Clinical trial NCT01027195: Evaluation of the Efficacy of the Bipolar Sealer Aquamantys 6.0 in Patients Undergoing Total Hip Arthroplasty
Official title: Evaluation of the Efficacy of the Bipolar Sealer Aquamantys 6.0 in Patients Undergoing Total Hip Arthroplasty
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Hip Arthritis
Lead sponsor: The Cleveland Clinic
Sponsor class: OTHER
Collaborators: name: Salient Surgical Technologies
First posted: 2009-12-07
Enrollment: 140
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The present prospective, single-center, clinical trial is designed to evaluate the hemostatic efficacy of the hemostatic sealer Aquamantys 6.0™ in patients managed with total hip arthroplasty (THA). It is hypothesized that Aquamantys 6.0™ can improve hemostasis following total hip arthroplasty. Comparison of the functional and clinical results between THA patients having been exposed to Aquamantys 6.0™ versus a control group will be analyzed using several outcome measures including the Harris Hip Score and a pain scale. The primary variable of interest is transfusion requirements - specifically, number of patients managed with blood transfusion during the hospital stay after surgery. However, of secondary interest will be: 1) number of units transfused, 2) estimated intraoperative total blood loss, 3) change in pre- and post-operative hemoglobin levels, 4) total narcotic usage during hospital stay, 5) length of stay, 6) functional and pain outcomes (Harris Hip Score and Pain Scale), and 7) adverse events.


Eligibility criteria: Inclusion Criteria:

* Age: 18 - 85 years
* Sex: Both male and female will be included. The male-to-female ratio will depend upon the patient population.
* Stable Health: At the time of surgery based on physical examination and medical history.
* Patient exhibited preoperative radiographic evidence of joint degeneration consistent with THA that could not have been treated in non-operative fashion.
* Patient had severe hip pain and disability due to degenerative joint disease.
* Patient or patient's legal representative has signed the Informed Consent form. The patient is capable of making informed decisions regarding his/her healthcare.

Exclusion Criteria:

* Patients with history of cardiac disease, liver disease or renal disease. Severe cardiac disease, liver disease and renal dysfunction can confound different parameters within this study. Patients with decreased cardiac function from prior myocardial infarction, cardiomyopathy or congestive heart failure will likely require transfusions with packed red blood cells at lower thresholds relative to healthy counterparts for cardioprotection. Therefore, patients with a prior history of myocardial infarction, cardiomyopathy, congestive heart failure or other significant cardiac history will be excluded from this study. In addition, patients with liver dysfunction from cirrhosis or hepatitis may have impaired production of factors in the clotting cascade which may make these individuals more prone to bleed, especially with the use of anticoagulants such as lovenox. For this reason, these patients will also be excluded from this study. Finally, individuals with renal dysfunction will have decreased creatinine clearance, which may artificially elevate the levels of lovenox, thereby promoting bleeding. In addition, individuals with severe renal disease may also have associated anemia which would complicate the transfusion threshold. For this reason, individuals with chronic renal failure, diabetic nephropathy, or decreased creatinine clearance will be excluded from this study.
* Patients predonating autologous blood.
* Patients with preoperative hemoglobin level less than 11.5 g/dL or a hematocrit less than 35%. Patients with a preoperative platelet count of less than 100,000.
* Patients undergoing bilateral or revision surgery.
* Evidence of bleeding or metabolic - based hemolytic disorder (hemophilia or anticoagulation use)
* Previous history of infection in the affected joint.
* Peripheral vascular disease.
* Patient was a poor compliance risk - treated for ethanol or drug abuse, physical or mental handicap, etc.
* Patients whose personal beliefs exclude the use of blood transfusions (example: Jehovah's witness).

Primary outcomes:
measure: Number of Patients Managed With Blood Transfusion
timeFrame: daily during hospital stay (an expected average of 4 days)
Secondary outcomes:
measure: Number of Units Transfused
timeFrame: daily during hospital stay (an expected average of 4 days)
measure: Estimated Blood Loss
timeFrame: Intraoperative (day of surgery)
measure: Change in Hemoglobin Level
timeFrame: within 30 days before surgery (preop), day of hospital discharge
measure: Total Narcotic Usage (Morphine-equivalent mg) During Hospital Stay
timeFrame: daily during hospital stay (an expected average of 4 days)
measure: Length of Stay
timeFrame: day of hospital discharge
measure: Harris Hip Score (Outcome Score)
timeFrame: within 30 days before surgery (preop), 4 weeks after surgery, 12 weeks after surgery
measure: Pain Score Scale
timeFrame: within 30 days before surgery (preop), 4 weeks after surgery, 12 weeks after surgery
Other outcomes:
Locations:
Study officials:
affiliation: The Cleveland Clinic
name: Wael K Barsoum, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Barsoum WK, Klika AK, Murray TG, Higuera C, Lee HH, Krebs VE. Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer. J Bone Joint Surg Am. 2011 Mar 16;93(6):513-8. doi: 10.2106/JBJS.J.00036.