Hip Arthroscopy vs Total Hip Replacement for Hip Osteoarthritis

Recruiting at 1 trial location

Overseen By Stephanie Horst, BSc, CCRP

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Western University, Canada

Disqualifiers: Advanced OA, Pregnancy, Prior arthroplasty, others

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

Compensation: Varies

Number of Visits: 7

Duration: 6 weeks

160 Participants Needed

Trial Summary

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 Hip Arthroscopy vs Total Hip Replacement for Hip Osteoarthritis?

Research shows that hip arthroscopy can improve pain and function in the short term, but some patients may still need a total hip replacement later. Total hip replacement generally provides significant improvement in function for those with severe osteoarthritis. ^{1 2 3 4 5}

Is hip arthroscopy or total hip replacement generally safe for humans?

Hip arthroscopy is generally considered safe with a relatively low complication rate, though some complications may be underreported. Total hip replacement is a common follow-up procedure after hip arthroscopy, and while it can be more challenging if done after arthroscopy, it does not significantly affect clinical outcomes. ^{6 7 8 9 10}

How does the treatment of hip arthroscopy differ from total hip replacement for hip osteoarthritis?

Hip arthroscopy is a minimally invasive procedure aimed at preserving the hip joint and is often used to treat hip pain and other issues before they become severe. In contrast, total hip replacement (also known as total hip arthroplasty) involves replacing the entire hip joint and is typically used when the joint is significantly damaged, such as in advanced osteoarthritis. ^{2 4 9 11 12}

What is the purpose of this trial?

The aim of the proposed study is to perform a comparative pilot, randomized controlled trial of hip arthroscopy versus definitive total hip arthroplasty (THA) for the treatment of early hip osteoarthritis (Tönnis Grade 1-2) in patients between the ages of 40-60 years.

Research Team

Ryan M Degen, MD

Principal Investigator

Fowler Kennedy Sport Medicine Clinic

Eligibility Criteria

This trial is for people aged 40-60 with early hip osteoarthritis (Tönnis Grade 1-2) who've tried non-surgical treatments for at least 3 months without relief. It's not suitable for those with advanced arthritis, pregnant women, prior hip replacements on the other side, or certain hip shapes that make surgery risky.

Inclusion Criteria

My hip X-rays show mild to moderate arthritis.

I am between 40 and 60 years old.

I've been treated without surgery for over 3 months but still have symptoms.

Exclusion Criteria

I have or had hip dysplasia, with a specific hip angle measurement.

I have had hip replacement surgery on the opposite side.

Patients who are pregnant or may become pregnant around the time of surgery

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo either hip arthroscopy or total hip arthroplasty based on randomization

6 weeks

1 visit (in-person) for surgery

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 6 weeks, 3, 6, and 12 months

12 months

Multiple visits (in-person) at 6 weeks, 3, 6, and 12 months

Long-term cost-effectiveness analysis

Estimate the lifetime cost-effectiveness of arthroscopy vs THA using a Markov model

Treatment Details

Interventions

• Hip Arthroscopy
• Total Hip Arthroplasty

Trial Overview The study compares two procedures: less invasive hip arthroscopy and total hip replacement (arthroplasty), to see which is better for treating early-stage hip osteoarthritis in middle-aged patients.

Participant Groups

Group I: Total Hip Arthroplasty Active Control 1 Intervention

Patients randomized to the Total Hip Replacement (THR) group will undergo THR via a direct anterior approach. A slightly oblique skin incision measuring approximately 8 cm will be used, starting 3 cm distally and laterally to the anterosuperior iliac spine. The intervals between tensor fascia lata (TFL) and sartorius will be developed superficially, and between rectus femoris and gluteus minimus deeper. Capsulotomy will be performed. A double osteotomy of the femoral neck will be performed to facilitate removal of the head followed by traditional preparation of the acetabulum using an offset reamer and the acetabular component will be inserted. Next, the superior capsule will be released to elevate the femur to allow access to the femoral canal, followed by standard preparation by use of an offset broach and the stem will be implanted

Group II: Hip Arthroscopy Active Control 1 Intervention

Patients in the Hip Arthroscopy group will undergo arthroscopy in the supine position under general anesthesia, with all procedures performed by two subspecialty-trained hip arthroscopists. An algorithmic surgical approach will be utilized to sequentially address pathology in the central and peripheral compartments of the hip based on both preoperative imaging findings and intraoperative findings. Emphasis will be placed on labral preservation and refixation, with osseous decompression under fluoroscopic guidance.

Hip Arthroscopy is already approved in European Union, United States, Canada, Japan for the following indications:

Approved in European Union as Hip Arthroscopy for:

• Labral tears
• Femoroacetabular impingement (FAI)
• Synovitis
• Chondral lesions
• Loose bodies

Approved in United States as Hip Arthroscopy for:

• Labral tears
• Femoroacetabular impingement (FAI)
• Synovitis
• Chondral lesions
• Loose bodies
• Mild to moderate hip osteoarthritis

Approved in Canada as Hip Arthroscopy for:

• Labral tears
• Femoroacetabular impingement (FAI)
• Synovitis
• Chondral lesions
• Loose bodies

Approved in Japan as Hip Arthroscopy for:

• Labral tears
• Femoroacetabular impingement (FAI)
• Synovitis
• Chondral lesions
• Loose bodies

Who Is Running the Clinical Trial?

Western University, Canada

Lead Sponsor

Trials

270

Recruited

62,500+

Findings from Research

In a study of 1417 patients undergoing hip arthroscopic surgery, significant improvements were observed in patient-reported outcome scores (PROs) at the 2-year follow-up, indicating effective pain management and functional recovery after surgery.

There was a moderate correlation between pain levels measured by the visual analog scale (VAS) and patient satisfaction, as well as changes in the four PRO scores, suggesting that both VAS and satisfaction assessments are valuable for evaluating surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery. Chandrasekaran, S., Gui, C., Walsh, JP., et al.[2020]

Patients who underwent total hip arthroplasty (THA) after a previous hip arthroscopy had satisfactory functional outcomes, but these outcomes were significantly worse compared to patients who had THA for primary osteoarthritis, based on Oxford Hip Scores.

Despite the difference in functional outcomes, the rate of complications was similar between the two groups, indicating that previous hip arthroscopy does not increase the risk of complications during THA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional outcome of total hip arthroplasty after a previous hip arthroscopy: a retrospective comparative cohort study. Jain, MV., Rajpura, A., Kumar, VS., et al.[2022]

Patients who had undergone hip arthroscopy (HA) before total hip arthroplasty (THA) experienced significantly lower rates of medical complications, such as readmission and pulmonary embolism, compared to those without prior HA, suggesting a potential protective effect of previous HA on postoperative outcomes.

The prior HA cohort also showed a reduced likelihood of prolonged opioid use after THA, with fewer patients filing opioid claims beyond 30 days post-surgery, indicating that previous HA may help in managing pain and reducing dependency on opioids after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is Prior Hip Arthroscopy Associated With Higher Complication Rates or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study. Ross, BJ., Wortman, RJ., Lee, OC., et al.[2022]

Hip arthroscopy can lead to positive outcomes in pain and function for patients with hip osteoarthritis (OA), but these benefits are generally smaller compared to those seen in patients without OA, indicating that the procedure may be less effective for those with more severe joint issues.

Patients with greater severity of hip OA and older age are at a higher risk of progressing to total hip arthroplasty (THA) after undergoing hip arthroscopy, suggesting that these factors should be considered when evaluating treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip arthroscopy in the setting of hip osteoarthritis: systematic review of outcomes and progression to hip arthroplasty. Kemp, JL., MacDonald, D., Collins, NJ., et al.[2022]

Patients who underwent hip arthroscopy for labral tears achieved similar functional outcomes to those who had total hip arthroplasty (THA), with no significant difference in modified Harris Hip Scores (82.9 for arthroscopy vs 87.3 for THA).

Both groups reported high levels of patient satisfaction, with scores of 8.1 for hip arthroscopy and 8.8 for THA, indicating that hip arthroscopy can be an effective alternative for appropriate candidates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip Arthroscopy Results in Similar Short-Term Function Compared to Total Hip Arthroplasty in Patients of Similar Demographic Profiles. Lall, AC., Secretov, E., Battaglia, MR., et al.[2022]

In a study of 91 hip arthroscopy procedures, higher age was linked to lower patient satisfaction, while a longer duration of symptoms before surgery negatively affected functional outcomes, as measured by the modified Harris Hip Score (mHHS).

Despite some patients undergoing revision arthroscopy (4%) or total hip arthroplasty (THA) (11%) within an average follow-up of 1.6 years, no specific risk factors for these outcomes were identified, and overall satisfaction rates were relatively high at 66%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Satisfaction, functional outcomes and predictors in hip arthroscopy: a cohort study. van der Valk, MR., Wolterbeek, N., van Assen, T., et al.[2022]

In a study of 908 patients undergoing primary hip arthroscopy, the overall complication rate was found to be low at 7.3%, with minor complications occurring in 4.9% of cases and major complications in 2.4%.

The most common severe complications included iatrogenic cartilage damage and instrument breakage, while perineal hypoaesthesia and heterotopic ossifications were the most frequent minor complications, highlighting the importance of surgeon training and experience in minimizing risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study. Zeman, P., Rafi, M., Kautzner, J.[2022]

In a study of 62 patients who underwent hip arthroscopy, 24% reported complications, with a total of 32% of complications identified, highlighting that complications may be underreported when patients are asked general questions.

The study suggests that more detailed and specific questioning about complications can provide a clearer picture of the true incidence of issues following hip arthroscopy, which is important for understanding the safety and efficacy of the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Complications of Hip Arthroscopy: Patient Perspectives. Sharfman, ZT., Amar, E., Tsvieli, O., et al.[2022]

Patients who underwent total hip arthroplasty (THA) after having hip arthroscopy experienced lower clinical outcomes, including lower Harris Hip Scores and satisfaction levels, compared to those who had THA without prior hip surgery.

The study, which matched 35 patients with prior hip arthroscopy to controls, found that while there were no significant differences in reoperation rates, the prior surgery was associated with higher complication rates and increased pain, suggesting that hip arthroscopy may negatively impact THA outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prior Arthroscopy Leads to Inferior Outcomes in Total Hip Arthroplasty: A Match-Controlled Study. Perets, I., Mansor, Y., Mu, BH., et al.[2018]

In a study analyzing Medicare data from 2005-2016, it was found that 68.4% of patients with osteoarthritis who underwent hip arthroscopy converted to total hip arthroplasty (THA) within 2 years, indicating a high conversion rate.

Patients who had hip arthroscopy prior to THA faced a significantly increased risk of needing revision surgery (3.72 times higher), as well as higher risks of periprosthetic joint infection and aseptic loosening, suggesting that hip arthroscopy may not be advisable for osteoarthritis patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty. Malahias, MA., Gu, A., Richardson, SS., et al.[2022]

A survey of 42 Indian orthopedic surgeons revealed that while 38 perform hip arthroscopy, most conduct fewer than ten surgeries per year, indicating limited experience and practice in this technique.

Only nine studies on hip arthroscopy from India were found, mostly case reports, with satisfactory outcomes reported, highlighting the need for more research and training to enhance the use of this minimally invasive surgery in the country.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Status of Hip Arthroscopy in India: A Short Questionnaire Based Survey and Review of Literature. Kumar, P., Palanisamy, Y., Verma, A., et al.[2022]

Hip arthroscopy can be safely and effectively performed in patients who have undergone hip arthroplasty, with positive outcomes reported in almost all cases, particularly for conditions like iliopsoas tendinopathy.

The review included 171 patients across 18 studies, highlighting that hip arthroscopy is beneficial for various indications, including unexplained symptoms after hip replacement and periprosthetic infections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hip arthroscopy in the setting of hip arthroplasty. Heaven, S., de Sa, D., Simunovic, N., et al.[2022]

References

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

Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery. [2020]

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

Functional outcome of total hip arthroplasty after a previous hip arthroscopy: a retrospective comparative cohort study. [2022]

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

Is Prior Hip Arthroscopy Associated With Higher Complication Rates or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study. [2022]

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

Hip arthroscopy in the setting of hip osteoarthritis: systematic review of outcomes and progression to hip arthroplasty. [2022]

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

Hip Arthroscopy Results in Similar Short-Term Function Compared to Total Hip Arthroplasty in Patients of Similar Demographic Profiles. [2022]

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

Satisfaction, functional outcomes and predictors in hip arthroscopy: a cohort study. [2022]

7. Germany pubmed.ncbi.nlm.nih.gov

Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study. [2022]

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

Complications of Hip Arthroscopy: Patient Perspectives. [2022]

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

Prior Arthroscopy Leads to Inferior Outcomes in Total Hip Arthroplasty: A Match-Controlled Study. [2018]

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

Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty. [2022]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Status of Hip Arthroscopy in India: A Short Questionnaire Based Survey and Review of Literature. [2022]

12. Germany pubmed.ncbi.nlm.nih.gov

Hip arthroscopy in the setting of hip arthroplasty. [2022]