Functional Capacity After Computer Assisted Periacetabular Osteotomy in Patients With Hip Dysplasia
Primary Purpose
Hip Dysplasia
Status
Completed
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
computer-assisted surgery
Sponsored by
About this trial
This is an interventional treatment trial for Hip Dysplasia
Eligibility Criteria
Inclusion Criteria:
- Radiological diagnosed dysplasia (i.e. centre-edge angle < 25 degrees)
- osteoarthritis degree ≤ 1 according to the criteria of Tonnis
- pain from hip
- minimum 110 degrees flexion in the hip and good rotation
- closed growth zones in the pelvis
Exclusion Criteria:
- neuromuscular diseases
- previously major hip surgery
- pain in the leg (>3 on VAS) other than from the hip
- persons with cognitive problems
- persons unable to speak or understand Danish
Sites / Locations
- Aarhus University Hospital
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
computer-assisted surgery
Arm Description
use of computer-assisted navigation during periacetabular osteotomy
Outcomes
Primary Outcome Measures
correction of acetabular fragment in 3D
position of acetabular fragment measured in three dimensions
Secondary Outcome Measures
functional capacity
measured in functional tests with inertia-based measurement analysis
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02015247
Brief Title
Functional Capacity After Computer Assisted Periacetabular Osteotomy in Patients With Hip Dysplasia
Official Title
Functional Capacity After Computer Assisted Periacetabular Osteotomy in Patients With Hip Dysplasia
Study Type
Interventional
2. Study Status
Record Verification Date
August 2013
Overall Recruitment Status
Completed
Study Start Date
December 2013 (undefined)
Primary Completion Date
November 2014 (Actual)
Study Completion Date
March 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Aarhus
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Pathogenesis of hip dysplasia Hip dysplasia is multifactorial in origin influenced by genetic and intrauterine factors, such as mechanical (rump presentation and oligohydramnios) and hormonal factors1. To ease the passage through the birth canal, the hip joint is quite mobile perinatally. Postnatally, the laxity of the ligaments will subside and the femoral head will normally position itself deeply in the acetabulum2. The theory is that if the femoral head does not migrate sufficiently into the acetabulum, dysplasia may develop because the matrice to stimulate acetabular growth is not correctly positioned. Normally, at birth the femoral head sits deep in the acetabulum held by surface tension of the synovial liquid. The growth and the hemispherical morphology of acetabulum are dependent on the presence of a normally growing and correctly placed spherical femoral head that works as a convex matrice. If for some reason the normal development is disturbed pre- or postnatally, pathologic relations may develop between the femoral head and the acetabulum3, leading to hip dysplasia.
Purpose of this research project is to investigate if the correction of the acetabulum is accurately performed when the surgeon use navigation equipment during PAO.
Detailed Description
Morphological changes in hip dysplasia The dysplastic hip joint has a complex morphology characterised by a wide shallow acetabular cavity with an excessively oblique articulating roof. The acetabular cover of the femoral head is globally deficient4;5 and the acetabular rim is hypertrophied possibly due to excessive pull from the often hypertrophic labrum. Anteversion is normal5-7, but occasionally the acetabulum is retroverted8;9. The weight-bearing area between the acetabular roof and head is reduced and the articular cartilage is significantly thicker than normal10. Hip dysplasia is often associated with increased anteversion of the femoral neck5;11 and with valgus neck-shaft angle that results in a reduced abductor lever arm12. However the deformities vary from individual to individual and retroversion of the femoral neck has also been reported in hip dysplasia12. Patients with hip dysplasia are prone to developing osteoarthritis of the hip at a young age 13;14. The reasons for this are not fully understood, but an explanation could be that the reduced contact area between acetabulum and the femoral head as well as a reduced abductor lever arm increase the load per contact-area in the hip joint4. The increased load is a strain on the articular cartilage and believed to result in degeneration of cartilage and the subchondral bone and eventually osteoarthritis14-17. The purpose of periacetabular osteotomy (PAO) is to increase acetabular cover of the femoral head and thereby distribute pressures better over the available cartilage surface.
PAO followed by rehabilitation At PAO, the pubic bone is osteotomized and under fluoroscopic control, the ischial osteotomies and the posterior iliac osteotomy are performed. The acetabular fragment is repositioned to optimise coverage of the femoral head. The repositioning is very challenging and clearly the most demanding aspect of the procedure18. Four weeks after discharge, the rehabilitation is initiated and carried out by two physiotherapists specialised in orthopaedics. The patients come to the hospital for physiotherapy twice a week and each exercise session is 1 hour with a 30-minute aerobic and strength program followed by a 30-minute program of mobility and gait training. Physiotherapy is ended 2-3 months after PAO when the physiotherapists assess that the patient has achieved predetermined functional goals e.g. walking at speed without crutches and ability to run. As a result of the patients' young age, they have had a high physical function and it is the aim, that they will regain this level of function after PAO. It is not yet examined whether PAO patients after surgery attain the functional capacity comparable to the age- and gender-matched population.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hip Dysplasia
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
41 (Actual)
8. Arms, Groups, and Interventions
Arm Title
computer-assisted surgery
Arm Type
Other
Arm Description
use of computer-assisted navigation during periacetabular osteotomy
Intervention Type
Procedure
Intervention Name(s)
computer-assisted surgery
Intervention Description
use of computer-assisted navigation during periacetabular osteotomy
Primary Outcome Measure Information:
Title
correction of acetabular fragment in 3D
Description
position of acetabular fragment measured in three dimensions
Time Frame
4 months postop
Secondary Outcome Measure Information:
Title
functional capacity
Description
measured in functional tests with inertia-based measurement analysis
Time Frame
1 year postop
Other Pre-specified Outcome Measures:
Title
activity
Description
activity measured with 3-axial accelerometer
Time Frame
4 and 12 months postop
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Radiological diagnosed dysplasia (i.e. centre-edge angle < 25 degrees)
osteoarthritis degree ≤ 1 according to the criteria of Tonnis
pain from hip
minimum 110 degrees flexion in the hip and good rotation
closed growth zones in the pelvis
Exclusion Criteria:
neuromuscular diseases
previously major hip surgery
pain in the leg (>3 on VAS) other than from the hip
persons with cognitive problems
persons unable to speak or understand Danish
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kjeld Søballe, DMSc
Organizational Affiliation
University of Aarhus
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Inger Mechlenburg, PhD
Organizational Affiliation
University of Aarhus
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Inger Mechlenburg, PhD
Organizational Affiliation
Aarhus University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Aarhus University Hospital
City
Aarhus
ZIP/Postal Code
8000
Country
Denmark
12. IPD Sharing Statement
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Functional Capacity After Computer Assisted Periacetabular Osteotomy in Patients With Hip Dysplasia
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