Arthroplasty, Replacement, Knee Clinical Trial
Official title:
Durable, Real-component Antibiotic Spacers vs All-cement Articulating Spacers for the Treatment of Periprosthetic Knee Infection
In the US, if you get an infection in your artificial knee joint that doesn't heal with antibiotics alone, the standard treatment is a two-stage revision of the artificial knee. In the first stage, your surgeon will remove your artificial knee and clean out the area around the knee. They will then place an antibiotic spacer. An antibiotic spacer is a type of artificial joint that will release antibiotics in to the knee space continuously over time. The spacer allows only very basic function of the knee. You may need to use crutches or a walker while the antibiotic spacer is in place. After surgery to place the antibiotic spacer, your surgeon may prescribe a course of antibiotics as well. Because the antibiotic spacer is not as durable as a regular artificial joint, after the infection is gone, another surgery is required to take the spacer out and put a new artificial knee joint in. There is another way for artificial joint infections to be treated. This is a one-stage revision. In this treatment, the surgeon will remove your artificial knee and clean out the area around the knee. Then they will place a new artificial knee in using a special kind of cement that contains antibiotics. The cement will release antibiotics in to the knee space continuously over time (your surgeon may prescribe a course of antibiotics as well). The new artificial joint with antibiotic cement will function almost the same as your original artificial knee. This means that while the infection is healing you will be able to do most of your regular daily activities. However, the antibiotic cement is not as durable as what is normally used to implant an artificial knee. The artificial knee with the antibiotic cement may need to be replaced with a regular artificial knee. When replacement will need to be done is dependent on your weight, bone strength and activity level, among other things. When it is time to replace the antibiotic cement artificial knee, you will have another surgery where the surgeon will take the antibiotic cement artificial knee and but a new artificial knee joint in. We know that both the one- and two-stage revision work equally well to heal the infection, but we don't know which patients prefer or which provides better function after many years. This study will randomly assign patients to receive either a one-stage or two-stage revision and then follow them for 5 years to ask them about pain, function, and satisfaction.
Status | Not yet recruiting |
Enrollment | 153 |
Est. completion date | December 2026 |
Est. primary completion date | March 2026 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Patients diagnosed with a chronic periprosthetic joint infection after a primary total knee arthroplasty with plan for explant and placement of an antibiotic spacer - PJI defined according to Musculoskeletal Infection Society (MSIS) 2018 Consensus Criteria Exclusion Criteria: - Patients who are unable to consent - Infection at site of revision TKA - Soft tissue envelope compromise - Allergies to study materials (cement, vancomycin, tobramycin) - Incompetent extensor mechanism - Extensive bone loss Randomization-specific exclusion criteria - Extensive soft tissue defect - Extensor mechanism compromise |
Country | Name | City | State |
---|---|---|---|
United States | Northwestern Medicine | Chicago | Illinois |
Lead Sponsor | Collaborator |
---|---|
Northwestern University |
United States,
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018 May;33(5):1309-1314.e2. doi: 10.1016/j.arth.2018.02.078. Epub 2018 Feb 26. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Revision/reoperation for infection (defined by positive culture by MSIS criteria) | Count and percentage of occurrence of revision/reoperation for infection | 24 months after surgery | |
Other | revision for aseptic failure (defined by negative culture by MSIS criteria) | Count and percentage of occurrence of reoperation for aseptic failure | 24 months after surgery | |
Primary | 24 month Knee Injury and Osteoarthritis Outcome Score (KOOS) | Scores range from 0 to 100 with a score of 0 indicating the worst possible knee symptoms and 100 indicating no knee symptoms. | 24 months after surgery | |
Secondary | 6 week Knee Injury and Osteoarthritis Outcome Score (KOOS) | Scores range from 0 to 100 with a score of 0 indicating the worst possible knee symptoms and 100 indicating no knee symptoms. | 6 weeks after surgery | |
Secondary | 6 week 10-item PROMIS Global Health survey (PROMIS-10) | Raw PROMIS-10 (v1.0) scores for Physical Health (PH) and Mental Health (MH) will be converted to standardized T-score values. A T-score of 50 represents the mean of the general population and higher scores indicate better physical or mental health. | 6 weeks after surgery | |
Secondary | 6 month Knee Injury and Osteoarthritis Outcome Score (KOOS) | Scores range from 0 to 100 with a score of 0 indicating the worst possible knee symptoms and 100 indicating no knee symptoms. | 6 months after surgery | |
Secondary | 6 month 10-item PROMIS Global Health survey (PROMIS-10) | Raw PROMIS-10 (v1.0) scores for Physical Health (PH) and Mental Health (MH) will be converted to standardized T-score values. A T-score of 50 represents the mean of the general population and higher scores indicate better physical or mental health. | 6 months after surgery | |
Secondary | 12 month Knee Injury and Osteoarthritis Outcome Score (KOOS) | Scores range from 0 to 100 with a score of 0 indicating the worst possible knee symptoms and 100 indicating no knee symptoms. | 12 months after surgery | |
Secondary | 12 month 10-item PROMIS Global Health survey (PROMIS-10) | Raw PROMIS-10 (v1.0) scores for Physical Health (PH) and Mental Health (MH) will be converted to standardized T-score values. A T-score of 50 represents the mean of the general population and higher scores indicate better physical or mental health. | 12 months after surgery | |
Secondary | 24 month 10-item PROMIS Global Health survey (PROMIS-10) | Raw PROMIS-10 (v1.0) scores for Physical Health (PH) and Mental Health (MH) will be converted to standardized T-score values. A T-score of 50 represents the mean of the general population and higher scores indicate better physical or mental health. | 24 months after surgery |
Status | Clinical Trial | Phase | |
---|---|---|---|
Active, not recruiting |
NCT05666479 -
CGM Monitoring in T2DM Patients Undergoing Orthopaedic Replacement Surgery
|
||
Recruiting |
NCT05002387 -
Diagnostic Knee Needle Arthroscopy in Predicting Unicompartmental Knee Osteoarthritis
|
N/A | |
Recruiting |
NCT06080763 -
Biomechanics and Clinical Outcomes in Responders and Non-Responders
|
||
Completed |
NCT03008967 -
A Study of Patients Undergoing Total Knee and Hip Arthroplasty at a Regional Hospital in Denmark
|
N/A | |
Withdrawn |
NCT02255877 -
ZIPS Study - Zip Incision Approximation vs. STAPLE
|
Phase 4 | |
Completed |
NCT02642731 -
Kidney Biomarkers of Acute Kidney Injury in Patients With Knee Arthroplasty
|
N/A | |
Completed |
NCT01799772 -
The Feasibility of a Comprehensive Behavioral Intervention in Patient Post TKA
|
Phase 1/Phase 2 | |
Completed |
NCT02525588 -
Polyethylene Wear Study on the Triathlon Total Knee Prosthesis
|
N/A | |
Completed |
NCT02520531 -
Scorpio Posterior Stabilised (PS) vs Scorpio NRG ("Energize") PS - Total Knee Arthroplasty
|
N/A | |
Completed |
NCT03183856 -
Comparison of Ambulatory and Functional Improvement by Morning Walk
|
N/A | |
Completed |
NCT03569397 -
Music Therapy Versus Control for Total Knee Arthroplasty
|
N/A | |
Terminated |
NCT02711592 -
Pharmacogenomics Information in Enhancing Post-operative Total Joint Replacement Pain Management: a Pilot Study
|
N/A | |
Completed |
NCT03145493 -
Effect of Suction Drains in Total Knee Arthroplasty With Tranexamic Acid
|
N/A | |
Terminated |
NCT05602701 -
Preoperative Prediction of Postoperative Physical Function
|
||
Recruiting |
NCT03570944 -
Postoperative Outcomes Within an Enhanced Recovery After Surgery Protocol (POWER2)
|
||
Withdrawn |
NCT02553122 -
The Combined Efficacy of Evicel and Tranexamic Acid on Total Knee Arthroplasty
|
Phase 3 | |
Completed |
NCT02773537 -
Motor-Sparing Peripheral Nerve Blockade Facilitates Mobility Post Total Knee Arthroplasty: A Randomized Controlled Trial
|
N/A | |
Recruiting |
NCT02385383 -
An Intravenous Iron Based Protocol for Preoperative Anaemia in Hip and Knee Surgery - An Observational Study
|
N/A | |
Completed |
NCT02121392 -
Epidural Catheter With or Without Adductor Canal Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty
|
N/A | |
Terminated |
NCT02155712 -
Triathlon Tritanium Knee Outcomes Study
|
N/A |