Total Knee Arthroplasty Guidance Systems Study

Osteoarthritis, Knee Clinical Trial

Official title:

A Comparison of Surgical Technologies for Accuracy of Prosthesis Placement and Ease of Surgeon Use in Total Knee Arthroplasty

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02830997
• Other study ID #: AOC-OM-St-2015-026
• Status: Completed
• Start date: July 12, 2016
• Est. completion date: January 5, 2021

Study information

• Verified date: July 2022
• Source: Athens Orthopedic Clinic, P.A.
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

In total knee replacement operations, the surgeon uses techniques and instruments to guide the operation and ensure that all parts of the prosthesis (the artificial knee surfaces) are placed into the correct position. There are many techniques a surgeon can use to achieve accuracy in the operation. This study will compare the Principal Investigator's present precision-guided technique and instrumentation methods with a newly developed technique that uses a computer-based stereotactic guidance system. The purposes of the study are: 1.) to learn whether the use of the different guidance systems results in differences of accuracy of the placement of the prosthesis; 2.) to compare the length of time it takes an experienced joint replacement specialist to complete the operation using the different guidance systems; 3.) to learn whether there are advantages of either system in terms of the function and recovery of patients over the first year after surgery; and, 4.) to provide the manufacturer of the stereotactic guidance system with feedback on the technical ease of use and workflow ease of the system which may be used for training and education purposes and/or for planning further refinements to the system. The study will enroll up to 150 patients from Athens Orthopedic Clinic over 2 to 3 years.

Description:

The open-label study aims to enroll up to 75 participants into the conventional guidance arm followed by 75 participants into the stereotactic guidance arm, in sequence.

Detailed observational data will be collected during the surgical procedures, and participating patients will be evaluated at prescribed intervals (pre-operatively, and 2,4,6, and 12 months post-operatively) using survey instruments, clinical indicators, and routine radiologic outcomes. Radiologic outcomes will be assessed using standard x-rays that are obtained in the course of normal care for all patients who undergo total knee arthroplasty (TKA). A subset of the first 30 patients enrolled into each treatment arm will, in addition, be asked to voluntarily undergo a computed tomography (CT) scan of the lower extremity (hip, knee, and ankle joints) 8-12 weeks after surgery to measure 3-dimensional accuracy of prosthesis placement and limb alignment.

Data collection will include:

1. Demographic and background information (age, sex, height, weight, social (occupation/employment), major comorbidity (broadly classified), smoking)

2. Patient reported outcome measures (Veteran's Rand 12-item Health Survey; 2011 Knee Society Score)

3. Physical Examination (knee range of motion, knee stability)

4. Details of the surgical operation

5. Operating room workflow details, including skin-to-skin surgical time

6. Post-operative disposition

7. Radiologic outcomes

1. Routine pre- and post-operative radiographs will be reviewed for limb alignment and evidence of prosthesis fixation

2. Post-operative CT scans (hip, knee, ankle) will be used to evaluate accuracy of placement of the TKA prosthesis (femoral and tibial components) and accuracy of limb alignment in the coronal, sagittal, and axial planes. The values measured from the post-operative CT scan will be compared to those of the final intra-operative plan; lack of difference between the two will constitute 'accuracy'.

8. Adverse events

9. Patients may optionally participate in an additional clinical follow-up visit at 2 years post-operatively, which will include the patient reported outcome measures, physical, examination, and radiographic examination.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 150
• Est. completion date: January 5, 2021
• Est. primary completion date: February 6, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 45 Years and older

Eligibility

Inclusion Criteria:

1. Scheduled to undergo unilateral primary total knee arthroplasty performed by the Principal Investigator at St. Mary's Hospital

2. Use of Triathlon® CR Total Knee System is indicated

3. Spinal anesthetic is planned

4. Age 45 years or greater

5. Body mass index (BMI) = 40 kg/m2

6. Patient is willing and able to undergo postoperative follow-up requirements and self evaluations

7. Patient gives valid informed consent and signs the approved Informed Consent and Protected Health Information Use Authorization forms

Exclusion Criteria:

1. Age < 45 years

2. BMI > 40 kg/m2

3. General anesthetic is planned

4. Patient scheduled for bilateral total knee arthroplasty, or plans to undergo arthroplasty of another lower extremity joint within one year

5. Prior high tibial osteotomy or previous reconstruction to the affected knee including partial arthroplasty

6. Neuromuscular disorders, muscular atrophy, or vascular deficiency in the affected limb

7. Patient is skeletally immature

8. Active infection or suspected infection in or about the joint

9. Bone stock that is inadequate to support fixation of the prosthesis

10. Collateral ligament insufficiency

11. Blood supply limitations, refusal to receive blood transfusion (e.g., religious objection), or medical condition that predisposes patient to increased risk of blood loss (e.g., hemophilia)

12. Patient is non-ambulatory

13. Female patient is pregnant or lactating

14. Patient is incarcerated

15. Patient is critically ill or medically frail

16. Patient with mental or neurological conditions who may be incapable of following instructions

17. Previous history of radiation therapy, or other significant lifetime radiation exposure or contraindication to voluntary medical radiation exposure

18. Has previously participated in or was previously invited to participate in this study during surgery of the contralateral knee, or was previously invited to participate in the opposite treatment arm during surgery of the same knee.

19. Cannot or does not give valid informed consent

Related Conditions & MeSH terms

• Arthroplasty, Replacement, Knee
• Osteoarthritis, Knee

Intervention

Device:
• Stereotactic guidance system

Locations

Country	Name	City	State
United States	Athens Orthopedic Clinic, P.A.	Athens	Georgia

Sponsors (2)

Lead Sponsor	Collaborator
Ormonde M. Mahoney, MD	Stryker Orthopaedics

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Accuracy of total knee arthroplasty component placement in the coronal, axial, and sagittal planes measured by computed tomography scan	Difference of coronal alignment between pre-operative plan and resultant alignment measured by post-operative CT scan	2 months post-operatively
Secondary	Skin-to-skin surgical time in minutes	Skin-to-skin surgical time in minutes	measured during the surgical operation
Secondary	Patient reported physical function measured by 2011 Knee Society Scoring System	Patient reported physical function measured by 2011 Knee Society Scoring System	2, 4, 6, and 12 months post-operatively
Secondary	Patient reported health related quality of life measured by the Veteran's Rand 12-item Health Survey	Patient reported health related quality of life measured by the Veteran's Rand 12-item Health Survey	2, 4, 6, and 12 months post-operatively
Secondary	Patient reported satisfaction measured by 2011 Knee Society Scoring System	Patient reported satisfaction measured by 2011 Knee Society Scoring System	2,4,6, and 12 months post-operatively