Talar Avascular Necrosis: Surgical Angiogenesis vs. Core Decompression

NCT ID: NCT02291900

Last Updated: 2014-11-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-02-28

Study Completion Date

2016-11-30

Brief Summary

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The purpose of this study is to determine if surgical angiogenesis performed in talar avascular necrosis by free microvascular bone grafts from the femoral condyle is a superior technique compared to core decompression and nonvascularized osseous autografts.

Detailed Description

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The aim of this prospective randomized clinical trial is the comparison of two surgical treatment options for talar avascular necrosis (analogical to Ficat and Arlet stage II and III). The randomized study design allows direct comparability of the outcome after either core decompression and nonvascularized osseous autografting from the iliac crest or core decompression and osseous autografting with a free microvascular medial femoral condyle.

Talar avascular necrosis is caused by osseous malperfusion leading to malnutrition and destruction of the talar bone. The extend of this malperfusion is variable and can be categorized in 4 stages. The osseous defects can remain without consequences (stage I) or lead to irreversible talar destruction. The current treatment option for stage II and III is the core decompression followed by osseous auto grafting from the iliac crest. Reducing the intraosseal pressure and filling the drill holes with the bone graft can lead to reperfusion of the talus.

A new technique is to fill the drill hole with a vascularized bone graft from the medial femoral condyle, using microvascular anastomosis. This procedure has already been approved for the treatment of avascular necrosis and malperfusion of the carpus (lunate and scaphoid) as well as the femoral head.

Patients are examined preoperative as well as 3, 6 and 12 month after operation, documenting the active range of motion and pain sensation while resting and on activity. Well established scores like the AOFAS Ankle-Hindfoot Score and the Lower Extremity Functional Scale are used to get subjective and objective informations about patients' daily life and postoperative satisfaction. X-Rays are taken at the same stages. MRIs of the ankle joint with contrast agent are performed before as well as 6 and 12 months after surgery.

Statistical analysis is performed using the Statistical Package for the Social Sciences (SPSS). The Study protocol has been approved by the Ethics Commission of Rheinland-Pfalz. Interventions are done according to the declaration of Helsinki.

Conditions

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Avascular Necrosis of Bone

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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medial femoral condyle

Patients in this arm receive core decompression followed by free vascularized medial femoral condyle graft

Group Type ACTIVE_COMPARATOR

core decompression

Intervention Type PROCEDURE

retrograd drilling of the avascular talar necrosis, followed by osseous autograft

core decompression

Patients in this arm receive core decompression followed by osseous autograft from the iliac crest

Group Type ACTIVE_COMPARATOR

core decompression

Intervention Type PROCEDURE

retrograd drilling of the avascular talar necrosis, followed by osseous autograft

Interventions

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core decompression

retrograd drilling of the avascular talar necrosis, followed by osseous autograft

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Avascular talar necrosis stage 2 and 3 (Ficat and Arlet)
* signed patient consent form

Exclusion Criteria

* steroid or chemo therapy
* participation in a different study
* pregnancy
* peripheral artery occlusive disease stage 3 and 4
* avascular talar necrosis stage 1
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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BG Trauma Center Ludwigshafen

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ulrich Kneser, Phd, MD

Role: STUDY_CHAIR

BG Trauma Center Ludwigshafen

Locations

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BG Trauma Center Ludwigshafen

Ludwigshafen am Rhein, Rhineland-Palatinate, Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Victoria F Struckmann, MD

Role: CONTACT

0049-17663158299

Thomas Kremer, PhD, MD

Role: CONTACT

0049-162-68108913

Facility Contacts

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Victoria F Struckmann, MD

Role: primary

0049-176-63158299

Thomas Kremer, PhD, MD

Role: backup

0049-621-68108913

Other Identifiers

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BGU - 01/14

Identifier Type: -

Identifier Source: org_study_id