Clinical trial NCT01857505: Hip Replacement in a High Volume Community Hospital: Effect on Length of Stay and Hospital Cost
Official title: Introduction of the Direct Anterior Approach to Hip Replacement Into a High Volume Community Hospital: Effect on Length of Stay and Hospital Cost
Study type: OBSERVATIONAL
Overall status: WITHDRAWN
Conditions: Hip Osteoarthritis
Keywords: Total Hip replacement
Fracture table
DePuySynthes
Direct anterior approach hip replacement
Posterior approach hip replacement
Lead sponsor: Anne Arundel Health System Research Institute
Sponsor class: OTHER
Collaborators: name: DePuy Orthopaedics
First posted: 2013-05-20
Enrollment: 0
Sex: ALL
Minimum age (years): 40
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients who have undergone primary uncemented hip replacement at our institution (Anne Arundel Medical Center) through either a posterior approach or direct anterior approach on a fracture table utilizing the identical post operative protocol.

Brief summary: The investigators propose to evaluate and compare the percentage of patients who are able to be discharged in less than 3 days after undergoing total hip arthroscopy through either a direct anterior or posterior approach, utilizing the identical post operative protocol. The investigators also propose to evaluate the costs associated with the two different approaches to hip replacement in the same group of patients. Post operative resource utilization, discharge disposition, and pain medicine requirement will also be evaluated.

Detailed description: The investigators hypothesize that a higher proportion of patients treated with the direct anterior approach for hip replacement will be able to leave the hospital in less than 3 days when compared with a less invasive posterior approach. Secondly, decreased length of stay associated with the procedure may reduce hospital costs.

Eligibility criteria: Inclusion Criteria:

1. Consecutive single surgeon series of patients who have undergone primary uncemented hip replacement at our institution through either a posterior approach or direct anterior approach on a fracture table. Posterior approach patient - most recent patient prior to March, 2010, compared with consecutive recent anterior approach patients with minimum of 6 month follow-up.
2. Diagnosis of osteoarthritis, inflammatory arthritis, or avascular necrosis.
3. No previous surgery on affected hip.
4. Age 40-90 at time of surgery

Exclusion Criteria:

1. Patient not permitted to bear full weight after the procedure, per post operative instructions
2. Hip replacement performed for acute fracture.
3. Previous hip surgery.

Primary outcomes:
measure: Length of Hospital Stay
timeFrame: Retrospective review of hospital discharge records
measure: Hospital cost
timeFrame: Retrospective review of utilization records
Secondary outcomes:
measure: Post Operative Pain Medication Utilization
timeFrame: After retrospective chart review is complete -- approximately 6 months
measure: Utilization of inpatient physical therapy resources
timeFrame: Retrospective review -- of hospital discharge
Other outcomes:
Locations:
city: Annapolis
country: United States
facility: Anne Arundel Medical Center
state: Maryland
Study officials:
affiliation: Anne Arundel Medical Center / Anne Arundel Orthopedic Surgeons
name: Paul King, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL. Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplasty. 2000 Jun;15(4):448-52. doi: 10.1054/arth.2000.4346.
citation: Vorhies JS, Wang Y, Herndon J, Maloney WJ, Huddleston JI. Readmission and length of stay after total hip arthroplasty in a national Medicare sample. J Arthroplasty. 2011 Sep;26(6 Suppl):119-23. doi: 10.1016/j.arth.2011.04.036. Epub 2011 Jul 1.
citation: Duwelius PJ, Moller HS, Burkhart RL, Waller F, Wu Y, Grunkemeier GL. The economic impact of minimally invasive total hip arthroplasty. J Arthroplasty. 2011 Sep;26(6):883-5. doi: 10.1016/j.arth.2010.09.011. Epub 2010 Nov 3.
citation: Matta JM, Ferguson TA. The anterior approach for hip replacement. Orthopedics. 2005 Sep;28(9):927-8. doi: 10.3928/0147-7447-20050901-11. No abstract available.
citation: 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.