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36 mm Ceramic-on-Ceramic Acetabular Cup Total Hip Replacement

Primary Purpose

Non-inflammatory Degenerative Joint Disease

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
36 mm ceramic head on a ceramic acetabular liner
28 mm ceramic head on a polyethylene acetabular liner
Sponsored by
DePuy Orthopaedics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-inflammatory Degenerative Joint Disease focused on measuring Hip arthroplasty, Acetabular cup, Ceramic-on-polyethylene

Eligibility Criteria

20 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Non-inflammatory degenerative joint disease. Composite diagnoses of NIDJD include osteoarthritis, avascular necrosis, post-traumatic arthritis, slipped capital femoral epiphysis (SCFE), fracture of the pelvis, and developmental dysplasia.
  • X-ray evaluation confirms the presence of NIDJD
  • Femoral and acetabular bone stock is sufficient, regarding strength and shape, and is suitable to receive the implants.
  • Individuals 20 to 75 years of age at the time of surgery
  • Patients with a previous total hip replacement of the contralateral leg who have a pain rating of none or slight and who are at least one year post arthroplasty are eligible for participation in the study.
  • Harris Hip Score of 70 or lower
  • Pain at least Moderate

Exclusion Criteria:

  • Presence of a previous prosthetic hip replacement device (any type, including surface replacement arthroplasty, endoprosthesis, etc.) in the hip joint to be operated.
  • Previous Girdlestone procedure (resection arthroplasty) or surgical fusion of the hip to be operated.
  • Acute femoral neck fracture.
  • Above knee amputation of the contralateral and/or ipsilateral leg.
  • Patients with bilateral degenerative joint disease requiring staged or simultaneous hip replacements.
  • Patients with an existing total hip arthroplasty in the contralateral hip with a Harris Hip pain rating of mild, moderate, marked or totally disabled.
  • Patients who have undergone total hip arthroplasties in their contralateral hips within the past 12 months.
  • Patients with a known allergy to metal (e.g. jewelry).
  • Skeletally immature patients (tibial and femoral epiphyses are not closed).
  • Evidence of active infections that may spread to other areas of the body (e.g., osteomyelitis, pyogenic infection of the hip joint, overt infection, urinary tract infection, etc.).
  • The presence of highly communicable disease or diseases that may limit follow-up (e.g., immuno-compromised conditions, hepatitis, active tuberculosis, etc.).
  • Presence of known metastatic or neoplastic disease.
  • Significant neurologic or musculoskeletal disorders or disease that may adversely affect gait or weight bearing, (e.g., muscular dystrophy, multiple sclerosis).
  • Conditions that may interfere with the total hip arthroplasty's survival or outcome, (e.g., Paget's disease, Charcot's disease).
  • Any patient believed to be unwilling or unable to comply with a rehabilitation program for a cementless total hip replacement or who indicates difficulty or inability to return for follow-up visits prescribed by the study protocol.
  • Patient is known to be pregnant, a prisoner, mentally incompetent, and/or alcohol or drug abuser.
  • Any systemic steroid therapy, excluding inhalers, within three months prior to surgery.
  • Patients carrying the diagnosis of inflammatory degenerative arthritis (IDJD) to include the following composite diagnoses: rheumatoid arthritis, systemic lupus erythematosus, pigmented villonodular synovitis, juvenile rheumatory arthritis and other arthritic processes of inflammatory or autoimmune etiology.
  • Patients requiring structural bone grafts in order to support the prosthetic component(s) or to shape the bone to receive the implant(s).
  • Patients who refuse to provide consent to participate in the clinical investigation.
  • Surgical replacement requires the use of an acetabular liner and femoral head greater or smaller than a 36mm diameter

Sites / Locations

  • Colorado Joint Replacement
  • Cardinal Orthopaedic Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Other

Arm Label

36 mm

28 mm ceramic-on-polyethylene

Arm Description

36 mm ceramic head on ceramic acetabular liner

28 mm ceramic-on-polyethylene historical control

Outcomes

Primary Outcome Measures

Total Harris Hip Score
The Harris Hip scoring system assigns a numeric value to responses from patients and assessments made by a surgeon. A score of 91-100 is excellent, 81-90 is good, 71-80 is fair, 70 or below is poor. The patient records the following: pain level, need for assistance when walking, presence of a limp, distance able to walk, ability to put on shoes and socks, climb stairs, use public transportation and the length of time one is able to comfortably sit in a chair are all scored. The Total Harris Hip Score is a sum of its subscores (Pain, Function, Activities, Deformity, and Range of Motion).

Secondary Outcome Measures

Harris Hip Subscale Score: Pain
The Harris Hip's pain subscale is a numeric value from 0 to 44. A lower score indicates more pain; a score of 44 indicates no pain.
Harris Hip Subscale Score: Function
The Harris Hip's function subscale is a numeric value from 0 to 33. A lower score indicates less function; a score of 33 indicates no limitations in function level.
Harris Hip Subscale Score: Activities
The Harris Hip's Activities subscale is a numeric value from 0 to 14. A lower score indicates a lower ability to perform daily activities; a score of 14 indicates no limitations in daily activities.
Harris Hip Subscale Score: Deformity
The Harris Hip's Deformity subscale is a numeric value from 0 to 4. A lower score indicates more deformity; a score of 4 indicates no deformity.
Harris Hip Subscale Score: Range of Motion
The Harris Hip's Range of Motion subscale is a numeric value from 0 to 5. A lower score indicates a lower range of motion; a score of 5 indicates full range of motion.
Harris Hip Score Longitudinal Analysis
The Harris Hip scoring system assigns a numeric value to responses from patients and assessments made by a surgeon, with a range of 0 to 100. Lower scores indicate a worse outcome and a score of 100 is the best possible outcome. Longitudinal analysis (repeated measures) was performed to compare post-operative Harris Hip sores over time.
Proportion of Composite Successes
A subject was deemed to be a composite success at 24 months or greater if at the time of last clinical follow-up there had not been a revision of any THA components, the latest Harris Hip score was 80 or greater, and on the latest radiographic evaluation there were no radiolucencies greater than 2mm, no evidence of acetabular migration greater than 4mm, no change in acetabular shell inclination angle greater than 4 degrees, and no osteolysis.

Full Information

First Posted
June 3, 2009
Last Updated
April 9, 2019
Sponsor
DePuy Orthopaedics
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1. Study Identification

Unique Protocol Identification Number
NCT00953719
Brief Title
36 mm Ceramic-on-Ceramic Acetabular Cup Total Hip Replacement
Official Title
Delta Ceramax 36 mm Ceramic-on-Ceramic Acetabular Cup Prosthesis Study
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
April 1, 2003 (Actual)
Primary Completion Date
August 1, 2008 (Actual)
Study Completion Date
July 1, 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
DePuy Orthopaedics

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is a supplement to the 28 mm Ceramic-on-Ceramic study which was designed to evaluate artificial hips with a 28 mm ceramic head and liner to determine whether they perform as well as artificial hips with a 28 mm ceramic head and a polyethylene liner. This arm of the study is designed to compare a 36 mm ceramic head and sleeve with a subset of the control (28mm ceramic head and a polyethylene sleeve) from the original study (G030075) (NCT#00208507) with additional follow-up, to determine if they perform as well.
Detailed Description
Total Hip Arthroplasty (THA) is the surgical reconstruction of the hip joint through replacement of the femoral head and the acetabular articulating surfaces with fixed prosthetic devices. The goals of THA are relief from pain, restoration of function, and correction of deformity. THA is one of the most common adult reconstructive procedures. Over the past 25 years, patients who have needed to have their hip joint replaced, either due to trauma or arthritic disease, typically have had their hip joint bone articular surfaces replaced with a metal hip stem, metal ball head (either stainless steel or chrome cobalt) and a plastic acetabular cup (metal/metal/plastic). While the basic device has remained essentially unchanged over that period, technological advancements in implant designs and materials, and improvements in surgical technique and instrumentation have made THA one of the most durable and successful procedures in medicine. Reproducible, high-quality, short-term and mid-term results are attained regularly, and total hip replacements commonly last 10 to 15 years and longer. The success of this procedure has allowed its expansion into a wider, and often younger and more active population. In spite of the improvements in THA, little change has occurred for the acetabular cup liner, which is usually made out of Ultra High Molecular Weight Polyethylene plastic (UHMWPe). Because it is plastic and inherently soft and somewhat pliable under load, the cup's articular surface must inevitability wear and produce debris. This biologic response is now thought to be a significant contributor to prosthetic component loosening, a primary failure mode of THR. UHMWPe also degrades with time in the body. As concerns about polyethylene wear and the associated untoward effects of the generated wear debris, and as THA continues to be used in younger and higher-demand patients with increasing life expectancies, interest in ceramic on ceramic total hip prosthesis has been renewed. An alumina ceramic-on-ceramic acetabular coupling has been employed as an alternative to metal/polyethylene couplings. This ceramic-on-ceramic coupling has many advantages, including the elimination of polyethylene from the device system, wear rates that are appreciably less than those experienced with metal/polyethylene couplings and reduced biologic reactivity. The potential benefits of an alumina ceramic/ceramic bearing are significant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-inflammatory Degenerative Joint Disease
Keywords
Hip arthroplasty, Acetabular cup, Ceramic-on-polyethylene

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
243 (Actual)

8. Arms, Groups, and Interventions

Arm Title
36 mm
Arm Type
Active Comparator
Arm Description
36 mm ceramic head on ceramic acetabular liner
Arm Title
28 mm ceramic-on-polyethylene
Arm Type
Other
Arm Description
28 mm ceramic-on-polyethylene historical control
Intervention Type
Device
Intervention Name(s)
36 mm ceramic head on a ceramic acetabular liner
Other Intervention Name(s)
Delta Ceramax head on a ceramic liner.
Intervention Description
Total hip replacement with a 36 mm ceramic head on a ceramic liner
Intervention Type
Device
Intervention Name(s)
28 mm ceramic head on a polyethylene acetabular liner
Other Intervention Name(s)
Delta Ceramax head on a polyethylene liner
Intervention Description
Total hip replacement with a 28 mm ceramic head on a polyethylene liner.
Primary Outcome Measure Information:
Title
Total Harris Hip Score
Description
The Harris Hip scoring system assigns a numeric value to responses from patients and assessments made by a surgeon. A score of 91-100 is excellent, 81-90 is good, 71-80 is fair, 70 or below is poor. The patient records the following: pain level, need for assistance when walking, presence of a limp, distance able to walk, ability to put on shoes and socks, climb stairs, use public transportation and the length of time one is able to comfortably sit in a chair are all scored. The Total Harris Hip Score is a sum of its subscores (Pain, Function, Activities, Deformity, and Range of Motion).
Time Frame
At final follow-up visit, 24 months or later, up to 72 months
Secondary Outcome Measure Information:
Title
Harris Hip Subscale Score: Pain
Description
The Harris Hip's pain subscale is a numeric value from 0 to 44. A lower score indicates more pain; a score of 44 indicates no pain.
Time Frame
At final follow-up visit, 24 months or later, up to 72 months
Title
Harris Hip Subscale Score: Function
Description
The Harris Hip's function subscale is a numeric value from 0 to 33. A lower score indicates less function; a score of 33 indicates no limitations in function level.
Time Frame
At final follow-up visit, 24 months or later, up to 72 months
Title
Harris Hip Subscale Score: Activities
Description
The Harris Hip's Activities subscale is a numeric value from 0 to 14. A lower score indicates a lower ability to perform daily activities; a score of 14 indicates no limitations in daily activities.
Time Frame
At final follow-up visit, 24 months or later, up to 72 months
Title
Harris Hip Subscale Score: Deformity
Description
The Harris Hip's Deformity subscale is a numeric value from 0 to 4. A lower score indicates more deformity; a score of 4 indicates no deformity.
Time Frame
At final follow-up visit, 24 months or later, up to 72 months
Title
Harris Hip Subscale Score: Range of Motion
Description
The Harris Hip's Range of Motion subscale is a numeric value from 0 to 5. A lower score indicates a lower range of motion; a score of 5 indicates full range of motion.
Time Frame
At final follow-up visit, 24 months or later, up to 72 months
Title
Harris Hip Score Longitudinal Analysis
Description
The Harris Hip scoring system assigns a numeric value to responses from patients and assessments made by a surgeon, with a range of 0 to 100. Lower scores indicate a worse outcome and a score of 100 is the best possible outcome. Longitudinal analysis (repeated measures) was performed to compare post-operative Harris Hip sores over time.
Time Frame
6 week, 6 month, 12 month, 24 month, 36 month, and 48 months post-operatively
Title
Proportion of Composite Successes
Description
A subject was deemed to be a composite success at 24 months or greater if at the time of last clinical follow-up there had not been a revision of any THA components, the latest Harris Hip score was 80 or greater, and on the latest radiographic evaluation there were no radiolucencies greater than 2mm, no evidence of acetabular migration greater than 4mm, no change in acetabular shell inclination angle greater than 4 degrees, and no osteolysis.
Time Frame
At final follow-up visit, 24 months or later, up to 72 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Non-inflammatory degenerative joint disease. Composite diagnoses of NIDJD include osteoarthritis, avascular necrosis, post-traumatic arthritis, slipped capital femoral epiphysis (SCFE), fracture of the pelvis, and developmental dysplasia. X-ray evaluation confirms the presence of NIDJD Femoral and acetabular bone stock is sufficient, regarding strength and shape, and is suitable to receive the implants. Individuals 20 to 75 years of age at the time of surgery Patients with a previous total hip replacement of the contralateral leg who have a pain rating of none or slight and who are at least one year post arthroplasty are eligible for participation in the study. Harris Hip Score of 70 or lower Pain at least Moderate Exclusion Criteria: Presence of a previous prosthetic hip replacement device (any type, including surface replacement arthroplasty, endoprosthesis, etc.) in the hip joint to be operated. Previous Girdlestone procedure (resection arthroplasty) or surgical fusion of the hip to be operated. Acute femoral neck fracture. Above knee amputation of the contralateral and/or ipsilateral leg. Patients with bilateral degenerative joint disease requiring staged or simultaneous hip replacements. Patients with an existing total hip arthroplasty in the contralateral hip with a Harris Hip pain rating of mild, moderate, marked or totally disabled. Patients who have undergone total hip arthroplasties in their contralateral hips within the past 12 months. Patients with a known allergy to metal (e.g. jewelry). Skeletally immature patients (tibial and femoral epiphyses are not closed). Evidence of active infections that may spread to other areas of the body (e.g., osteomyelitis, pyogenic infection of the hip joint, overt infection, urinary tract infection, etc.). The presence of highly communicable disease or diseases that may limit follow-up (e.g., immuno-compromised conditions, hepatitis, active tuberculosis, etc.). Presence of known metastatic or neoplastic disease. Significant neurologic or musculoskeletal disorders or disease that may adversely affect gait or weight bearing, (e.g., muscular dystrophy, multiple sclerosis). Conditions that may interfere with the total hip arthroplasty's survival or outcome, (e.g., Paget's disease, Charcot's disease). Any patient believed to be unwilling or unable to comply with a rehabilitation program for a cementless total hip replacement or who indicates difficulty or inability to return for follow-up visits prescribed by the study protocol. Patient is known to be pregnant, a prisoner, mentally incompetent, and/or alcohol or drug abuser. Any systemic steroid therapy, excluding inhalers, within three months prior to surgery. Patients carrying the diagnosis of inflammatory degenerative arthritis (IDJD) to include the following composite diagnoses: rheumatoid arthritis, systemic lupus erythematosus, pigmented villonodular synovitis, juvenile rheumatory arthritis and other arthritic processes of inflammatory or autoimmune etiology. Patients requiring structural bone grafts in order to support the prosthetic component(s) or to shape the bone to receive the implant(s). Patients who refuse to provide consent to participate in the clinical investigation. Surgical replacement requires the use of an acetabular liner and femoral head greater or smaller than a 36mm diameter
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joel Politi, MD
Organizational Affiliation
Cardinal Orthopaedic Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Douglas Dennis, MD
Organizational Affiliation
Colorado Joint Replacement
Official's Role
Principal Investigator
Facility Information:
City
Sacramento
State/Province
California
ZIP/Postal Code
95816
Country
United States
Facility Name
Colorado Joint Replacement
City
Denver
State/Province
Colorado
ZIP/Postal Code
80210
Country
United States
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27103
Country
United States
Facility Name
Cardinal Orthopaedic Institute
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43213
Country
United States
City
Alexandria
State/Province
Virginia
ZIP/Postal Code
22306
Country
United States

12. IPD Sharing Statement

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36 mm Ceramic-on-Ceramic Acetabular Cup Total Hip Replacement

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