Comparison of outcome measures and complication rates following three different approaches for primary total hip arthroplasty: a pragmatic randomised controlled trial

Abstract

BackgroundTotal hip arthroplasty is one of the most commonly performed surgical procedures worldwide. There are a number of surgical approaches for total hip arthroplasty and no high-level evidence supporting one approach over the other. Each approach has its unique benefits and drawbacks. This trial aims to directly compare the three most common surgical approaches for total hip arthroplasty.Methods/designThis is a single-centre study conducted at Western Health, Melbourne, Australia; a large metropolitan centre. It is a pragmatic, parallel three-arm, randomised controlled trial. Sample size will be 243 participants (81 in each group). Randomisation will be secure, web-based and managed by an independent statistician. Patients and research team will be blinded pre-operatively, but not post-operatively.Intervention will be either direct anterior, lateral or posterior approach for total hip arthroplasty, and the three arms will be directly compared. Participants will be aged over 18 years, able to provide informed consent and recruited from our outpatients. Patients who are having revision surgery or have indications for hip replacement other than osteoarthritis (i.e., fracture, malignancy, development dysplasia) will be excluded from the trial.The Oxford Hip Score will be determined for patients pre-operatively and 6 weeks, 6, 12 and 24 months post-operatively. The Oxford Hip Score at 24 months will be the primary outcome measure. Secondary outcome measures will be dislocation, infection, intraoperative and peri-prosthetic fracture rate, length of hospital stay and pain level, reported using a visual analogue scale.DiscussionMany studies have evaluated approaches for total hip arthroplasty and arthroplasty registries worldwide are now collecting this data. However no study to date has compared these three common approaches directly in a randomised fashion. No trial has used patient-reported outcome measures to evaluate success. This pragmatic study aims to identify differences in patient perception of total hip arthroplasty depending on surgical approach.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12617000272392. Registered on 22 February 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-017-2368-7) contains supplementary material, which is available to authorized users.

What is important to people living with dementia?: the ‘long-list’ of outcome items in the development of a core outcome set for use in the evaluation of non-pharmacological community-based health and social care interventions

“…First ( Phase 1a) , interviews and focus groups were undertaken with key stakeholder groups that asked which outcomes they thought were important from the perspectives of a person living with dementia. As outlined in the study protocol [19], these groups were: People living with dementia - a person either formally or self-diagnosed with dementia and who lives at home. Care partners [19] - a person with current or past experiences of providing care for a person living with dementia. Health and social care professionals – a person currently or recently employed by a public or private organisation that provides care or support in a health or social setting for people living with dementia. Researchers – a person with current or recent experiences of undertaking dementia related research (i.e. as denoted by being a lead or co-author on dementia related peer-reviewed publications, or involvement in current dementia-related research). Policymakers - a person in a senior role with influence to shape national, regional or local dementia policy, or commission dementia service provision.…”

“…Whilst the perspectives of people living with dementia and carers on desirable outcomes of community care captured by Bamford and Bruce constitutes important research [18], it is nearly two decades old. In recent years recommendations relating to outcome measures for use in dementia trials has mainly come from professional groups [19]. People living with dementia are rarely, if at all, consulted [20].…”

“…This study methodology, including how we have utilised the lived experience of people living with dementia as co-researchers [23] to modify and design an accessible Delphi method is outlined in greater detail elsewhere [19, 24]. The clarity and transparency of COS reporting is described in a recent review as suboptimal [25] and the important initial phase of developing the ‘long-list’ often goes under reported.…”

Imaging of Hip Arthroplasties: Normal Findings and Hardware Complications

“…3,9 Surgical approaches for hip arthroplasty include the anterior, anterolateral, direct lateral, lateral transtrochanteric, and posterior approach, with ongoing debate on the best approach. 14,15 The posterior and direct lateral approaches are the most common. 3,14 The direct lateral approach entails incision along the greater trochanter, separating the anterior gluteus medius and gluteus minimus footprints from native bone.…”

What’s New in Hip Replacement

“…There is an ongoing debate on what is the "best" approach for primary THA. A pragmatic, parallel, 3-arm randomized controlled trial is currently underway in Australia comparing the outcome measures and complication rates following 3 different approaches (anterior, lateral and posterior) for primary THA and hopefully will shed light on this issue 46 .…”