A Multicentre Trial to Compare Two Articulating Bearing Surfaces as Used in Cementless Primary Hip Arthroplasty

Study Overview
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Brief Summary
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The aim of this study is to demonstrate the non-inferiority of the ceramic-on-metal articulation using large diameter bearings (38mm to 60mm) compared to the metal on metal articulation using the same cup in regards to the composite clinical success (CCS) rate at 2 years postoperatively (delta = 10% minimum clinically significant difference in rates).

Detailed Description
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This multicentre randomised controlled trial will compare the clinical outcome of the ceramic-on-metal articulation against a metal-on-metal articulation using the same Recap Acetabular cup. The metal ion release will be evaluated at predetermined postoperative intervals during the first 36 months. A trial will be conducted as a clinical trial in accordance with the Medical Devices Directive 93/42/EEC (2002). A total of 150 patients have to be recruited from the South African centre (2 groups) The initial study assessment period will be 48 months; 24 months recruitment and 24 months follow-up. The follow-up reviews will be at 6 weeks, 6 months, 1 year, 2 years and 3 years. A 5 year and 10 year clinical review will also be carried out with all patients. An assessment of incidences of adverse events and metal ion release concentrations will be made when all patients are at 6 months postoperatively.

Official Title
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A Multicentre Prospective Randomised Control Trial to Compare Two Articulating Bearing Surfaces, Ceramic on Metal and Metal on Metal Large Diameter Femoral Heads, as Used in Cementless Primary Hip Arthroplasty

Conditions
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Osteoarthritis

Intervention / Treatment
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* Device: Metal on ceramic articulation
* Device: Metal-on-Metal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary total hip replacement Patient with degenerative joint disease (inflammatory or non-inflammatory) or any of the composite diagnoses of osteoarthritis,avascular necrosis, legg perthes, rheumatoid arthritis, diastrophic variant, fracture of the pelvis, fused hip, slipped capital epiphysis, subcapital fractures, traumatic arthritis Patients preoperative Harris hip score < 80 points Patients with limited co-morbidity - ASA I - III Patients with normal urea and electrolyte levels and creatinine levels Patients must be able to understand instructions and be willing to return for follow-up Patients willing to provide blood and urine samples for metal ion analysis at follow-up Exclusion Criteria: Patient preoperative Harris hip score > 80 points Pre-existing metal implants Patients with significant co-morbidity - ASSA IV - V Dementia and inability to understand and follow instructions Neurological conditions affecting movement Women younger than 45 years old Presence of symptomatic arthritis in other lower limb joints Patients requiring smaller than 38mm and larger than 60mm diameter femoral heads Patients taking NSAIDs and / all drugs that will affect bone metabolism

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Metal on ceramic articulation<br>The arm consists of patients with Ceramic femoral heads articulating with metal acetabular cups | Device: Metal on ceramic articulation<br>* Metal on ceramic articulation against metal-on-metal articulation using the same Recap Acetabular cup<br>* Other names: MagnumC;|
| Active Comparator: Metal-on-metal<br>The arm consists of patients with Metal femoral heads articulating with metal acetabular cups | Device: Metal-on-Metal<br>* Metal on Metal articulation<br>* Other names: Magnum;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Metal ion concentration in blood and urine | Metal ion concentration will be determined from patients blood and urine at prescribed intervals | 2 years post operatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite Clinical Score (CCS) rate at 2 years post operative |  | 2 years post operatively |