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Evaluation of the Efficacy of the Bipolar Sealer Aquamantys 6.0 in Patients Undergoing Total Hip Arthroplasty (Hip)

Primary Purpose

Hip Arthritis

Status
Completed
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Bipolar Radiofrequency (Aquamantys 6.0)
Standard Bovie Electrocautery
Sponsored by
The Cleveland Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hip Arthritis

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age: 18 - 85 years
  • Sex: Both male and female will be included. The male-to-female ratio will depend upon the patient population.
  • Stable Health: At the time of surgery based on physical examination and medical history.
  • Patient exhibited preoperative radiographic evidence of joint degeneration consistent with THA that could not have been treated in non-operative fashion.
  • Patient had severe hip pain and disability due to degenerative joint disease.
  • Patient or patient's legal representative has signed the Informed Consent form. The patient is capable of making informed decisions regarding his/her healthcare.

Exclusion Criteria:

  • Patients with history of cardiac disease, liver disease or renal disease. Severe cardiac disease, liver disease and renal dysfunction can confound different parameters within this study. Patients with decreased cardiac function from prior myocardial infarction, cardiomyopathy or congestive heart failure will likely require transfusions with packed red blood cells at lower thresholds relative to healthy counterparts for cardioprotection. Therefore, patients with a prior history of myocardial infarction, cardiomyopathy, congestive heart failure or other significant cardiac history will be excluded from this study. In addition, patients with liver dysfunction from cirrhosis or hepatitis may have impaired production of factors in the clotting cascade which may make these individuals more prone to bleed, especially with the use of anticoagulants such as lovenox. For this reason, these patients will also be excluded from this study. Finally, individuals with renal dysfunction will have decreased creatinine clearance, which may artificially elevate the levels of lovenox, thereby promoting bleeding. In addition, individuals with severe renal disease may also have associated anemia which would complicate the transfusion threshold. For this reason, individuals with chronic renal failure, diabetic nephropathy, or decreased creatinine clearance will be excluded from this study.
  • Patients predonating autologous blood.
  • Patients with preoperative hemoglobin level less than 11.5 g/dL or a hematocrit less than 35%. Patients with a preoperative platelet count of less than 100,000.
  • Patients undergoing bilateral or revision surgery.
  • Evidence of bleeding or metabolic - based hemolytic disorder (hemophilia or anticoagulation use)
  • Previous history of infection in the affected joint.
  • Peripheral vascular disease.
  • Patient was a poor compliance risk - treated for ethanol or drug abuse, physical or mental handicap, etc.
  • Patients whose personal beliefs exclude the use of blood transfusions (example: Jehovah's witness).

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Placebo Comparator

    Experimental

    Arm Label

    Standard Bovie Electrocautery

    Bipolar Radiofrequency

    Arm Description

    Standard Bovie electrocautery [Valleylab, Boulder, Colorado] used on surgical site during primary total hip arthroplasty to deliver high frequency electrical current to seal tissues and blood vessels.

    Aquamantys 6.0 bipolar sealer [Salient Surgical Technologies, Portsmouth, New Hampshire] used on surgical site during primary total hip arthroplasty to deliver radiofrequency energy coupled with saline solution irrigation for hemostatic sealing (i.e. shrinking of collagen in the walls of tissue vessels) at lower temperatures (<100 degrees Celsius) than standard Bovie electrocautery.

    Outcomes

    Primary Outcome Measures

    Number of Patients Managed With Blood Transfusion

    Secondary Outcome Measures

    Number of Units Transfused
    Estimated Blood Loss
    Change in Hemoglobin Level
    Change in hemoglobin level from baseline to the day of hospital discharge.
    Total Narcotic Usage (Morphine-equivalent mg) During Hospital Stay
    Sum of daily morphine-equivalent mg narcotic usage during hospital stay.
    Length of Stay
    Harris Hip Score (Outcome Score)
    A scoring system used to evaluate the outcome after total hip replacement. Domains include pain (44 points), function (47 points), deformity (4 points), and range of motion (5 points). A total score is computed by summing the individual domain scores, with a maximum of 100 points. Higher values represent better outcomes. A total Harris Hip Score below 70 points is generally considered a poor result, 70 to 80 fair, 80 to 90 good, and 90 to 100 excellent.
    Pain Score Scale
    A single scoring system used to evaluate overall pain on a scale of integers 0 to 10, with 0 representing "no pain" and 10 representing "unbearable pain." Thus, in this context, lower values represent better outcomes.

    Full Information

    First Posted
    December 3, 2009
    Last Updated
    October 30, 2012
    Sponsor
    The Cleveland Clinic
    Collaborators
    Salient Surgical Technologies
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01027195
    Brief Title
    Evaluation of the Efficacy of the Bipolar Sealer Aquamantys 6.0 in Patients Undergoing Total Hip Arthroplasty
    Acronym
    Hip
    Official Title
    Evaluation of the Efficacy of the Bipolar Sealer Aquamantys 6.0 in Patients Undergoing Total Hip Arthroplasty
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2012
    Overall Recruitment Status
    Completed
    Study Start Date
    August 2006 (undefined)
    Primary Completion Date
    April 2009 (Actual)
    Study Completion Date
    June 2009 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    The Cleveland Clinic
    Collaborators
    Salient Surgical Technologies

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The present prospective, single-center, clinical trial is designed to evaluate the hemostatic efficacy of the hemostatic sealer Aquamantys 6.0™ in patients managed with total hip arthroplasty (THA). It is hypothesized that Aquamantys 6.0™ can improve hemostasis following total hip arthroplasty. Comparison of the functional and clinical results between THA patients having been exposed to Aquamantys 6.0™ versus a control group will be analyzed using several outcome measures including the Harris Hip Score and a pain scale. The primary variable of interest is transfusion requirements - specifically, number of patients managed with blood transfusion during the hospital stay after surgery. However, of secondary interest will be: 1) number of units transfused, 2) estimated intraoperative total blood loss, 3) change in pre- and post-operative hemoglobin levels, 4) total narcotic usage during hospital stay, 5) length of stay, 6) functional and pain outcomes (Harris Hip Score and Pain Scale), and 7) adverse events.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Hip Arthritis

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    140 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Standard Bovie Electrocautery
    Arm Type
    Placebo Comparator
    Arm Description
    Standard Bovie electrocautery [Valleylab, Boulder, Colorado] used on surgical site during primary total hip arthroplasty to deliver high frequency electrical current to seal tissues and blood vessels.
    Arm Title
    Bipolar Radiofrequency
    Arm Type
    Experimental
    Arm Description
    Aquamantys 6.0 bipolar sealer [Salient Surgical Technologies, Portsmouth, New Hampshire] used on surgical site during primary total hip arthroplasty to deliver radiofrequency energy coupled with saline solution irrigation for hemostatic sealing (i.e. shrinking of collagen in the walls of tissue vessels) at lower temperatures (<100 degrees Celsius) than standard Bovie electrocautery.
    Intervention Type
    Device
    Intervention Name(s)
    Bipolar Radiofrequency (Aquamantys 6.0)
    Other Intervention Name(s)
    Aquamantys 6.0
    Intervention Type
    Device
    Intervention Name(s)
    Standard Bovie Electrocautery
    Primary Outcome Measure Information:
    Title
    Number of Patients Managed With Blood Transfusion
    Time Frame
    daily during hospital stay (an expected average of 4 days)
    Secondary Outcome Measure Information:
    Title
    Number of Units Transfused
    Time Frame
    daily during hospital stay (an expected average of 4 days)
    Title
    Estimated Blood Loss
    Time Frame
    Intraoperative (day of surgery)
    Title
    Change in Hemoglobin Level
    Description
    Change in hemoglobin level from baseline to the day of hospital discharge.
    Time Frame
    within 30 days before surgery (preop), day of hospital discharge
    Title
    Total Narcotic Usage (Morphine-equivalent mg) During Hospital Stay
    Description
    Sum of daily morphine-equivalent mg narcotic usage during hospital stay.
    Time Frame
    daily during hospital stay (an expected average of 4 days)
    Title
    Length of Stay
    Time Frame
    day of hospital discharge
    Title
    Harris Hip Score (Outcome Score)
    Description
    A scoring system used to evaluate the outcome after total hip replacement. Domains include pain (44 points), function (47 points), deformity (4 points), and range of motion (5 points). A total score is computed by summing the individual domain scores, with a maximum of 100 points. Higher values represent better outcomes. A total Harris Hip Score below 70 points is generally considered a poor result, 70 to 80 fair, 80 to 90 good, and 90 to 100 excellent.
    Time Frame
    within 30 days before surgery (preop), 4 weeks after surgery, 12 weeks after surgery
    Title
    Pain Score Scale
    Description
    A single scoring system used to evaluate overall pain on a scale of integers 0 to 10, with 0 representing "no pain" and 10 representing "unbearable pain." Thus, in this context, lower values represent better outcomes.
    Time Frame
    within 30 days before surgery (preop), 4 weeks after surgery, 12 weeks after surgery

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    85 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Age: 18 - 85 years Sex: Both male and female will be included. The male-to-female ratio will depend upon the patient population. Stable Health: At the time of surgery based on physical examination and medical history. Patient exhibited preoperative radiographic evidence of joint degeneration consistent with THA that could not have been treated in non-operative fashion. Patient had severe hip pain and disability due to degenerative joint disease. Patient or patient's legal representative has signed the Informed Consent form. The patient is capable of making informed decisions regarding his/her healthcare. Exclusion Criteria: Patients with history of cardiac disease, liver disease or renal disease. Severe cardiac disease, liver disease and renal dysfunction can confound different parameters within this study. Patients with decreased cardiac function from prior myocardial infarction, cardiomyopathy or congestive heart failure will likely require transfusions with packed red blood cells at lower thresholds relative to healthy counterparts for cardioprotection. Therefore, patients with a prior history of myocardial infarction, cardiomyopathy, congestive heart failure or other significant cardiac history will be excluded from this study. In addition, patients with liver dysfunction from cirrhosis or hepatitis may have impaired production of factors in the clotting cascade which may make these individuals more prone to bleed, especially with the use of anticoagulants such as lovenox. For this reason, these patients will also be excluded from this study. Finally, individuals with renal dysfunction will have decreased creatinine clearance, which may artificially elevate the levels of lovenox, thereby promoting bleeding. In addition, individuals with severe renal disease may also have associated anemia which would complicate the transfusion threshold. For this reason, individuals with chronic renal failure, diabetic nephropathy, or decreased creatinine clearance will be excluded from this study. Patients predonating autologous blood. Patients with preoperative hemoglobin level less than 11.5 g/dL or a hematocrit less than 35%. Patients with a preoperative platelet count of less than 100,000. Patients undergoing bilateral or revision surgery. Evidence of bleeding or metabolic - based hemolytic disorder (hemophilia or anticoagulation use) Previous history of infection in the affected joint. Peripheral vascular disease. Patient was a poor compliance risk - treated for ethanol or drug abuse, physical or mental handicap, etc. Patients whose personal beliefs exclude the use of blood transfusions (example: Jehovah's witness).
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Wael K Barsoum, MD
    Organizational Affiliation
    The Cleveland Clinic
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    21411700
    Citation
    Barsoum WK, Klika AK, Murray TG, Higuera C, Lee HH, Krebs VE. Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer. J Bone Joint Surg Am. 2011 Mar 16;93(6):513-8. doi: 10.2106/JBJS.J.00036.
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