Sutures for Hip Arthroscopy

Overseen By Vicki Jones, MEd, CCRP

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Missouri-Columbia

Disqualifiers: Under 18, Anesthesia issues, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

Duration: 1 day

100 Participants Needed

Trial Summary

What is the purpose of this trial?

The study is to prospectively compare absorbable sutures with non-absorbable sutures used for capsular repair during hip arthroscopic procedures. Major outcomes will be measured using three questionnaires ((1) International Hip Outcome Tool-12 (iHOT-12), (2) modified Harris hip score, (3) hip outcome score) in addition to the standard of care set of 9 questionnaires. The other major outcome will be any radiographic heterotrophic ossification at the 6-month follow-up time point.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Sutures for Hip Arthroscopy?

The research highlights that intraoperative suture anchor failure during hip arthroscopy is uncommon, suggesting that the use of sutures, whether absorbable or non-absorbable, is generally reliable in this context. ^{1 2 3 4 5}

Is the use of sutures in hip arthroscopy generally safe?

Hip arthroscopy, including the use of sutures, is generally considered safe with low rates of complications, although minor issues may be underreported. Some specific risks include suture anchor perforation and intraoperative anchor failure, but these are uncommon. ^{3 5 6 7 8}

How do absorbable and non-absorbable sutures differ in hip arthroscopy treatment?

Absorbable sutures dissolve over time and are absorbed by the body, which can be beneficial for reducing the need for suture removal, while non-absorbable sutures remain in the body and may provide longer-lasting support but might require removal if they cause irritation or complications. The choice between these sutures can affect healing, patient satisfaction, and the risk of complications, as seen in other procedures like knee and Achilles tendon repairs. ^{9 10 11 12 13}

Eligibility Criteria

This trial is for individuals with a hip labral tear or femoroacetabular impingement who are undergoing hip arthroscopy. Participants should be suitable candidates for the procedure and willing to complete follow-up questionnaires.

Inclusion Criteria

I need surgery for my hip problem.

Exclusion Criteria

I am under 18 years old.

I am unable to understand and agree to the study's details on my own.

I have a health issue that makes anesthesia or surgery unsafe for me.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Assessment

Participants complete preoperative questionnaires and assessments

1 week

1 visit (in-person)

Treatment

Participants undergo hip arthroscopic procedures with either absorbable or non-absorbable sutures

1 day

1 visit (in-person)

Postoperative Follow-up

Participants are monitored postoperatively with questionnaires and radiographic assessments

12 months

Visits at 6 weeks, 3 months, 6 months, 1 year

Treatment Details

Interventions

• Absorbable Suture
• Non-Absorbable Sutures

Trial Overview The study compares two types of sutures used in hip surgery: absorbable and non-absorbable. It will assess patient outcomes through questionnaires and check for any bone growth issues at the surgical site after 6 months.

Participant Groups

Group I: Absorbable Suture Active Control 1 Intervention

Absorbable suture

Group II: Non-Absorbable Suture Active Control 1 Intervention

Non-Absorbable Sutures

Who Is Running the Clinical Trial?

University of Missouri-Columbia

Lead Sponsor

Trials

387

Recruited

629,000+

Findings from Research

In a study testing various suture anchors for hip arthroscopy, most anchors showed minimal displacement (less than 2.0 mm) after 500 cycles of cyclic loading, indicating good stability under stress.

The Bio-Mini Revo anchor demonstrated the highest ultimate failure load at 255 N, while the PEEK SutureTak had the lowest at 154 N, suggesting that while all anchors performed adequately, some may offer better strength for specific applications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cyclic load testing and ultimate failure strength of suture anchors in the acetabular rim. Ruiz-Suarez, M., Aziz-Jacobo, J., Barber, FA.[2019]

Hip arthroscopy has significantly improved in terms of function and survivorship over the past decade, indicating advancements in surgical techniques and patient outcomes.

A retrospective review has identified key factors that influence the long-term success of hip arthroscopy, highlighting the need for ongoing research to further understand these factors and improve future practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Arthroscopy of the hip: factors affecting outcome. McCarthy, J., Mc Millan, S.[2022]

In a study of 529 patients undergoing hip arthroscopy, the major complication rate was very low at 0.6%, indicating that the procedure is generally safe, although minor complications like hematoma and temporary neurapraxia were common, affecting 22.5% and 16.4% of patients respectively.

The study found that as surgeons gain experience, the rate of major complications decreases significantly after performing more than 60 procedures per year, highlighting the importance of the surgeon's learning curve in improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of surgeon's learning curve: complications and outcome after hip arthroscopy. Schüttler, KF., Schramm, R., El-Zayat, BF., et al.[2022]

In a study of 97 patients undergoing hip arthroscopy, the first 30 surgeries (Group A) showed a higher complication rate of 16.6%, primarily due to transient nerve issues, indicating a steep learning curve for new surgeons.

In contrast, the subsequent 67 surgeries (Group B) had a significantly lower complication rate of 2.9% and shorter average traction time, highlighting the importance of experience and training in improving surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Learning curve of arthroscopic hip surgery]. Vilchez, F., Erquicia, J., Tey, M.[2022]

Intraoperative suture anchor failure during hip arthroscopy is rare and does not significantly differ across various demographic groups, indicating it is a common challenge faced by surgeons regardless of experience.

Current research primarily consists of biomechanical cadaveric studies, with a need for more in vivo investigations to deepen our understanding of anchor failure in real surgical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Editorial Commentary: What Irks a Hip Arthroscopist? Intraoperative Anchor Failure. Nho, SJ., Neal, WH.[2019]

Hip arthroscopy has a low 30-day readmission rate of 1.3% and a complication rate of 1.7%, indicating that the procedure is generally safe for patients.

Patients with hypertension requiring medication and those using chronic corticosteroids or immunosuppressants are at a higher risk for readmission after hip arthroscopy, suggesting that these factors should be considered in preoperative assessments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk factors for 30-day readmission following hip arthroscopy. Hartwell, MJ., Morgan, AM., Johnson, DJ., et al.[2020]

Suture anchor placement in hip arthroscopy can lead to complications such as articular cartilage violation and psoas tunnel perforation, particularly when anchors are placed at anterior acetabular rim positions (3- to 4-o'clock position), which have the thinnest bone and highest risk of perforation.

Using small-diameter (≤1.8-mm) all-suture anchors and drilling at angles of 10° to 20° can reduce the risk of articular perforation while maintaining stability, suggesting safer techniques for suture anchor insertion.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What Makes Suture Anchor Use Safe in Hip Arthroscopy? A Systematic Review of Techniques and Safety Profile. Shah, A., Kay, J., Memon, M., et al.[2020]

Complications and failures following hip arthroscopy are generally rare, but the exact rates are not well-defined due to a lack of recent comprehensive studies.

As the popularity of hip arthroscopy grows among surgeons and patients, it is crucial to remain vigilant about potential adverse events associated with the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Avoiding complications and treating failures of arthroscopic femoroacetabular impingement correction. Bedi, A., Ross, JR., Kelly, BT., et al.[2015]

In a study of 247 patients undergoing knee arthroscopy, those who had nonabsorbable sutures reported higher satisfaction levels at both 6 and 12 weeks post-surgery compared to those with absorbable sutures.

Although patients with nonabsorbable sutures experienced more skin discoloration at 2 and 6 weeks, this did not affect overall satisfaction, indicating that the choice of suture type can influence patient outcomes in terms of satisfaction despite some cosmetic concerns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Greater Patient Satisfaction With Use of Nonabsorbable Sutures Compared to Absorbable Sutures for Skin Closure Following Knee Arthroscopy: A Randomized Controlled Trial. Hanna, AJ., Sonnier, JH., Coladonato, C., et al.[2023]

In a study of 14 patients with 16 meniscal repairs, only 56% of repairs healed completely, indicating a higher-than-expected failure rate, particularly since these patients were selected due to ongoing issues.

Nonabsorbable sutures used in the repairs did not cause damage to the knee joint surfaces and were found to integrate well into the meniscus, suggesting they are safe for use in meniscal repairs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Arthroscopic review of meniscal repair: assessment of healing parameters. Stone, RG., VanWinkle, GN.[2019]

In a study involving arthritic rabbit knees, polyglyconate sutures lost all strength by 6 weeks, while polydioxanone sutures retained only 40% of their strength at 6 weeks and none by 9 weeks, indicating poor long-term efficacy for these materials in arthroscopic procedures.

In contrast, polycaprolactone sutures maintained about 90% of their strength after 18 weeks, and green braided polyester sutures showed no loss of strength, suggesting they are more reliable options for surgeries like meniscus repair and shoulder stabilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of inflammatory synovial fluid on the breaking strength of new "long lasting" absorbable sutures. Barber, FA., Click, JN.[2019]

In a study of 234 women undergoing sacrospinous ligament fixation (SSLF), both absorbable and permanent sutures showed similar anatomical success rates (69% vs 67%) and subjective cure rates (97.2% vs 94.3%) at 12 months, indicating that the type of suture material does not significantly impact surgical outcomes.

However, patients using permanent sutures experienced significantly higher immediate postoperative pain compared to those with absorbable sutures, suggesting that while both options are effective, absorbable sutures may offer a more comfortable recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Permanent or absorbable suture material for sacrospinous ligament fixation: Does it matter? Padoa, A., Ziv, Y., Tsviban, A., et al.[2023]

A systematic review of five studies involving 255 patients found that absorbable sutures used in acute Achilles tendon rupture repair have similar outcomes to nonabsorbable sutures, with no significant differences in rerupture rates, infection risks, or foreign body reactions.

Both suture types resulted in comparable recovery scores, suggesting that absorbable sutures can be a safe and effective alternative to nonabsorbable sutures in this surgical procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis. Oesman, I., Canintika, AF.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Cyclic load testing and ultimate failure strength of suture anchors in the acetabular rim. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Arthroscopy of the hip: factors affecting outcome. [2022]

3. Germany pubmed.ncbi.nlm.nih.gov

The effect of surgeon's learning curve: complications and outcome after hip arthroscopy. [2022]

4. Mexico pubmed.ncbi.nlm.nih.gov

[Learning curve of arthroscopic hip surgery]. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Editorial Commentary: What Irks a Hip Arthroscopist? Intraoperative Anchor Failure. [2019]

6. Germany pubmed.ncbi.nlm.nih.gov

Risk factors for 30-day readmission following hip arthroscopy. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

What Makes Suture Anchor Use Safe in Hip Arthroscopy? A Systematic Review of Techniques and Safety Profile. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Avoiding complications and treating failures of arthroscopic femoroacetabular impingement correction. [2015]

9. United States pubmed.ncbi.nlm.nih.gov

Greater Patient Satisfaction With Use of Nonabsorbable Sutures Compared to Absorbable Sutures for Skin Closure Following Knee Arthroscopy: A Randomized Controlled Trial. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Arthroscopic review of meniscal repair: assessment of healing parameters. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

The effect of inflammatory synovial fluid on the breaking strength of new "long lasting" absorbable sutures. [2019]

12. Ireland pubmed.ncbi.nlm.nih.gov

Permanent or absorbable suture material for sacrospinous ligament fixation: Does it matter? [2023]

13. United States pubmed.ncbi.nlm.nih.gov

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis. [2023]