Minimal Invasive Surgery in Total Hip Arthroplasty Patients; Short- and Long Term Results

Study Overview
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Brief Summary
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The aim of the present study is to explore the most efficient surgical approach in total hip replacement in short and long term when concerning strength, functionality and postoperative complications. The objective is to register muscular strength, hip joint functionality/mobilisation and complications after total hip arthroplasty (THA) performed by the direct lateral approach (DLA), the posterior approach (PA) and the anterior approach (AA). The latter is a modified Smith-Petersen approach which follows the principles of minimally invasive surgery (MIS). The primary working hypothesis is that due to a minimal dissection and reduced trauma in the muscles, patients will tolerate early hospital discharge better after the AA than the PA and the DLA. Patients in the AA group are also thought to be more active and maintain muscular strength and hip joint functionality/mobilisation better than patients in the lateral group.

Detailed Description
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With total hip replacement surgery, the orthopaedic surgeon's aim is not only pain relief for the patient, but also restoration of hip joint biomechanics resulting in a minimal functional deficit and maximal longevity of the implant. It is not exceptional that these patients still experience mild to moderate long-term impairments postoperatively. These impairments include pain, muscle weakness of the hip abductors, contracture of the hip, gait disorders, as well as weakness of hip extensors and flexors. These problems may in turn lead to complications such as joint instability and loosening of the implant. MIS is defined as a surgical approach performed through a short skin and muscle incision to avoid injury to muscles and tendons. Following minimally invasive approach reduced muscle trauma has been found. Moreover clinical outcome improved, as the gluteus medius muscle can be spared more successfully. However, it is debated whether or not the overall results of MIS are superior, or even as good as the traditional hip replacement surgery in terms of component placing and time to revision of the prosthesis.

Official Title
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Minimal Invasive Surgery in Total Hip Arthroplasty Patients; Short- and Long Term Results

Conditions
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Hip Osteoarthritis

Intervention / Treatment
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* Procedure: Total hip arthroplasty direct lateral approach
* Procedure: Total hip arthroplasty posterior approach
* Procedure: Total hip arthroplasty, anterior approach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for THA Diagnosis of primary osteoarthritis as the main cause for elective THA American Society of Anesthesiologists (ASA) score I, II, and stable III Exclusion Criteria: Musculoskeletal diseases Current heart/pulmonary- or malignant diseases likely to influence the physical testing performance.

Ages Eligible for Study
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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: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: THA Direct lateral<br>Total hip arthroplasty (THA) carried out by direct lateral approach (DLA) | Procedure: Total hip arthroplasty direct lateral approach<br> <br> * Other names: THA;|
| Experimental: THA Posterior<br>Total hip arthroplasty (THA) carried out by posterior approach (DLA) | Procedure: Total hip arthroplasty posterior approach<br> <br> * Other names: THA;|
| Experimental: THA Anterior<br>Total hip arthroplasty (THA) carried out by anterior approach (DLA) | Procedure: Total hip arthroplasty, anterior approach<br> <br> * Other names: THA;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle strength | Measured by 1 repetition maximum (1 RM) | 3 months postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hip joint functionality and mobility | Measured by patient completed questionnaires and clinician reported scores | 3 months postoperatively | 
| activity level | Measured by an activity monitor | 6 subsequent days postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Arthroplasty, Replacement, Hip, Surgical Procedures, Operative, Surgical Procedures, Minimally Invasive