Surgical Approaches for Total Hip Replacement

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Nova Scotia Health Authority

Disqualifiers: Infection, Morbid obesity, Osteoporosis, others

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

Compensation: Varies

Number of Visits: 5

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores two methods for hip replacement surgery in individuals with painful hip arthritis. The direct superior (DS) approach uses a smaller incision and aims to minimize tissue damage, potentially enhancing hip stability post-surgery. The posterior approach (PA) is more common but may result in more dislocations. The trial seeks to determine which method is more effective. Individuals with hip arthritis who require surgery may qualify for this study. As an unphased trial, it offers patients the chance to contribute to significant research that may enhance surgical outcomes.

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 prior data suggests that these surgical approaches are safe for total hip replacement?

Research has shown that the direct superior approach (DSA) for hip replacement is generally well-tolerated by patients. Studies have found that it results in less blood loss and a reduced need for blood transfusions compared to the traditional posterior approach (PA). This method typically involves a smaller incision, which can lead to less postoperative pain and a quicker recovery.

Moreover, the DSA often facilitates better early recovery. Patients tend to experience less pain and shorter hospital stays. This indicates that the procedure might be less taxing on the body overall. While all surgeries carry risks, these findings suggest there may be fewer complications with the DSA compared to the PA. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these surgical approaches for total hip replacement because they may offer different benefits compared to the traditional methods. The Direct Superior Approach is unique because it aims to minimize muscle and tendon damage, potentially leading to faster recovery and less postoperative pain. On the other hand, the Posterior Approach is already a well-established method known for providing excellent visibility and access during surgery, which may offer consistent outcomes. By comparing these approaches, researchers hope to determine the optimal surgical technique that balances quick recovery with long-lasting results for patients undergoing total hip arthroplasty.

What evidence suggests that these surgical approaches are effective for total hip replacement?

This trial will compare the direct superior (DS) approach with the traditional posterior approach (PA) for hip replacement. Research has shown that the DS approach offers several advantages over the PA. Studies have found that patients undergoing the DS approach typically have shorter hospital stays, experience less bleeding, and feel less pain post-surgery. The DS approach also involves a smaller incision and causes less damage to surrounding tissue, aiding faster recovery. Additionally, this method carries a lower risk of hip joint dislocation after surgery compared to the PA. Overall, the DS approach is considered an effective and potentially superior option for hip replacement surgery. ^{2 4 5 6 7}

Are You a Good Fit for This Trial?

This trial is for adults aged 18-80 with hip pain from osteoarthritis, indicating they need surgery. They must be suitable for a specific type of hip implant and able to consent to the study. It's not open to those who don't meet these criteria.

Inclusion Criteria

Ability to give informed consent

Uncemented femoral stem and acetabular cup indicated

I need surgery for my painful hip arthritis.

Exclusion Criteria

I have severe bone loss.

Patients with known or tested-positive allergy to metals

Pregnancy

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Surgery

Participants undergo total hip arthroplasty using either the direct superior or posterior approach

1 day

1 visit (in-person)

Postoperative Recovery

Participants recover from surgery, with monitoring of narcotic use, length of stay, and complications

0-30 days

Follow-up

Participants are monitored for safety and effectiveness after surgery, with follow-up exams at 6 weeks, 6 months, 12 months, and 24 months

24 months

4 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Direct Superior Approach
• Posterior Approach
• Total Hip Arthroplasty

Trial Overview The study compares two surgical methods for hip replacement: the Direct Superior (DS) approach, which uses a smaller cut and less soft tissue damage, versus the traditional Posterior Approach (PA), known for higher dislocation rates but excellent outcomes.

How Is the Trial Designed?

Group I: Direct Superior Approach Experimental Treatment 2 Interventions

The intervention being tested is the surgical approach.

Group II: Posterior Approach Active Control 2 Interventions

Who Is Running the Clinical Trial?

Nova Scotia Health Authority

Lead Sponsor

Trials

302

Recruited

95,300+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10824060/

Which approach of total hip arthroplasty is the best efficacy ... DSA/SuperPath had better earlier functional outcome than PA, but still could not overcome the result of DAA. This technique might be the other preferred option ...

2. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-023-04233-2

The efficacy and safety of direct superior approach (DSA) for ... The DSA was superior to conventional access in terms of incision length, bleeding, postoperative transfusion rate, and early postoperative HHS.

3. sciencedirect.com sciencedirect.com/science/article/pii/S0972978X2500220X

Evaluating the direct superior approach compared to ... Compared to PA, DSA demonstrated better perioperative outcomes, including reduced hospital stay, shorter incision length, and lower VAS pain scores. Without a ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2800844

Evaluation of Comparative Efficacy and Safety of Surgical ... All surgical approaches except the direct lateral approach were associated with greater improvements of hip score when compared with the posterior approach.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6687490/

Direct Superior Approach to the Hip for Total Hip Arthroplasty A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10563322/

The efficacy and safety of direct superior approach (DSA) ... The results of this study showed that the amount of blood loss and transfusion rate in total hip arthroplasty with DSA were lower than those in ...

7. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39518441/

A Systematic Review and Meta-Analysis Conclusions: The DSA offers significant perioperative advantages over the PA, including reduced blood loss, transfusion rates, LOS, incision ...