Knee Arthroplasty Performed With Conventional and Customized Instrumentation

NCT ID: NCT01124305

Last Updated: 2013-12-18

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-05-31

Study Completion Date

2012-11-30

Brief Summary

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The main purpose of this study is to determine whether the surgical time required for primary total knee arthroplasty is significantly less when performed with Customized Patient Instrumentation (CPI) than with conventional instrumentation. Each case will be recorded by video camera, in order to time the length of surgery and each surgical step. The number of surgical trays required for each case will be recorded. As an additional endpoint, the investigators will measure limb and component alignment on x-rays to determine if these two methods achieve equivalent alignment results. The thickness of bone cuts will be compared to the surgical plan and to each other.

The primary hypothesis is that the use of customized patient instrumentation will reduce the operative time required for total knee arthroplasty.

Detailed Description

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Patient-specific instrumentation (PSI) has been developed for total knee arthroplasty (TKA) with several potential advantages over traditional instrumentation (TI). Shortened surgical time, fewer surgical instruments, and improved alignment are some of these proposed advantages. We sought to examine these assertions.

52 patients (26 per group) were enrolled in a prospective, randomized trial comparing CT-based PSI with TI. No difference was seen in average patient age (68 years) or BMI (31) between groups (p=0.84 and p=0.89), although there were more males in the PSI group (14 vs 7, p=0.002). A single surgeon and consistent staff performed the surgeries with the same knee prostheses, and all cases were videotaped to measure the length of surgery and each individual step. Any additional bone cuts, size changes, or ligament releases made to achieve correct alignment and balance were documented. The number of instrument trays opened for each case was recorded. Postoperative long alignment and lateral radiographs were taken to measure the coronal and sagittal plane component alignment and mechanical axis in each patient.

Conditions

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Knee Arthritis

Keywords

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Total Knee Arthroplasty Instrumentation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Traditional Instrumentation

Control group: Cases performed with traditional surgical instruments

Group Type ACTIVE_COMPARATOR

Traditional Instrumentation

Intervention Type DEVICE

Traditional surgical instruments will be used to make bone cuts and size the components in this control group.

Customized Patient Instrumentation

Experimental group: Cases performed with custom instruments specifically made for each patient using pre-op CT scans.

Group Type EXPERIMENTAL

Customized Patient Instrumentation

Intervention Type DEVICE

Custom cutting guides based on computed tomography (CT) images of the patient's leg are used to make the bone cuts and select the implant size.

Interventions

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Customized Patient Instrumentation

Custom cutting guides based on computed tomography (CT) images of the patient's leg are used to make the bone cuts and select the implant size.

Intervention Type DEVICE

Traditional Instrumentation

Traditional surgical instruments will be used to make bone cuts and size the components in this control group.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patient requires unilateral primary total knee arthroplasty

Exclusion Criteria

* Body mass index greater than 41
* Previous ipsilateral hip or ankle replacement
* Knee flexion contracture greater than 20 degrees
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Anderson Orthopaedic Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Nancy Parks

Knee Project Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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William G Hamilton, MD

Role: PRINCIPAL_INVESTIGATOR

Anderson Orthopaedic Research Institute

Locations

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Anderson Orthopaedic Research Institute

Alexandria, Virginia, United States

Site Status

Countries

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United States

References

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Lombardi AV Jr, Berend KR, Adams JB. Patient-specific approach in total knee arthroplasty. Orthopedics. 2008 Sep;31(9):927-30. doi: 10.3928/01477447-20080901-21. No abstract available.

Reference Type BACKGROUND
PMID: 18814618 (View on PubMed)

Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res. 2012 Jan;470(1):99-107. doi: 10.1007/s11999-011-1996-6.

Reference Type BACKGROUND
PMID: 21809150 (View on PubMed)

Howell SM, Kuznik K, Hull ML, Siston RA. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics. 2008 Sep;31(9):857-63. doi: 10.3928/01477447-20080901-15.

Reference Type BACKGROUND
PMID: 18814593 (View on PubMed)

Bali K, Walker P, Bruce W. Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplasty. 2012 Jun;27(6):1149-54. doi: 10.1016/j.arth.2011.12.006. Epub 2012 Jan 27.

Reference Type BACKGROUND
PMID: 22285230 (View on PubMed)

Watters TS, Mather RC 3rd, Browne JA, Berend KR, Lombardi AV Jr, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv. 2011 Summer;20(2):112-6.

Reference Type BACKGROUND
PMID: 21838072 (View on PubMed)

Other Identifiers

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AORI2010-0101

Identifier Type: -

Identifier Source: org_study_id