Avascular Necrosis of Hip, Bone Marrow Edema, Dysplasia; Hip, Femoroacetabular Impingement, Insufficiency Fractures, Subchondral Bone Edema, Subchondral Cysts
Conditions
Keywords
Subchondroplasty, Bone Marrow Lesion, Arthroscopy, Bone Substitute Material, AccuFill, Subchondral Bone Defect
Brief summary
Post-market clinical outcomes study to collect data on the short- and long-term outcomes for subjects who are undergoing or have undergone the Subchondroplasty® (SCP®) Procedure in the hip in a standard clinical setting. Outcomes to be assessed include medication usage, pain, function, activity levels and patient satisfaction.
Detailed description
This study is designed as a post-market, single arm, non-randomized multi-center investigation. Male and female subjects, at least 18 years of age, with at least one subchondral bone defect in the form of a cyst and/or bone marrow lesion (BML), insufficiency fracture or bone defect associated with early stage avascular osteonecrosis (AVN) in the femoral head, femoral neck and/or acetabulum who are suitable candidates for use of AccuFill during the Subchondroplasty Procedure are eligible for enrollment in this study. A maximum of 15 study sites, in the United States of America, will enroll a target of 50 subjects. Each Investigator must obtain IRB approval, or favorable opinion by an EC, prior to consent of the first subject; no study-related procedures can occur without the approval and oversight of a registered IRB or EC. If the study site does not have an IRB of record, a central IRB may be utilized upon approval by Zimmer Biomet. Demographics, medical history, hip history and use of pain medication and therapy will be recorded at the time of subject consent. Additionally, patient reported outcomes measures will be obtained pre-operatively. Operative details including the SCP Procedure, concomitant surgical procedures and intraoperative safety events will be recorded at the time of surgery. Prospective subjects will be considered enrolled in this study once their Subchondroplasty Procedure has been performed. Subjects will complete only the Numeric Pain Scale at 2 weeks post-operatively. Thereafter, subjects will complete self-reported outcomes measures post-operatively at 6 weeks, 12 weeks, 6 months, 1 year and 2 years. These measures include information on pain medication and therapy, pain levels, function, activity and subject satisfaction. Screening for adverse events and conversion will occur throughout the study. Subjects will complete the study at 2 years or will be withdrawn if they undergo conversion of the Subchondroplasty site. For the purposes of this protocol, a conversion will be defined as total hip arthroplasty or any procedure involving removal of the AccuFill material on the index hip.
Interventions
Injection of the commercially available flowable calcium phosphate (CaP) synthetic bone-void filler, AccuFill®, into subchondral bone defects in the hip (Subchondroplasty (SCP) Procedure).
Sponsors
Study design
Eligibility
Inclusion criteria
* Candidates must meet ALL of the following: 1. Surgeon considers the patient appropriate for the SCP Procedure of the hip. 2. Subchondral bone defect(s) in the femoral head, femoral neck and/or acetabulum has been confirmed via radiographic finding on MRI or x-ray. 3. Subject provides voluntary signature on the IRB approved Informed Consent Form. 4. Subject is at least 18 years of age. 5. Subject must be physically and mentally willing and able, in the Investigator's opinion at the time of enrollment, to be compliant with the protocol and complete outcome forms via email, telephone, in-person or by regular mail.
Exclusion criteria
* Candidates will be excluded if they meet ANY of the following: 1. Subject has collapse of subchondral bone. 2. Subject is pregnant at the time of surgery. 3. Subject is incarcerated. 4. Subject is involved in active litigation related to the condition being treated. 5. Subject is not comfortable with speaking, reading, and understanding questions and providing responses in an available language for the PROs in the protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Group Mean Improvement From Baseline of the Modified Harris Hip Score (mHHS) at 2 Years | 2 Years | Change in Modified Harris Hip Score using a 0-100 overall score, from baseline at 2-years. Subscales of pain, function, and activity levels are combined to generate the overall score. Pain is scored out of 44 possible points, function is scored out of 33 possible points and subject activities are scored out of 14 possible points. The maximum score of 91 is multiplied by 1.1 to give a total score out of 100; a higher score represents better patient reported pain, function and activity levels. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain and Functional Performance by Numeric Pain Scale (NPS) | 2 weeks postoperative | Pain intensity was assessed using the Numeric Pain Scale (0-10), where 0 indicates no pain and 10 indicates worst possible pain. |
| Modified Harris Hip Score (mHHS) | 6 weeks postoperative | Hip function and pain were assessed using the Modified Harris Hip Score (mHHS), a validated instrument that evaluates pain, daily activities, and gait. Scores range from 0 to 100, where higher scores indicate better hip function and less pain. Change from baseline was calculated at each follow-up timepoint. |
| Subject Quality-of-life Measured by the EQ-5D-5L Score | 6 weeks | Quality of life will be assessed using the EQ-5D-5L questionnaire, which evaluates five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension is rated on five levels of severity. Responses will be converted into a single utility index score using the appropriate value set, with values typically ranging from 0 (worst health) to 1 (best health). Higher scores indicate better quality of life. |
| Subject Quality-Of-Life Measured by the EQ-5D-5L Visual Analog Scale (VAS) | 6 Weeks | The EQ-5D-5L VAS records the subject's self-rated health on a scale from 0 (worst imaginable health) to 100 (best imaginable health). |
Countries
United States
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 2 Participants |
| Age, Categorical Between 18 and 65 years | 75 Participants |
| Age, Continuous | 41.5 years STANDARD_DEVIATION 12 |
| EQ-5D-5L Index Score All subjects | 0.2 Index Score STANDARD_DEVIATION 0.4 |
| EQ-5D-5L Index Score Off-Label Subjects | 0.3 Index Score STANDARD_DEVIATION 0.4 |
| EQ-5D-5L Index Score On-Label Subjects | 0.2 Index Score STANDARD_DEVIATION 0.4 |
| EQ-5D-5L Visual Analog Scale (VAS) All Subjects | 67.4 Score (0-100) on a scale STANDARD_DEVIATION 22.5 |
| EQ-5D-5L Visual Analog Scale (VAS) Off-Label Subjects | 68.7 Score (0-100) on a scale STANDARD_DEVIATION 24.7 |
| EQ-5D-5L Visual Analog Scale (VAS) On-Label Subjects | 66.9 Score (0-100) on a scale STANDARD_DEVIATION 21.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 76 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Modified Harris Hip Score (mHHS) All Subjects | 55.0 Points (0-100 scale) STANDARD_DEVIATION 20.6 |
| Modified Harris Hip Score (mHHS) Off-Label Subjects | 53.4 Points (0-100 scale) STANDARD_DEVIATION 22.2 |
| Modified Harris Hip Score (mHHS) On-Label Subjects | 55.5 Points (0-100 scale) STANDARD_DEVIATION 20.2 |
| Numeric Pain Scale (NPS) All Subjects | 5.9 Score on a scale STANDARD_DEVIATION 2.6 |
| Numeric Pain Scale (NPS) Off-Label | 6.4 Score on a scale STANDARD_DEVIATION 2.5 |
| Numeric Pain Scale (NPS) On-Label Subjects | 5.8 Score on a scale STANDARD_DEVIATION 2.7 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 15 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 61 Participants |
| Sex: Female, Male Female | 27 Participants |
| Sex: Female, Male Male | 50 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 59 | 0 / 18 |
| other Total, other adverse events | 2 / 59 | 2 / 18 |
| serious Total, serious adverse events | 11 / 59 | 4 / 18 |