HIPGEN: a randomized, multicentre phase III study using intramuscular PLacenta-eXpanded stromal cells therapy for recovery following hip fracture arthroplasty : a study design

Abstract

Aims: The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells.

Methods: HIPGEN is a multicentre, multinational, randomized, double-blind, placebo-controlled trial. A total of 240 patients aged 60 to 90 years with low-energy femoral neck fractures (FNF) will be allocated to two arms and receive an intramuscular injection of either 150 × 10⁶ PLX-PAD cells or placebo into the medial gluteal muscle after direct lateral implantation of total or hemi hip arthroplasty. Patients will be followed for two years. The primary endpoint is the Short Physical Performance Battery (SPPB) at week 26. Secondary and exploratory endpoints include morphological parameters (lean body mass), functional parameters (abduction and handgrip strength, symmetry in gait, weightbearing), all-cause mortality rate and patient-reported outcome measures (Lower Limb Measure, EuroQol five-dimension questionnaire). Immunological biomarker and in vitro studies will be performed to analyze the PLX-PAD mechanism of action. A sample size of 240 subjects was calculated providing 88% power for the detection of a 1 SPPB point treatment effect for a two-sided test with an α level of 5%.

Conclusion: The HIPGEN study assesses the efficacy, safety, and tolerability of intramuscular PLX-PAD administration for the treatment of muscle injury following arthroplasty for hip fracture. It is the first phase III study to investigate the effect of an allogeneic cell therapy on improved mobilization after hip fracture, an aspect which is in sore need of addressing for the improvement in standard of care treatment for patients with FNF. Cite this article: Bone Jt Open 2022;3(4):340-347.

Keywords: Allogeneic cell therapy; Cell therapy; Femoral neck fracture; Hip fracture; Hip fractures; Lower Extremities; PLX-PAD; arthroplasty; cell-based therapy; femoral neck fractures; hip arthroplasty; intramuscular injections; muscle injuries; strength; stromal cells.

Fig. 1

Schematic study design of the HIPGEN trial. Main study period comprises four periods (screening and pre-surgery; surgery and treatment with placenta-derived adherent stromal cells (PLX-PAD) or placebo (Pbo); hospital follow-up until discharge; follow-up period of 104 weeks). d, day; HA, hemiarthroplasty; placebo; THA, total hip arthroplasty; w, week.

Fig. 2

The ten sites of injection after suture using the direct lateral approach.