Augment® Injectable Bone Graft Compared to Autologous Bone Graft as a Bone Regeneration Device in Hindfoot Fusions

NCT ID: NCT01305356

Last Updated: 2018-12-26

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

299 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-03-31

Study Completion Date

2014-04-30

Brief Summary

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STUDY OBJECTIVES:

To demonstrate equivalent clinical and radiologic outcomes as "gold standard" (Autologous Bone Graft) in a representative clinical model (hindfoot fusions)

STUDY HYPOTHESIS:

Augment® Injectable is an equivalent bone grafting substitute to autologous bone graft in applications as shown by superiority analysis for safety and non-inferiority analysis for effectiveness

STUDY RATIONALE:

To evaluate a fully synthetic bone graft material to facilitate fusion in conditions or injuries requiring bone graft in a representative clinical fusion model and thus the opportunity to provide equivalent union rates as Autologous Bone Graft without necessitating an additional invasive procedure to harvest the graft

Detailed Description

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STUDY DESIGN:

Prospective, randomized, controlled, non-inferiority, multi-center trial

NUMBER OF STUDY CENTERS:

25

NUMBER OF SUBJECTS:

299 Subjects (see "Study Population"). The subject population included subjects enrolled in 3 separate Clinical Trials. (BMTI-2006-01, BMTI-2009-01, and BMTI-2010-01)

STUDY POPULATION:

Male and female subjects 18 years of age or older requiring a hindfoot fusion procedure involving a bone grafting procedure.

TREATMENT GROUPS:

Group I: Standard Rigid Fixation + Autologous Bone Graft Group II: Standard Rigid Fixation + Augment® Injectable Bone Graft

Subjects will be randomized in a 2:1 ratio (Augment® Injectable:Autologous Bone Graft).

ROUTE OF ADMINISTRATION:

Investigational device is manually implanted inside and around the fusion space to ensure Augment® Injectable Bone Graft (beta-TCP/bovine collagen matrix +rhPDGF-BB) or autologous bone graft is contained within the joint space

STUDY DURATION:

Twenty-four month follow-up post-surgery

Conditions

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Degenerative Joint Disease Congenital Deformity Arthritis Osteoarthritis Rheumatoid Arthritis

Keywords

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degenerative joint disease DJD joint fusion hindfoot congenital deformity osteoarthritis rheumatoid arthritis post-traumatic arthritis ankylosing spondylitis Augment(tm) Injectable Bone Graft autologous bone graft autogenous bone graft beta-TCP bovine collagen rhPDGF(bb)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Augment® Injectable Bone Graft

Standard rigid fixation + Augment® Injectable Bone Graft (beta-TCP/bovine collagen matrix + rhPDGF-BB)

Group Type EXPERIMENTAL

Augment® Injectable Bone Graft

Intervention Type DEVICE

Implantation of up to 9cc of Augment® Injectable Bone Graft

Autologous bone graft

Standard Rigid Fixation + Autologous bone graft

Group Type ACTIVE_COMPARATOR

Autologous bone graft

Intervention Type PROCEDURE

Implantation of up to 9cc of autologous bone graft

Interventions

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Augment® Injectable Bone Graft

Implantation of up to 9cc of Augment® Injectable Bone Graft

Intervention Type DEVICE

Autologous bone graft

Implantation of up to 9cc of autologous bone graft

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* at least 18 years old and considered skeletally mature
* diagnosed with degenerative joint disease (DJD) affecting the hindfoot due to a congenital or acquired deformity, osteoarthritis, rheumatoid arthritis, post- traumatic arthritis or ankylosing spondylitis of the ankle, subtalar, calcaneocuboid, and/or talonavicular joints
* requires one of the following hindfoot fusion proceduress with supplemental bone graft/substitute: ankle fusion (tibiotalar), subtalar fusion (talocalcaneal), calcaneocuboid fusion, talonavicular fusion, triple arthrodesis (subtalar, talonavicular and calcaneocuboid joints) OR double fusions (any combination of any two of the following: subtalar, talonavicular and calcaneocuboid joints)
* fusion site able to be rigidly stabilized with no more than 3 screws across the fusion site

* supplemental pins or staples allowed
* supplemental screws external to the fusion site(s) allowed
* signed informed consent document, independent, ambulatory, and can comply with all post-operative evaluations and visits

Exclusion Criteria

* undergone previous fusion surgery at the proposed location, i.e., revision of a failed fusion
* more than one previous procedure at the involved joints
* retained hardware spanning the joint(s) intended for fusion
* procedure anticipated to require plate fixation (including claw plates), IM nails or more than 3 screws to achieve rigid fixation based on pre-op planning
* procedure expected to require more than 9cc of graft material based on pre-op planning
* procedure expected to require structural bone graft, allograft, bone graft substitute, platelet rich plasma (PRP) or bone marrow aspirate
* procedure expected to require a pantalar fusion, i.e., fusion of ankle plus all hindfoot joints (talonavicular, subtalar, and calcaneocuboid) or an ankle fusion in combination with any hindfoot fusion
* radiographic evidence of bone cysts, segmental defects or growth plate fracture near the fusion site that could negatively impact the proposed fusion procedure
* tested positive or been treated for a malignancy in the past or is suspected of having a malignancy or currently undergoing radio- or chemotherapy treatment for a malignancy anywhere in the body, whether adjacent to or distant from the proposed surgical site
* pre-existing sensory impairment, e.g., diabetics with baseline sensory impairment, which limits ability to perform objective functional measurements and may be at risk for complications

\- diabetics not sensitive to the 5.07 monofilament (Semmes-Weinstein) are to be excluded
* metabolic disorder known to adversely affect the skeleton other than primary osteoporosis or diabetes, e.g., renal osteodystrophy or hypercalcemia
* use of chronic medications known to affect the skeleton, e.g., glucocorticoid usage \> 10mg/day
* pre-fracture neuromuscular or musculoskeletal deficiency which limits the ability to perform objective functional measurements
* physically or mentally compromised, e.g., current treatment for a psychiatric disorder, senile dementia, Alzheimer's disease, etc., to the extent that the Investigator judges the subject to be unable or unlikely to remain compliant
* allergic to yeast-derived products or bovine collagen or other bovine-sourced products
* received an investigational therapy within 30 days of proposed surgery or during the follow-up phase of the study
* is a prisoner, known or suspected transient or a history of drug/alcohol abuse within the 12 months prior to screening
* pregnant or intending to become pregnant within 12 months of the study procedure
* morbidly obese defined as BMI \> 45 kg/m2
* currently has an acute infection at the surgical site
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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BioMimetic Therapeutics

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Stephen Roach

Role: STUDY_DIRECTOR

Stryker Trauma and Extremities

Christopher DiGiovanni, MD

Role: PRINCIPAL_INVESTIGATOR

University Orthopaedics, Inc.

Locations

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Tucson Orthopaedic Research Center

Tucson, Arizona, United States

Site Status

University of Arizona

Tucson, Arizona, United States

Site Status

California Pacific Medical Center

San Francisco, California, United States

Site Status

Illinois Bone & Joint Institute, Ltd.

Glenview, Illinois, United States

Site Status

Loyola University Medical Center

Maywood, Illinois, United States

Site Status

Union Memorial Hospital

Baltimore, Maryland, United States

Site Status

Mid Michigan Orthopaedic Institute

East Lansing, Michigan, United States

Site Status

Orthopaedic Associates of Michigan, PC

Grand Rapids, Michigan, United States

Site Status

Desert Orthopaedic Center

Las Vegas, Nevada, United States

Site Status

University of Medicine & Dentistry of New Jersey

Newark, New Jersey, United States

Site Status

Hospital for Special Surgery

New York, New York, United States

Site Status

University of Rochester Medical Center

Rochester, New York, United States

Site Status

OrthoCarolina, PA

Charlotte, North Carolina, United States

Site Status

Cleveland Clinic Orthopaedic

Cleveland, Ohio, United States

Site Status

Orthopedic Foot & Ankle Center

Columbus, Ohio, United States

Site Status

Health Research Institute, Inc.

Oklahoma City, Oklahoma, United States

Site Status

The Rothman Institute

Philadelphia, Pennsylvania, United States

Site Status

Campbell Clinic / InMotion Orthopaedic Research Center

Memphis, Tennessee, United States

Site Status

Texas Health Research & Education Institute

Dallas, Texas, United States

Site Status

St. Luke's Episcopal Hospital

Houston, Texas, United States

Site Status

Life Mark Health Centre

Calgary, Alberta, Canada

Site Status

St. Paul's Hospital

Vancouver, British Columbia, Canada

Site Status

Queen Elizabeth II Health Services

Halifax, Nova Scotia, Canada

Site Status

The Ottawa Hospital

Ottawa, Ontario, Canada

Site Status

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

Countries

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United States Canada

References

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Daniels TR, Younger AS, Penner MJ, Wing KJ, Le IL, Russell IS, Lalonde KA, Evangelista PT, Quiton JD, Glazebrook M, DiGiovanni CW. Prospective Randomized Controlled Trial of Hindfoot and Ankle Fusions Treated With rhPDGF-BB in Combination With a beta-TCP-Collagen Matrix. Foot Ankle Int. 2015 Jul;36(7):739-48. doi: 10.1177/1071100715576370. Epub 2015 Apr 6.

Reference Type RESULT
PMID: 25848134 (View on PubMed)

DiGiovanni CW, Lin SS, Baumhauer JF, Daniels T, Younger A, Glazebrook M, Anderson J, Anderson R, Evangelista P, Lynch SE; North American Orthopedic Foot and Ankle Study Group. Recombinant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/beta-TCP): an alternative to autogenous bone graft. J Bone Joint Surg Am. 2013 Jul 3;95(13):1184-92. doi: 10.2106/JBJS.K.01422.

Reference Type RESULT
PMID: 23824386 (View on PubMed)

Other Identifiers

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BMTI-2010-01

Identifier Type: -

Identifier Source: org_study_id

NCT01008891

Identifier Type: -

Identifier Source: nct_alias