Knee Injection RCT

NCT ID: NCT03694821

Last Updated: 2020-02-18

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

18 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-05

Study Completion Date

2019-07-16

Brief Summary

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Hypothesis: Ketorolac injection is a cost-effective adjunct in the nonoperative treatment of knee osteoarthritis (OA) compared to steroids and viscosupplementation.

Aims/objectives: The objective of this randomized, controlled, double-blinded, prospective study is to assess the efficacy and cost-effectiveness of knee injection with ketorolac in the nonsurgical management of symptomatic OA compared to injections with corticosteroids and viscosupplements.

Detailed Description

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The purpose of this research study is to examine the effectiveness of intra-articular (inside the joint) ketorolac injection compared to injection with either corticosteroid or hyaluronic acid for the treatment of painful knee osteoarthritis. Patients will be randomly assigned to receive either ketorolac (a nonsteroidal anti-inflammatory drug, methylprednisolone (a steroid), hyaluronic acid (a substance that is naturally present in the human body).

Conditions

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Osteoarthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Ketorolac

One knee injection of 2cc of ketorolac tromethamine (15mg/cc) in 5cc of 0.5% ropivacaine hydrochloride without epinephrine

Group Type EXPERIMENTAL

Ketorolac Tromethamine Injection

Intervention Type DRUG

One knee injection of 2cc of ketorolac tromethamine (15mg/cc) in 5cc of 0.5% ropivacaine hydrochloride without epinephrine

Corticosteroid

One knee injection of 2 cc of methylprednisolone acetate (40mg/cc) in 5cc of 0.5% ropivacaine hydrochloride without epinephrine

Group Type ACTIVE_COMPARATOR

Methylprednisolone Acetate Injection

Intervention Type DRUG

One knee injection of 2 cc of methylprednisolone acetate (40mg/cc) in 5cc of 0.5% ropivacaine hydrochloride without epinephrine

Hyaluronic Acid

One knee injection of Hylan G-F 20 (Synvisc-One)

Group Type ACTIVE_COMPARATOR

Hylan G-F 20

Intervention Type DRUG

One knee injection of Hylan G-F 20 (Synvisc-One)

Interventions

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Ketorolac Tromethamine Injection

One knee injection of 2cc of ketorolac tromethamine (15mg/cc) in 5cc of 0.5% ropivacaine hydrochloride without epinephrine

Intervention Type DRUG

Methylprednisolone Acetate Injection

One knee injection of 2 cc of methylprednisolone acetate (40mg/cc) in 5cc of 0.5% ropivacaine hydrochloride without epinephrine

Intervention Type DRUG

Hylan G-F 20

One knee injection of Hylan G-F 20 (Synvisc-One)

Intervention Type DRUG

Other Intervention Names

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Ketorolac Tromethamine; NDC 63323-162-02; J Code J1885 DEPO-MEDROL; NDC 0009-3073-01; J Code J1030 Synvisc-One; NDC 58468-0090-03; J Code J7325

Eligibility Criteria

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Inclusion Criteria

* Patients over the age of 18 who present with 1) symptomatic knee OA and radiographic evidence of joint space narrowing and 2) are interested in knee injections for pain relief.

Exclusion Criteria

* Prior injections into the same knee within the past 6 months,
* Pregnant and/or lactating women,
* Inflammatory joint disease including rheumatoid or psoriatic arthritis,
* Concurrent use of anti-rheumatic drugs,
* Allergy or hypersensitivity to the study medications,
* Patients on an active pain management contract,
* Patients with insurance that requires pre-certification for any of the study drugs,
* Inability to make own decisions regarding the informed consent,
* Inability to read and/or understand English,
* Patients who are unable to return for follow-up or be reached by phone.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Orthopedic Research and Education Foundation

OTHER

Sponsor Role collaborator

UConn Health

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mohamad J. Halawi, MD

Role: PRINCIPAL_INVESTIGATOR

UConn Health

Locations

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UConn Health

Farmington, Connecticut, United States

Site Status

Countries

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United States

References

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Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005 Mar 12-18;365(9463):965-73. doi: 10.1016/S0140-6736(05)71086-2.

Reference Type BACKGROUND
PMID: 15766999 (View on PubMed)

Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006 Jan;54(1):226-9. doi: 10.1002/art.21562.

Reference Type BACKGROUND
PMID: 16385518 (View on PubMed)

Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States. http://www.boneandjointburden.org/2014-report/ivh12/osteoarthritis-and-allied-disorders

Reference Type BACKGROUND

Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013 Sep;21(9):571-6. doi: 10.5435/JAAOS-21-09-571.

Reference Type BACKGROUND
PMID: 23996988 (View on PubMed)

Gray RG, Gottlieb NL. Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res. 1983 Jul-Aug;(177):235-63.

Reference Type BACKGROUND
PMID: 6345042 (View on PubMed)

Hunter DJ. Viscosupplementation for osteoarthritis of the knee. N Engl J Med. 2015 Mar 12;372(11):1040-7. doi: 10.1056/NEJMct1215534. No abstract available.

Reference Type BACKGROUND
PMID: 25760356 (View on PubMed)

van der Weegen W, Wullems JA, Bos E, Noten H, van Drumpt RA. No difference between intra-articular injection of hyaluronic acid and placebo for mild to moderate knee osteoarthritis: a randomized, controlled, double-blind trial. J Arthroplasty. 2015 May;30(5):754-7. doi: 10.1016/j.arth.2014.12.012. Epub 2014 Dec 13.

Reference Type BACKGROUND
PMID: 25548079 (View on PubMed)

Campbell KA, Erickson BJ, Saltzman BM, Mascarenhas R, Bach BR Jr, Cole BJ, Verma NN. Is Local Viscosupplementation Injection Clinically Superior to Other Therapies in the Treatment of Osteoarthritis of the Knee: A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Oct;31(10):2036-45.e14. doi: 10.1016/j.arthro.2015.03.030. Epub 2015 May 19.

Reference Type BACKGROUND
PMID: 25998016 (View on PubMed)

Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis Cartilage. 2013 Jan;21(1):16-21. doi: 10.1016/j.joca.2012.11.012. Epub 2012 Nov 27.

Reference Type BACKGROUND
PMID: 23194896 (View on PubMed)

Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013 Sep;21(9):577-9. doi: 10.5435/JAAOS-21-09-577. No abstract available.

Reference Type BACKGROUND
PMID: 23996989 (View on PubMed)

Reuben SS, Connelly NR. Postoperative analgesia for outpatient arthroscopic knee sugery with intraarticular bupivacaine and ketorolac. Anesth Analg. 1995 Jun;80(6):1154-7. doi: 10.1097/00000539-199506000-00015.

Reference Type BACKGROUND
PMID: 7762844 (View on PubMed)

Desai A, Ramankutty S, Board T, Raut V. Does intraarticular steroid infiltration increase the rate of infection in subsequent total knee replacements? Knee. 2009 Aug;16(4):262-4. doi: 10.1016/j.knee.2008.12.002. Epub 2009 Jan 12.

Reference Type BACKGROUND
PMID: 19138855 (View on PubMed)

Jones AC, Pattrick M, Doherty S, Doherty M. Intra-articular hyaluronic acid compared to intra-articular triamcinolone hexacetonide in inflammatory knee osteoarthritis. Osteoarthritis Cartilage. 1995 Dec;3(4):269-73. doi: 10.1016/s1063-4584(05)80018-4.

Reference Type BACKGROUND
PMID: 8689462 (View on PubMed)

Leardini G, Mattara L, Franceschini M, Perbellini A. Intra-articular treatment of knee osteoarthritis. A comparative study between hyaluronic acid and 6-methyl prednisolone acetate. Clin Exp Rheumatol. 1991 Jul-Aug;9(4):375-81.

Reference Type BACKGROUND
PMID: 1934686 (View on PubMed)

Bellamy JL, Goff BJ, Sayeed SA. Economic Impact of Ketorolac vs Corticosteroid Intra-Articular Knee Injections for Osteoarthritis: A Randomized, Double-Blind, Prospective Study. J Arthroplasty. 2016 Sep;31(9 Suppl):293-7. doi: 10.1016/j.arth.2016.05.015. Epub 2016 May 18.

Reference Type BACKGROUND
PMID: 27402605 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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18-093-1

Identifier Type: -

Identifier Source: org_study_id

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