Total Knee Arthroplasty Biomechanics

NCT ID: NCT03671954

Last Updated: 2023-11-30

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

COMPLETED

Clinical Phase

NA

Total Enrollment

38 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-05-01

Study Completion Date

2023-11-16

Brief Summary

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In total knee arthroplasty (TKA), the relationship between implant design, soft tissue balance, neuromuscular contributions, and rehabilitation strategies on patient satisfaction and functional outcomes is highly complex and poorly understood. The investigators will prospectively study the effects of these factors using in vivo assessments preoperatively, and postoperatively. Computer simulation models will also be used to analyze lower extremity biomechanics.

Detailed Description

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Total knee arthroplasty (TKA) is the primary treatment for end-stage knee osteoarthritis and effectively relieves pain and improves function after surgery. Nevertheless, as many as 1 in 5 patients are dissatisfied with the postoperative outcome, and knee instability remains one of the top indications for revision surgery. Implant design, soft tissue balance, neuromuscular capabilities, and rehabilitation strategies can all influence postoperative outcomes. However, the relationship between these factors and the most effective therapeutic approach for total knee arthroplasty has yet to be identified. The investigators will study preoperative and postoperative functional measures and patient satisfaction along with implant design and specific intraoperative data, which may help inform a targeted approach for optimal outcomes after total knee arthroplasty and improve future care of patients.

Conditions

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Total Knee Arthroplasty (TKA)

Keywords

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knee osteoarthritis rehabilitation strategies soft tissue balance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The intervention group will perform unsupervised home strengthening exercises for the hip abductors in addition to standard physical therapy, while the control group will receive standard physical therapy alone. Subjects will be assigned to one of two groups by block randomization, such that patients receiving each different implant design comprise each block.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Participant, outcome assessor

Study Groups

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TKA Intervention Group

The TKA intervention group will perform unsupervised home strengthening exercises for the hip abductors in addition to standard physical therapy.

Group Type EXPERIMENTAL

Home Strengthening Exercises

Intervention Type BEHAVIORAL

The intervention group will perform unsupervised home strengthening exercises for the hip abductors in addition to standard physical therapy, while the control group will receive standard physical therapy alone.

Standard Physical Therapy

Intervention Type OTHER

Physician determined standard of care for individual TKA patients.

TKA Control Group

The TKA control group will receive standard physical therapy alone.

Group Type ACTIVE_COMPARATOR

Standard Physical Therapy

Intervention Type OTHER

Physician determined standard of care for individual TKA patients.

Healthy Control Group

The Healthy Control Group, aged 49-85 years without any signs of degenerative joint, disease will undergo the preoperative assessments only.

Group Type ACTIVE_COMPARATOR

Preoperative Assessments

Intervention Type OTHER

Assessments will include:

* TUG (timed up and go test) \>12 sec indicates increased fall risk
* Tandem balance test \< 10 sec indicates increased fall risk
* Sit to Stand test (age based norms)
* Knee Range Of Motion (ROM)
* Quadriceps and hamstring strength (MMT or hand held dynamometer)
* Lower Extremity Functional Score (LEFS questionnaire)

Interventions

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Home Strengthening Exercises

The intervention group will perform unsupervised home strengthening exercises for the hip abductors in addition to standard physical therapy, while the control group will receive standard physical therapy alone.

Intervention Type BEHAVIORAL

Standard Physical Therapy

Physician determined standard of care for individual TKA patients.

Intervention Type OTHER

Preoperative Assessments

Assessments will include:

* TUG (timed up and go test) \>12 sec indicates increased fall risk
* Tandem balance test \< 10 sec indicates increased fall risk
* Sit to Stand test (age based norms)
* Knee Range Of Motion (ROM)
* Quadriceps and hamstring strength (MMT or hand held dynamometer)
* Lower Extremity Functional Score (LEFS questionnaire)

Intervention Type OTHER

Other Intervention Names

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Hip abductor strengthening program

Eligibility Criteria

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Inclusion Criteria

* Patients requiring unilateral TKA for knee osteoarthritis
* No osteoarthritis symptoms in contralateral knee
* Radiographic coronal deformity ≤ 15°
* Preoperative flexion ≥ 90°
* Receiving one of four implants used by UF Orthopaedic surgeons
* Able to walk for a short distance without the use of ambulatory aids
* Healthy Participants:

1. Age 49-85 years
2. Healthy with no signs or symptoms of lower limb arthritis or injury
3. Able to walk for a short distance without the use of ambulatory aids

Exclusion Criteria

* BMI \> 40 kg/m2
* Presence of knee, hip, or ankle prosthesis for either limb
* Presence of hip prosthesis in surgical limb (TKA only subjects)
* History of lower limb or spinal surgery within the last year
* Presence of neurologic or orthopaedic disorders that could affect gait or balance
* Chronic opioid or illicit drug use
* Poorly controlled diabetes (HbA1C \> 7 percent)
* Chronic pain syndrome
* Chronic back pain
* Presence of vestibular disorder
* Pregnancy
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Orthosensor, Inc.

INDUSTRY

Sponsor Role collaborator

University of Florida

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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MaryBeth Horodyski, EdD

Role: PRINCIPAL_INVESTIGATOR

University of Florida

Locations

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UF & Shands Orthopaedics and Sports Medicine Institute

Gainesville, Florida, United States

Site Status

UF Health Florida Surgical Center

Gainesville, Florida, United States

Site Status

UF Health at the University of Florida

Gainesville, Florida, United States

Site Status

UF Health Cancer Hospital

Gainesville, Florida, United States

Site Status

Countries

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United States

Other Identifiers

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OCR18180

Identifier Type: OTHER

Identifier Source: secondary_id

IRB201801019

Identifier Type: -

Identifier Source: org_study_id