includes standard physiotherapy care consisting of mobilizing and strengthening techniques. All patients will receive a booklet containing information about the surgery, weight bearing after the surgery, and rehabilitation in general.

Active Comparator: Anterolateral approach
A standard transgluteal approach is used. This means a large part of the gluteus medius muscle is released to obtain good access to the acetabulum.
Procedure: Ceramic on ceramic couple
All patients will get a standard total hip replacement (cementless hydroxyapatite coated cup and a titanium plasmasprayed stem) with a ceramic on ceramic (third generation biolox delta) couple. Preoperative leg length and offset are marked to reconstruct the preoperative leg length and to obtain the optimal offset.

Procedure: Anterolateral approach
Other: Usual care
Both groups will receive usual care (UC) after surgery. This includes standard physiotherapy care consisting of mobilizing and strengthening techniques. All patients will receive a booklet containing information about the surgery, weight bearing after the surgery, and rehabilitation in general.




Primary Outcome Measures :
  1. change in time needed for the timed get up and go test [ Time Frame: baseline, 4 weeks, 12 weeks ]
    The subject is asked to stand up from a chair, walk 3m to a cone, return to the chair and sit down again. The time needed to perform this test is recorded in seconds.


Secondary Outcome Measures :
  1. surface electromyography (sEMG) of gluteus medius [ Time Frame: baseline ]
    sEMG of the gluteus medius is recorded during maximally voluntary isometric contraction and during single leg stance.

  2. Change in hip abductor muscle strength measured by MicroFET 2 [ Time Frame: baseline, 4 weeks, 12 weeks ]
    The patient lies supine. Resistance is administered on the lateral side of the leg, just proximal of the knee joint. Patients will be asked for a maximally voluntary isometric contraction. The test will be repeated 3 times. The mean value will be recorded.

  3. Change in knee extensor muscle strength measured by MicroFET 2 [ Time Frame: baseline, 4 weeks, 12 weeks ]
    The patient is seated with the hips and knees bent 90°. Resistance is administered on the ventral side of the leg, just proximal of the ankle joint. Patients will be asked for a maximally voluntary isometric contraction. The test will be repeated 3 times. The mean value will be recorded.

  4. Score on the Trendelenburg test [ Time Frame: baseline ]

    The patient is asked to raise one leg (sound side) and lift the non-stance side of the pelvis as high as possible for 30 seconds. The response is classified as followed:

    1. Normal: the pelvis on the non-stance side can be lifted maximally during 30 seconds
    2. The pelvis on the non-stance side can be lifted, but not maximally
    3. The pelvis on the non-stance side is elevated, but not maintained for 30 seconds.
    4. No elevating of the pelvis on the non-stance side
    5. Drooping of the pelvis
    6. Non-valid response: due to hip pain or uncooperative patient

  5. Change in score on the Oxford Hip Score [ Time Frame: baseline, 4 weeks, 12 weeks ]
    The Oxford Hip Score (OHS) is a disease-specific questionnaire that consists of 12 questions for the evaluation of pain and hip function in relation to various activities. Each question contains 5 quantifiable answers, leading to a total score that can range from 12 (least problems) to 60 (most problems).

  6. Change in score on the SF-36 and it's subscales [ Time Frame: baseline, 4 weeks, 6 weeks ]
    The SF-36 is a generic questionnaire that contains 36 items measuring health on 8 different dimensions. These dimensions cover functional status, wellbeing and overall evaluation of health.

  7. Change in time needed to complete the 5 times sit-to-stand test [ Time Frame: baseline, 4 weeks, 12 weeks ]
    This easily feasible test where the patient has to stand up and sit back down 5 times as fast as possible is a good predictor of falling. A worse score (i.e. a longer time needed to complete the test) on the 5 times sit to stand (5tSTS) implies a greater chance of falling.

  8. Change in distance walked during the 6 minute walking test [ Time Frame: baseline, 4 weeks, 12 weeks ]
    The test measures the distance a patient can quickly walk on a flat, hard surface in a time-period of 6 minutes.

  9. surface electromyography (sEMG) of gluteus medius [ Time Frame: 4 weeks ]
    sEMG of the gluteus medius is recorded during maximally voluntary isometric contraction and during single leg stance.

  10. surface electromyography (sEMG) of gluteus medius [ Time Frame: 12 weeks ]
    sEMG of the gluteus medius is recorded during maximally voluntary isometric contraction and during single leg stance.

  11. Score on the trendelenburg test [ Time Frame: 4 weeks ]

    The patient is asked to raise one leg (sound side) and lift the non-stance side of the pelvis as high as possible for 30 seconds. The response is classified as followed:

    1. Normal: the pelvis on the non-stance side can be lifted maximally during 30 seconds
    2. The pelvis on the non-stance side can be lifted, but not maximally
    3. The pelvis on the non-stance side is elevated, but not maintained for 30 seconds.
    4. No elevating of the pelvis on the non-stance side
    5. Drooping of the pelvis
    6. Non-valid response: due to hip pain or uncooperative patient

  12. Score on the Trendelenburg test [ Time Frame: 12 weeks ]

    The patient is asked to raise one leg (sound side) and lift the non-stance side of the pelvis as high as possible for 30 seconds. The response is classified as followed:

    1. Normal: the pelvis on the non-stance side can be lifted maximally during 30 seconds
    2. The pelvis on the non-stance side can be lifted, but not maximally
    3. The pelvis on the non-stance side is elevated, but not maintained for 30 seconds.
    4. No elevating of the pelvis on the non-stance side
    5. Drooping of the pelvis
    6. Non-valid response: due to hip pain or uncooperative patient



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Ages Eligible for Study:   50 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • unilateral hip arthritis or avascular necrosis (AVN) in need for total hip replacement

Exclusion Criteria:

  • Comorbidities affecting functional outcome
  • Symptomatic lumbar pathology
  • Need of surgery or intervention on the ipsilateral knee and/or ankle/foot
  • Neurological disorders such as Parkinsonism and previous cardiovascular accidents (CVA)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02032017


Contacts
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Contact: Claudia Hendrickx, PhD student 0032 (0)3 821 32 92 Claudia.Hendrickx@uantwerpen.be

Locations
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Belgium
ZNA Middelheim Recruiting
Wilrijk, Antwerp, Belgium, 2020
Principal Investigator: Peter Mertens, MD         
UZA Recruiting
Antwerp, Belgium, 2000
Contact: Claudia Hendrickx, PhD student    0032 (0)3 821 32 92    Claudia.Hendrickx@uantwerpen.be   
Principal Investigator: Claudia Hendrickx, Phd Student         
Sponsors and Collaborators
Universiteit Antwerpen
Stöpler Belgium nv
Investigators
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Principal Investigator: Claudia Hendrickx, PhD student Universiteit Antwerpen

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Claudia Hendrickx, PhD student, Universiteit Antwerpen
ClinicalTrials.gov Identifier: NCT02032017     History of Changes
Other Study ID Numbers: B300201318915
First Posted: January 9, 2014    Key Record Dates
Last Update Posted: January 9, 2014
Last Verified: January 2014

Keywords provided by Claudia Hendrickx, Universiteit Antwerpen:
Total Hip Arthroplasty
Gluteus medius
Approach
Rehabilitation
Functional outcome