Total Knee Arthroplasty Guidance Systems Study
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Arthritis, Osteoarthritis (OA), Orthopedic |
| Therapuetic Areas: | Rheumatology, Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 45 - Any |
| Updated: | 1/12/2019 |
| Start Date: | July 12, 2016 |
| End Date: | June 1, 2021 |
A Comparison of Surgical Technologies for Accuracy of Prosthesis Placement and Ease of Surgeon Use in Total Knee Arthroplasty
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.
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.
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.
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.
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
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