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Arthroscopic Surgical Procedures vs Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears. (HIPARTI)

Primary Purpose

Surgery

Status
Recruiting
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Arthroscopic surgical procedures
Sponsored by
Oslo University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Surgery focused on measuring hip arthroscopy, femoroacetabular impingement, exercise therapy after hip arthroscopy, rehabilitation after hip arthroscopy

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • hip pain during daily and/or spor t ing activities;
  • intra-articular hip pain with radiological signs of FAI and/or labral tears eligible for hip arthroscopy (to be determined in a pragmatic fashion by the surgeon based on clinical examination and imaging
  • the patient is able to give written informed consent and to participate fully in the interventions and follow-up procedures

Exclusion Criteria:

  • pain that is not confirmed by physical examination of the hip
  • evidence of preexisting osteoarthritis, defined as Tonnis grade >1, or less than 3mm superior joint space width on AP pelvic radiograph
  • center edge angle on radiograph <25°; (v) previous known hip pathology such as Perthes' disease, slipped upper femoral epiphysis or avascular necrosis
  • previous hip injury such as acetabular fracture, hip dislocation or femoral neck fracture
  • previous hip surgery
  • medical conditions complicating surgery (ASA 3); (ix) inflammatory joint disease (RA, Bechterew etc)
  • physical inability to undertake testing procedures
  • expected lack of compliance such as cognitive impairment, drug abuse or similar;
  • inability to understand the written and spoken language of the treatment centre;
  • contra-indications to placebo surgery, which will include large loose body, chondral flap >1cm2 detached at 3 sides, complete labral radial flap tear and labral bucket-handle tear with complete avulsion >1.5cm long

Sites / Locations

  • LaTrobe University, School Allied Health, College of Science, Helath and EngineeringRecruiting
  • Division of Orthopedic Surgery, Oslo University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Placebo Comparator

Active Comparator

Arm Label

Hip arthroscopy surgical procedures (HIPARTI Study)

Sham surgery (HIPARTI Study)

Prospective Cohort (HARP Study)

Arm Description

Surgery is performed under general anaesthesia. Traction and joint access is controlled by fluoroscopy. A diagnostic round in the central and peripheral compartment is performed. Labrum, cartilage, and other possible conditions are looked for and findings are documented. Any labral, chondral and bony pathology (cam or pincer) is treated. Labrum may be debrided, sutured, detached and refixed if needed to treat a pincer lesion. Labrum is secured with suture anchors. Pincer and cam resection is performed using an arthroscopic burr. Cartilage lesions maybe left untreated or treated with debridement or microfracture.

The same arthroscopic procedures as stated above are preformed, but no surgical interventions related to Cam, Pincer, or labral tear are performed, only diagnostic round in the central and peripheral compartment is performed. Labrum, cartilage, and other possible conditions are looked for and findings are documented.

Those that are not willing to be included in the RCT (HIPARTI Study), will be asked if they are willing to be included in the prospective cohort, or ongoing in countries were ONLY the surgery is performed (Australia). They will sign an informed concent and will undergo surgical interventions as part of usual care. Outcomes collected and follow-ups will be the same as for the RCT (HIPARTI).

Outcomes

Primary Outcome Measures

International Hip Outcome Tool (IHOT-33)
Patient-reported outcome measure (PRO)

Secondary Outcome Measures

Expectations of surgery
Questionnaire
HOOS - Hip Dysfunction and Osteoarthritis Outcome Score
Patient-reported outcome measure (PRO) 5 subscales
ASES Arthritis Self-Efficacy Scale
Self-Efficacy Scale questionnaire
Tampa scale of Kinesiophobia
Fear of movement questionnaire
Hip Sports Activity Scale (HSAS)
Activity Level (type)
Work place Activity Limitation Survey (WALS)
Questionnaire (only for some of the study sites)- only in some study sites
Patient Spesific Functional Scale
Patient report on 3 specific activities and their limitations - only in some study sites
Measures of hip physical impairment:
Range of motion
Hip muscle strength
Dynamometer
Single leg squat performance
Performance tests - only in some study sites
Total Hip Replacement.
Data from the Norwegian National Joint Registry on total hip joint arthroplasty (or similar registries from the other countries)

Full Information

First Posted
February 15, 2016
Last Updated
May 15, 2017
Sponsor
Oslo University Hospital
Collaborators
La Trobe University, University of Aarhus, Lund University, University of Oxford, University of Ottawa
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1. Study Identification

Unique Protocol Identification Number
NCT02692807
Brief Title
Arthroscopic Surgical Procedures vs Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears.
Acronym
HIPARTI
Official Title
Arthroscopic Surgical Procedures Versus Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears. A Multicentre, International, Double-blinded Randomized, Controlled Trial.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Recruiting
Study Start Date
February 2016 (undefined)
Primary Completion Date
December 2020 (Anticipated)
Study Completion Date
December 2035 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Oslo University Hospital
Collaborators
La Trobe University, University of Aarhus, Lund University, University of Oxford, University of Ottawa

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary aim of this study is to determine the efficacy of hip arthroscopic surgery compared to a sham surgery (diagnostic arthroscopy only) for patients with symptomatic and radiological findings related to impingement (FAI) and/or labral tears using a randomized controlled design (HIPARTI Study: Primary aim and the main paper: primary end point: iHOT 1 year follow-up)). Our main hypothesis is that surgical procedures of the hip will demonstrate greater efficacy than sham surgery (diagnostic hip arthroscopy only) for hip related quality of life (iHOT-33) after 1 year and at further (HIPARTI Study). The secondary aim of this study is to establish modifiable risk factors associated with pain, function, work participation and quality of life over 1 year in people aged 18-50 years with hip impingement and/or labral tears diagnosed at hip arthroscopy. (HARP Study: A separate paper will be published with this main aim for the HARP Study) Long-term follow-ups for HIPARTI Study as well as HARP Study will be performed at 2, 5 and 10 years (secondary aims and separate papers).
Detailed Description
This is a multicenter, international, assessor and patient blinded clinical RCT with two groups (primary aim). the HIPARTI Study with The design of this trial conforms to the SPIRIT guidelines. All patients with hip pain eligible for hip arthroscopy in our routine care pathways will be identified in our outpatient clinics. Consultant orthopedic surgeons will determine a patient's eligibility for the study (based on inclusion and exclusion criteria for the study) and members of their team introduce the study to the patients and refer them to the research coordinators for further information. Patients will be provided with oral and written information about the study and be introduced to our consent form. If interest continues the patient will be provided with further information and arrangements will be made for a baseline appointment for assessment and consenting. The baseline assessment appointments will occur within one month of the initial approach. At the baseline appointment patients will meet with the research coordinator and the independent research assistant/tester (physical therapist) who will be the blinded tester. Patients will return their signed informed consent form and baseline questions completed. Those who are not willing to participate in the RCT (HIPARTI Study), will be asked if interested in being included in a prospective longitudinal cohort study including similar baseline and follow-up tests as those in the RCT (this will be the HARP Study with separate papers published). All patients in the HARP Study will undergo hip arthroscopy surgery. The Australian site will include most of their patients in the HARP Study, since the majority of orthopedic surgeons working privately will not participate in the HIPARTI Study. Data collection will be performed electronically for both the HIPARTI and the HARP Studies entering all data in the approved Checkware system (www.checkware.no). Each collaborating center will apply to the ethical committee and the Data Inspectorate in each country/institution. Approval was confirmed for Oslo University Hospital (HIPARTI) and Australia (HARP Study) in January 2016. Randomization (HIPARTI) will occur prior to surgery, after final eligibility is confirmed. Randomizations will be performed centrally using an automated computer generated system. Block randomization and stratification for each center will be performed. All patients will undergo imaging (which may include CT scan or at least 1.5 Tesla magnetic resonance imaging MRI) prior to the surgical assessment as part of routine care. All patients will also undergo standardized radiographs of the hips and pelvis also as part of routine care. Plain radiographs will be examined for evidence of osteoarthritis as joint space narrowing, osteophytes, cysts and subchondral hypertrophy. Several radiographic measurements will be performed among them: the alpha angle and lateral center-edge angle will be determined for the presence of FAI. Radiographs will also be part of follow-ups. Participating orthopedic surgeons will be asked to coordinate their waiting lists to ensure the hip arthroscopy patients are called for surgery in accordance with the study protocol. Ideally, patients will complete their baseline assessment as close to the randomized treatment as possible (within 1 months). In the event that surgery cannot be performed within 1 month after baseline assessment, the same questions and assessments completed at baseline will be completed again. The standard followed-ups at the 6 months and 1 year include primary and secondary outcomes. One year is the primary end point where randomization code will be broken according to a predefined published statistical protocol (HIPARTI). At all follow-ups the research coordinator/independent tester will attend. At the 6 month follow-up an independent orthopedic surgeon will attend regularly and take care of patients who are not satisfied. The aim is to use the following criteria as subjective complaint: equal or worse than 10 points for the IHOT-33 score compared to baseline. All patients can withdraw without giving a reason at any time (stated in the consent form that all patients need to sign). An unblinded orthopedic surgeon will of course be able to have access to the medical record regarding performed procedures at any time if need for the health of the patient. All patients (in both groups in the RCT (HIPARTI) as well as in the HARP study) will undergo a postoperative rehabilitation program based on the best available evidence. Each patient will be treated by physical therapists who will be trained and proficient in post-hip arthroscopy rehabilitation. Rehabilitation will be delivered a minimum of 8 sessions over 3-months and then once a month for the following three months. Details of rehabilitation are outlined in Appendix Rehabilitation. This contains a treatment algorithm to guide clinical reasoning and progression of treatment (manual therapy, exercises and education) through weeks 1-12. Long term follow-ups will be performed at 2, 5 and 10 years Due to lack of studies published within this field: clinical relevant differences as well as changes within groups and SD are difficult to estimate. Our sample size calculations are based on primary outcome iHOT 33 at 1 year: estimated effect-size to 0.6 and a power of 90, will give 60 in each group, and with expected 15% dropout will give 138 patients in total. Electronic randomization lists will be generated, and estimations of inclusion rates per site are included. Statistical analysis procedures will be published and analysis performed prior to opening the group allocation when all patients are included and followed through to the 1 year follow-up (main outcome).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Surgery
Keywords
hip arthroscopy, femoroacetabular impingement, exercise therapy after hip arthroscopy, rehabilitation after hip arthroscopy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
The RCT part of the HIPARTI Study has 2 arms, but there is also a prospective longitudinal study of those who are either not willing to participate in the RCT, or where the study takes part in collaborating countries were there is ONLY the prospective longitudial ongoing (Australia). This part of the study is the HARP study. The HIPARTI consists on one RCT trial eith two parallel arms, and one prospective cohort, the HARP study.
Masking
ParticipantOutcomes Assessor
Masking Description
This is only for the RCT Study - the double-blinded study. The HARP study consists of only a prospective longitudial study With same outcome measure and follow-ups; hence, given 3 arms. The below "Allocation" and "Number of Subjects" is ONLY for the RCT part of the study
Allocation
Randomized
Enrollment
140 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Hip arthroscopy surgical procedures (HIPARTI Study)
Arm Type
Active Comparator
Arm Description
Surgery is performed under general anaesthesia. Traction and joint access is controlled by fluoroscopy. A diagnostic round in the central and peripheral compartment is performed. Labrum, cartilage, and other possible conditions are looked for and findings are documented. Any labral, chondral and bony pathology (cam or pincer) is treated. Labrum may be debrided, sutured, detached and refixed if needed to treat a pincer lesion. Labrum is secured with suture anchors. Pincer and cam resection is performed using an arthroscopic burr. Cartilage lesions maybe left untreated or treated with debridement or microfracture.
Arm Title
Sham surgery (HIPARTI Study)
Arm Type
Placebo Comparator
Arm Description
The same arthroscopic procedures as stated above are preformed, but no surgical interventions related to Cam, Pincer, or labral tear are performed, only diagnostic round in the central and peripheral compartment is performed. Labrum, cartilage, and other possible conditions are looked for and findings are documented.
Arm Title
Prospective Cohort (HARP Study)
Arm Type
Active Comparator
Arm Description
Those that are not willing to be included in the RCT (HIPARTI Study), will be asked if they are willing to be included in the prospective cohort, or ongoing in countries were ONLY the surgery is performed (Australia). They will sign an informed concent and will undergo surgical interventions as part of usual care. Outcomes collected and follow-ups will be the same as for the RCT (HIPARTI).
Intervention Type
Procedure
Intervention Name(s)
Arthroscopic surgical procedures
Other Intervention Name(s)
Sham Surgery
Intervention Description
See arm/group description of Arthroscopic surgery and sham surgery (HIPARTI). HARP: only arthroscopic surgery
Primary Outcome Measure Information:
Title
International Hip Outcome Tool (IHOT-33)
Description
Patient-reported outcome measure (PRO)
Time Frame
Baseline, 6,12 an 24 months follow-ups - 1 year follow-up is main outcome
Secondary Outcome Measure Information:
Title
Expectations of surgery
Description
Questionnaire
Time Frame
Baseline
Title
HOOS - Hip Dysfunction and Osteoarthritis Outcome Score
Description
Patient-reported outcome measure (PRO) 5 subscales
Time Frame
Baseline, 6,12 an 24 months follow-ups - only in some study sites
Title
ASES Arthritis Self-Efficacy Scale
Description
Self-Efficacy Scale questionnaire
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Tampa scale of Kinesiophobia
Description
Fear of movement questionnaire
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Hip Sports Activity Scale (HSAS)
Description
Activity Level (type)
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Work place Activity Limitation Survey (WALS)
Description
Questionnaire (only for some of the study sites)- only in some study sites
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Patient Spesific Functional Scale
Description
Patient report on 3 specific activities and their limitations - only in some study sites
Time Frame
Baseline, 6,12 an 24 months follow-up
Title
Measures of hip physical impairment:
Description
Range of motion
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Hip muscle strength
Description
Dynamometer
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Single leg squat performance
Description
Performance tests - only in some study sites
Time Frame
Baseline, 6,12 an 24 months follow-ups
Title
Total Hip Replacement.
Description
Data from the Norwegian National Joint Registry on total hip joint arthroplasty (or similar registries from the other countries)
Time Frame
1, 2, 5 and 10 years follow-up

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: hip pain during daily and/or spor t ing activities; intra-articular hip pain with radiological signs of FAI and/or labral tears eligible for hip arthroscopy (to be determined in a pragmatic fashion by the surgeon based on clinical examination and imaging the patient is able to give written informed consent and to participate fully in the interventions and follow-up procedures Exclusion Criteria: pain that is not confirmed by physical examination of the hip evidence of preexisting osteoarthritis, defined as Tonnis grade >1, or less than 3mm superior joint space width on AP pelvic radiograph center edge angle on radiograph <25°; (v) previous known hip pathology such as Perthes' disease, slipped upper femoral epiphysis or avascular necrosis previous hip injury such as acetabular fracture, hip dislocation or femoral neck fracture previous hip surgery medical conditions complicating surgery (ASA 3); (ix) inflammatory joint disease (RA, Bechterew etc) physical inability to undertake testing procedures expected lack of compliance such as cognitive impairment, drug abuse or similar; inability to understand the written and spoken language of the treatment centre; contra-indications to placebo surgery, which will include large loose body, chondral flap >1cm2 detached at 3 sides, complete labral radial flap tear and labral bucket-handle tear with complete avulsion >1.5cm long
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
May Arna Risberg, PT, PhD
Phone
4741312776
Email
m.a.risberg@nih.no
First Name & Middle Initial & Last Name or Official Title & Degree
Agnethe Nilstad, PT, PhD
Phone
4799224469
Email
agnethe.nilstad@nih.no
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
May Arna Risberg, PT, PhD
Organizational Affiliation
Oslo University Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Lars Nordsletten, MD, PhD
Organizational Affiliation
Oslo University Hospital
Official's Role
Study Director
Facility Information:
Facility Name
LaTrobe University, School Allied Health, College of Science, Helath and Engineering
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3086
Country
Australia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kay Crossley, PT, PHD
Phone
+61411055738
Email
k.crossley@latrobe.edu.au
First Name & Middle Initial & Last Name & Degree
Joanne Kemp, PT, PHD
Facility Name
Division of Orthopedic Surgery, Oslo University Hospital
City
Oslo
ZIP/Postal Code
4956
Country
Norway
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sverre Loken, MD, PhD
Phone
+4790704448
Email
s-loek@online.no
First Name & Middle Initial & Last Name & Degree
Tom Ludvigsen, MD
Phone
+4790642130
Email
tomcl@getmail.no

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
Data will be shared across the sites participating in the HIPARTI and the HARP Study, according to the protocol and the decisions made by the Advisory Committee

Learn more about this trial

Arthroscopic Surgical Procedures vs Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears.

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