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Hip ArthrosisNCT02121964

Capsulectomy vs Capsulotomy With Repair in Direct Anterior Total Hip Arthroplasty

A study testing Capsulectomy in Direct Anterior Total Hip Arthroplasty and Capsulotomy in Direct Anterior Total Hip Arthroplasty in people with Hip Arthrosis and Osteoarthritis, run by Emory University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In this prospective, randomized study, investigators will look at the outcome of total hip arthroplasty through the anterior approach in regard to the surgical treatment of the anterior hip capsule. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Hip Arthrosis, Osteoarthritis, Arthritis
What is being tested?
Capsulectomy in Direct Anterior Total Hip Arthroplasty and Capsulotomy in Direct Anterior Total Hip Arthroplasty
Could I receive a placebo?
No, everyone receives an active treatment
How many people
98 participants
Where
1 siteUnited States
Study dates
Aug 2013to 31 May 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Elective unilateral or bilateral primary total hip arthroplasty
  • Direct anterior surgical approach
  • Osteoarthritis diagnosis
  • 18 years of age or older

Who cannot join

  • Revision hip arthroplasty
  • Avascular necrosis of the hip
  • Rheumatoid arthritis of the hip
  • Younger than 18 years of age

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Emory University School of Medicine

    Atlanta, Georgia, 30322

Other trials in United States

About this study

Official title: Anterior Capsulectomy Versus Capsulotomy With Repair in Direct Anterior Total Hip Arthroplasty

In this prospective, randomized study, investigators will look at the outcome of total hip arthroplasty through the anterior approach in regard to the surgical treatment of the anterior hip capsule. At this time, there are 2 different techniques: one is excising this capsule and the second one is cutting the capsule and repairing it at the end of the procedure. The investigators set out to determine whether incising or repairing the capsule will benefit the patients in terms of postoperative pain level, range of motion of the hip joint, joint stability, surgical time and blood loss. Both preserving and excising the joint capsule are accepted techniques in performing total hip arthroplasty. The Investigators hypothesize that capsulectomy may allow for reduction in operative time, provide superior surgical exposure, and increased range of motion after surgery. The influence on post operative pain and dislocation rate is unknown.

Read the detailed description

Utilization of the direct anterior approach for total hip arthroplasty (THA) has increased over the last ten years. The approach, as described by Keggi et al, superficially utilizes the internervous muscle plane between the tensor fascia lata and the sartorius and deeply between the rectus and gluteus medius (1). Performing this muscle sparing rather than muscle splitting approach has several purported benefits. The clinical reports of this surgical approach have documented low dislocation rates (2, 3), excellent cup position (4) improved outcome scores (5), less muscle damage (6, 7) and improved gait mechanics (8). The preservation and repair of the anterior hip capsule (iliofemoral and pubofemoral ligaments) has been recommended by some authors, while anterior capsulectomy has been described by other authors without a reported increase in dislocation rate. In contrast, the higher risk of posterior dislocation using the posterior approach improved significantly after repair of the capsule (9, 10). There are no studies to date that have investigated outcome scores based on capsular repair versus capsulectomy for the THA direct anterior approach. The effects of anterior capsular repair versus capsulectomy are unknown with regards to anterior hip pain, range of motion, and surgical recovery. We hypothesize that capsulectomy may allow for reduction in operative time, provide superior surgical exposure, and increased range of motion after surgery. The influence on post operative pain and dislocation rate is unknown.

In this prospective, randomized clinical study investigators will compare operative time, blood loss, postoperative pain, range of motion, strength, and adverse events using two different surgical techniques (anterior capsular repair versus anterior capsulectomy) during direct anterior total hip arthroplasty. Patients will be randomized at their screening visit to one of two groups (anterior capsule repair or anterior capsulectomy), and they will be blinded for the group assignment. The surgical procedures will be performed according to the surgeon's routine standard of care.

Being tested
Capsulectomy in Direct Anterior Total Hip Arthroplasty, Capsulotomy in Direct Anterior Total Hip Arthroplasty
Keywords
unilateral primary total hip arthroplasty, bilateral primary total hip arthroplasty, Arthritis, Orthopedic Disorders, Orthopedics, Surgery,, Orthopedic, arthroplasty, hip, osteoarthritis, capsulectomy, capsulotomy
Medical subject headings
Osteoarthritis, Hip, Osteoarthritis, Arthritis, Musculoskeletal Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Capsulectomy in Direct Anterior Total Hip ArthroplastyProcedure or surgery

    Surgical intervention in which the surgeon will perform anterior capsulectomy during total hip arthroplasty.

  • Capsulotomy in Direct Anterior Total Hip ArthroplastyProcedure or surgery

    Surgical intervention in which the surgeon will perform anterior capsulotomy during total hip arthroplasty. Surgeon will repair the joint capsule.

Study groups in NCT02121964
Study groupRoleWhat they receive
CapsulectomyOtherCapsulectomy in Direct Anterior Total Hip Arthroplasty
Receives: Procedure: Capsulectomy in Direct Anterior Total Hip Arthroplasty
CapsulotomyOtherCapsulotomy in Direct Anterior Total Hip Arthroplasty
Receives: Procedure: Capsulotomy in Direct Anterior Total Hip Arthroplasty

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Range of Motion- Resisted Hip Flexion Strength

    Measurement will be recorded taken with patient in the seated position with the hip flexed to 90 degrees. Strength will be measured when resistance is applied to the knee as the patient brings the leg up. The following scale will be used (each may be +/-, i.e. 5+):

    • 5 = NORMAL - the patient is able to actively move through the full available range of motion (ROM) against gravity and against maximal resistance
    • 4 = GOOD - the patient is able to actively move through the full available ROM against gravity and against moderate resistance
    • 3 = MODERATE - the patient is able to actively move through greater than one half the available ROM against gravity and against moderate resistance
    • 2 = POOR - the patient is unable to actively flex hip against gravity
    • 1 = BAD - the patient is unable to flex muscle properly

    Measured: Follow Up Visit (Up to six months)

  2. Change in Range of Motion - Maximum Hip Flexion

    This angle will be measured with the patient in the supine position utilizing a goniometer (recorded in degrees). Patients will flex the hip by bringing their leg as close to their trunk as possible with their knee bent. The angle between the trunk and leg will be recorded

    Measured: Screening Visit, Follow-up visit (Up to six months)

  3. Change in Range of Motion - Maximum Hip Extension

    This angle will be measured with the patient in the prone position utilizing a goniometer. The patient will raise the lower leg to the limit of extension. The angle between the leg and table is recorded.

    Measured: Screening Visit, Follow Up Visit (Up to six months)

  4. Change in Range of Motion - Evidence of Flexion Contraction (Thomas Test)

    This angle will be measured with the patient lying in the supine position. Patient will bring opposite knee to the chest, while the other leg remains extended. The angle between the extended leg and the table is recorded.

    Measured: Screening Visit, Follow Up Visit (Up to six months)

  5. Change in Pain Score with Resisted Hip Flexion

    Measured using the Pain Assessment scale (PAS) of 0-10 (0 being no pain; 10 being worst imaginable pain).

    Measured: Screening Visit, Follow Up Visit (Up to six months)

Secondary outcomes (4)
  1. Change in Hip Disability and Osteoarthritis Outcome Score

    Hip disability and osteoarthritis outcome survey (HOOS) administered to patients.

    Measured: Screening Visit, Follow Up Visit (Up to six months)

  2. Surgical Time

    This will be measured from the time of incision to the time the dressing is applied (per registered nurse (RN) operating room record).

    Measured: Inpatient Surgery Visit (Day 0)

  3. Transfusion Rate by Percent Hemoglobin Drop

    This will be recorded by review of inpatient medical records. Percent hemoglobin drop will be measured by comparing the preoperative hemoglobin to the inpatient nadir hemoglobin.

    Measured: Inpatient Surgery Visit (Day 0)

  4. Number of Adverse Events

    Patients will be assessed for complications that occur as a result of THA. These will be assessed at the standard of care intervals (6 week and 6 month follow-up visits). Any change in stem position including subsidence and radiolucencies will be reviewed.

    Measured: Duration of study (Up to six months)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Apr 2014 (estimated)
  2. Study startAug 2013
  3. Primary completion31 Dec 2016
  4. Study completion31 May 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
98 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02121964
Sponsor's protocol ID
IRB00054340
Status last verified
Aug 2020
First submitted
14 Apr 2014
Last updated
31 Aug 2020
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

  • Keggi KJ, Huo MH, Zatorski LE. Anterior approach to total hip replacement: surgical technique and clinical results of our first one thousand cases using non-cemented prostheses. Yale J Biol Med. 1993 May-Jun;66(3):243-56.

    PubMed 8209560
  • 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.

    PubMed 16330993
  • Restrepo C, Mortazavi SM, Brothers J, Parvizi J, Rothman RH. Hip dislocation: are hip precautions necessary in anterior approaches? Clin Orthop Relat Res. 2011 Feb;469(2):417-22. doi: 10.1007/s11999-010-1668-y.

    PubMed 21076896
  • Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008 Dec;31(12 Suppl 2):orthosupersite.com/view.asp?rID=37187.

    PubMed 19298019
  • Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010 Aug;25(5):671-9.e1. doi: 10.1016/j.arth.2010.02.002. Epub 2010 Apr 8.

    PubMed 20378307
  • Bremer AK, Kalberer F, Pfirrmann CW, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br. 2011 Jul;93(7):886-9. doi: 10.1302/0301-620X.93B7.25058.

    PubMed 21705558
  • Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006 Dec;453:293-8. doi: 10.1097/01.blo.0000238859.46615.34.

    PubMed 17006366
  • Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A, Krismer M, Leardini A. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech (Bristol). 2009 Dec;24(10):812-8. doi: 10.1016/j.clinbiomech.2009.07.010. Epub 2009 Aug 21.

    PubMed 19699566
  • Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res. 1998 Oct;(355):224-8. doi: 10.1097/00003086-199810000-00023.

    PubMed 9917607
  • Weeden SH, Paprosky WG, Bowling JW. The early dislocation rate in primary total hip arthroplasty following the posterior approach with posterior soft-tissue repair. J Arthroplasty. 2003 Sep;18(6):709-13. doi: 10.1016/s0883-5403(03)00254-7.

    PubMed 14513442
  • Schwartz AM, Goel RK, Sweeney AP, Bradbury TL Jr. Capsular Management in Direct Anterior Total Hip Arthroplasty: A Randomized, Single-Blind, Controlled Trial. J Arthroplasty. 2021 Aug;36(8):2836-2842. doi: 10.1016/j.arth.2021.03.048. Epub 2021 Mar 26.

    PubMed 33865648

Questions about this trial

What is this clinical trial studying?

A study testing Capsulectomy in Direct Anterior Total Hip Arthroplasty and Capsulotomy in Direct Anterior Total Hip Arthroplasty in people with Hip Arthrosis and Osteoarthritis, run by Emory University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 Aug 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Range of Motion- Resisted Hip Flexion Strength (time frame: Follow Up Visit (Up to six months)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02121964, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Aug 2020.

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