Gait After THA: Direct Anterior vs Manual Posterior vs Robotic Posterior

NCT ID: NCT07226973

Last Updated: 2025-11-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-09

Study Completion Date

2027-11-15

Brief Summary

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The purpose of this study is to evaluate the gait biomechanics following THA on 3 groups of subjects undergoing DAA (manual) and PA (manual and robotic) surgical approaches.

Detailed Description

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Single-center, three-arm, partially randomized interventional study comparing gait biomechanics after primary total hip arthroplasty (THA) via (1) manual direct anterior approach (DAA), (2) manual posterior approach (PA), and (3) robotic-assisted posterior approach (rPA). One surgeon's patients are randomized to DAA vs PA; the second surgeon's patients receive rPA per routine practice. Outcomes assessors are blinded (motion-capture suit conceals dressings/scars). Gait and sit-to-stand analyses are performed pre-op and at 6 and 12 weeks post-op using a Vicon motion capture system with force plates and surface EMG. Patient-reported outcomes are collected with standard instruments. The trial evaluates short-term biomechanical recovery and patient-reported outcomes across approaches.

Conditions

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Osteoarthritis (OA) of the Hip

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Robotic-Assisted Posterior Approach

Robotic-assisted THA introduces computer-navigated precision into implant alignment and biomechanical restoration. Contemporary systems (e.g., MAKO) offer intraoperative haptic guidance and preoperative CT-based planning to improve component placement accuracy.

Group Type ACTIVE_COMPARATOR

Robotic-assisted total hip arthroplasty via posterior approach

Intervention Type PROCEDURE

Primary THA via posterior approach using pre-op CT-based planning and intra-op robotic assistance

Manual Direct Anterior Approach (DAA)

The DAA utilizes an internervous and intermuscular approach, preserving abductor and posterior soft tissues, and is associated with reduced dislocation rates and accelerated early recovery.⁶ However, it carries a steep learning curve and an elevated risk of lateral femoral cutaneous nerve neuropraxia.

Group Type ACTIVE_COMPARATOR

Total hip arthroplasty via direct anterior approach (manual, non-robotic)

Intervention Type PROCEDURE

Primary THA performed via a direct anterior approach without robotic assistance

Manual Posterior Approach

PA remains the most commonly used technique worldwide, offering extensile exposure and preserved abductor function, though its historical association with increased dislocation risk has necessitated meticulous capsular and soft-tissue repair.

Group Type ACTIVE_COMPARATOR

Total hip arthroplasty via posterior approach (manual, non-robotic)

Intervention Type PROCEDURE

Primary THA performed via a posterior approach without robotic assistance

Interventions

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Total hip arthroplasty via direct anterior approach (manual, non-robotic)

Primary THA performed via a direct anterior approach without robotic assistance

Intervention Type PROCEDURE

Total hip arthroplasty via posterior approach (manual, non-robotic)

Primary THA performed via a posterior approach without robotic assistance

Intervention Type PROCEDURE

Robotic-assisted total hip arthroplasty via posterior approach

Primary THA via posterior approach using pre-op CT-based planning and intra-op robotic assistance

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adults aged \>18 undergoing primary elective THA for osteoarthritis
* BMI \<35
* Ability to walk unassisted (cane, walker, wheelchair, ect) for \> 150 feet preoperatively

Exclusion Criteria

* Previous hip surgery on the affected side
* Neurological disorders affecting gait
* Contraindication to either DAA or PA
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ochsner Health System

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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George Chimento, MD

Role: PRINCIPAL_INVESTIGATOR

Ochsner Health System

Locations

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Ochsner Health Center - Elmwood

Metairie, Louisiana, United States

Site Status RECRUITING

Ochsner Medical Center

New Orleans, Louisiana, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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George Chimento, MD

Role: CONTACT

Phone: 504-736-4800

Email: [email protected]

Ken Bode

Role: CONTACT

Phone: 504-842-1936

Email: [email protected]

Facility Contacts

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Miguel Jaramillo

Role: primary

Miguel Jaramillo

Role: primary

References

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Varin D, Lamontagne M, Beaule PE. Does the anterior approach for THA provide closer-to-normal lower-limb motion? J Arthroplasty. 2013 Sep;28(8):1401-7. doi: 10.1016/j.arth.2012.11.018. Epub 2013 Mar 16.

Reference Type BACKGROUND
PMID: 23507070 (View on PubMed)

Yan L, Ge L, Dong S, Saluja K, Li D, Reddy KS, Wang Q, Yao L, Li JJ, Roza da Costa B, Xing D, Wang B. Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2023 Jan 3;6(1):e2253942. doi: 10.1001/jamanetworkopen.2022.53942.

Reference Type BACKGROUND
PMID: 36719679 (View on PubMed)

Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty. 2015 Mar;30(3):419-34. doi: 10.1016/j.arth.2014.10.020. Epub 2014 Oct 22.

Reference Type BACKGROUND
PMID: 25453632 (View on PubMed)

Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Feb 8;20(1):63. doi: 10.1186/s12891-019-2450-2.

Reference Type BACKGROUND
PMID: 30736783 (View on PubMed)

Ang JJM, Onggo JR, Stokes CM, Ambikaipalan A. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2773-2792. doi: 10.1007/s00590-023-03528-8. Epub 2023 Apr 3.

Reference Type BACKGROUND
PMID: 37010580 (View on PubMed)

Putananon C, Tuchinda H, Arirachakaran A, Wongsak S, Narinsorasak T, Kongtharvonskul J. Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis. Eur J Orthop Surg Traumatol. 2018 Feb;28(2):255-267. doi: 10.1007/s00590-017-2046-1. Epub 2017 Sep 27.

Reference Type BACKGROUND
PMID: 28956180 (View on PubMed)

Wang Z, Bao HW, Hou JZ. Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 2019 Feb 26;14(1):63. doi: 10.1186/s13018-019-1095-z.

Reference Type BACKGROUND
PMID: 30808382 (View on PubMed)

Wang Z, Hou JZ, Wu CH, Zhou YJ, Gu XM, Wang HH, Feng W, Cheng YX, Sheng X, Bao HW. A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res. 2018 Sep 6;13(1):229. doi: 10.1186/s13018-018-0929-4.

Reference Type BACKGROUND
PMID: 30189881 (View on PubMed)

Fagotti L, Falotico GG, Maranho DA, Ayeni OR, Ejnisman B, Cohen M, Astur DC. POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Acta Ortop Bras. 2021 Nov-Dec;29(6):297-303. doi: 10.1590/1413-785220212906244610.

Reference Type BACKGROUND
PMID: 34849093 (View on PubMed)

Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013 Oct;28(9):1634-8. doi: 10.1016/j.arth.2013.01.034. Epub 2013 Mar 19.

Reference Type BACKGROUND
PMID: 23523485 (View on PubMed)

Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, Armstrong MS, Singh PJ. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach. J Arthroplasty. 2017 Mar;32(3):883-890. doi: 10.1016/j.arth.2016.08.027. Epub 2016 Aug 31.

Reference Type BACKGROUND
PMID: 27687805 (View on PubMed)

Rosenlund S, Broeng L, Holsgaard-Larsen A, Jensen C, Overgaard S. Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach. Acta Orthop. 2017 Jun;88(3):239-247. doi: 10.1080/17453674.2017.1291100. Epub 2017 Feb 18.

Reference Type BACKGROUND
PMID: 28464754 (View on PubMed)

Meneghini RM, Smits SA, Swinford RR, Bahamonde RE. A randomized, prospective study of 3 minimally invasive surgical approaches in total hip arthroplasty: comprehensive gait analysis. J Arthroplasty. 2008 Sep;23(6 Suppl 1):68-73. doi: 10.1016/j.arth.2008.05.014.

Reference Type BACKGROUND
PMID: 18722305 (View on PubMed)

Petis S, Howard J, Lanting B, Jones I, Birmingham T, Vasarhelyi E. Comparing the anterior, posterior and lateral approach: gait analysis in total hip arthroplasty. Can J Surg. 2018 Feb;61(1):50-57. doi: 10.1503/cjs.003217. Epub 2017 Dec 1.

Reference Type BACKGROUND
PMID: 29368677 (View on PubMed)

Reininga IH, Stevens M, Wagenmakers R, Boerboom AL, Groothoff JW, Bulstra SK, Zijlstra W. Comparison of gait in patients following a computer-navigated minimally invasive anterior approach and a conventional posterolateral approach for total hip arthroplasty: a randomized controlled trial. J Orthop Res. 2013 Feb;31(2):288-94. doi: 10.1002/jor.22210. Epub 2012 Aug 8.

Reference Type BACKGROUND
PMID: 22886805 (View on PubMed)

Nelms NJ, Birch CE, Halsey DH, Blankstein M, McGinnis RS, Beynnon BD. Assessment of Early Gait Recovery After Anterior Approach Compared to Posterior Approach Total Hip Arthroplasty: A Smartphone Accelerometer-Based Study. J Arthroplasty. 2020 Feb;35(2):465-470. doi: 10.1016/j.arth.2019.09.030. Epub 2019 Sep 26.

Reference Type BACKGROUND
PMID: 31629624 (View on PubMed)

Other Identifiers

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2025.027

Identifier Type: -

Identifier Source: org_study_id