Trial Outcomes & Findings for Traditional vs Oral Fluid Management in Total Knee Arthroplasty (NCT NCT03719378)
NCT ID: NCT03719378
Last Updated: 2021-03-16
Results Overview
Patient Weight will be monitored
COMPLETED
NA
150 participants
Change is patients weight from baseline at pre op to two weeks post op.
2021-03-16
Participant Flow
Participant milestones
| Measure |
Traditional Fluid
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Overall Study
STARTED
|
75
|
75
|
|
Overall Study
COMPLETED
|
65
|
65
|
|
Overall Study
NOT COMPLETED
|
10
|
10
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
Race and Ethnicity were not collected from any participant.
Baseline characteristics by cohort
| Measure |
Traditional Fluid
n=75 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=75 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
Total
n=150 Participants
Total of all reporting groups
|
|---|---|---|---|
|
Age, Continuous
|
61.2 Years
STANDARD_DEVIATION 7.5 • n=75 Participants
|
60.9 Years
STANDARD_DEVIATION 6.8 • n=75 Participants
|
61 Years
STANDARD_DEVIATION 7.2 • n=150 Participants
|
|
Sex: Female, Male
Female
|
44 Participants
n=75 Participants
|
42 Participants
n=75 Participants
|
86 Participants
n=150 Participants
|
|
Sex: Female, Male
Male
|
31 Participants
n=75 Participants
|
33 Participants
n=75 Participants
|
64 Participants
n=150 Participants
|
|
Race and Ethnicity Not Collected
|
—
|
—
|
0 Participants
Race and Ethnicity were not collected from any participant.
|
|
Region of Enrollment
United States
|
75 participants
n=75 Participants
|
75 participants
n=75 Participants
|
150 participants
n=150 Participants
|
|
BMI
|
28.5 kg/m^2 (BMI)
STANDARD_DEVIATION 4.9 • n=75 Participants
|
28.1 kg/m^2 (BMI)
STANDARD_DEVIATION 4.2 • n=75 Participants
|
28.3 kg/m^2 (BMI)
STANDARD_DEVIATION 4.6 • n=150 Participants
|
PRIMARY outcome
Timeframe: Change is patients weight from baseline at pre op to two weeks post op.Patient Weight will be monitored
Outcome measures
| Measure |
Traditional Fluid
n=64 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=64 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Body Weight
|
-1.9 pounds
Standard Deviation 4.4
|
-1.6 pounds
Standard Deviation 4.4
|
SECONDARY outcome
Timeframe: Post Op Day 1, 2 Weeks and 6 Weeks Post OpMeasurements will be done with a standard goniometer (Measurements below are shown as the difference from their pre operative base line measurement to the time points below)
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Knee Range of Motion
Post Op Day 1
|
-30.5 degrees
Standard Deviation 18.5
|
-26.7 degrees
Standard Deviation 16
|
|
Knee Range of Motion
2 Weeks Post Op
|
-27.9 degrees
Standard Deviation 17.5
|
-25.5 degrees
Standard Deviation 16.5
|
|
Knee Range of Motion
6 Weeks Post OP
|
-7.7 degrees
Standard Deviation 17
|
-4.8 degrees
Standard Deviation 13.2
|
SECONDARY outcome
Timeframe: Post op Day 1, 2 weeks and 6 weeks Post Opmeasurements will be performed at 5 \& 10 cm suprapatellar, midpatella, and 10 cm infrapatellar with the use of a standard tape measure. measurements below show the difference from their pre operative base line measurement to the timepoints below.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Leg Anthropometric (Girth) Measurements
(10 cm suprapatellar) Post Op day 1
|
2.5 inches
Standard Deviation 3.0
|
2.1 inches
Standard Deviation 3.1
|
|
Leg Anthropometric (Girth) Measurements
(10 cm suprapatellar) 2 weeks post op
|
0.9 inches
Standard Deviation 3.0
|
1.6 inches
Standard Deviation 4.0
|
|
Leg Anthropometric (Girth) Measurements
(10 cm suprapatellar) 6 weeks post op
|
0.00 inches
Standard Deviation 2.6
|
0.00 inches
Standard Deviation 3.3
|
|
Leg Anthropometric (Girth) Measurements
(5 cm suprapatellar) Post Op day 1
|
4.1 inches
Standard Deviation 2.4
|
4.0 inches
Standard Deviation 2.6
|
|
Leg Anthropometric (Girth) Measurements
(5 cm suprapatellar) 2 weeks post op
|
2.0 inches
Standard Deviation 2.3
|
2.8 inches
Standard Deviation 2.6
|
|
Leg Anthropometric (Girth) Measurements
(5 cm suprapatellar) 6 weeks post op
|
0.9 inches
Standard Deviation 1.9
|
1.0 inches
Standard Deviation 2.2
|
|
Leg Anthropometric (Girth) Measurements
(Midpatellar) Post Op day 1
|
4.6 inches
Standard Deviation 2.2
|
4.1 inches
Standard Deviation 2.6
|
|
Leg Anthropometric (Girth) Measurements
(Midpatellar) 2 weeks post op
|
2.2 inches
Standard Deviation 2.3
|
3.0 inches
Standard Deviation 2.0
|
|
Leg Anthropometric (Girth) Measurements
(Midpatellar) 6 weeks post op
|
1.3 inches
Standard Deviation 1.6
|
1.3 inches
Standard Deviation 2.0
|
|
Leg Anthropometric (Girth) Measurements
(10 cm inferior patella) Post Op day 1
|
2.7 inches
Standard Deviation 2.7
|
1.5 inches
Standard Deviation 4.6
|
|
Leg Anthropometric (Girth) Measurements
(10 cm inferior patella) 2 weeks post op
|
0.8 inches
Standard Deviation 2.1
|
0.9 inches
Standard Deviation 2.3
|
|
Leg Anthropometric (Girth) Measurements
(10 cm inferior patella) 6 weeks post op
|
-0.2 inches
Standard Deviation 1.3
|
0.1 inches
Standard Deviation 1.5
|
SECONDARY outcome
Timeframe: intra operative, Post Op Day #1 or #2Post Operative/Intra Operative Transfusions
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Number of Participants With Requiring Transfusions
|
0 Participants
|
1 Participants
|
SECONDARY outcome
Timeframe: Up to 6 weeks Post OPincidence of wound infection and wound drainage will be assessed and recorded
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Number of Participants With Off Wound Complications Post Operative
|
0 Participants
|
0 Participants
|
SECONDARY outcome
Timeframe: Post Opeartive until the 6 week follow up appointmentThe incidence of thromboembolic events will be recorded.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Number of Participants With Thromboembolic Disease
|
1 Participants
|
0 Participants
|
SECONDARY outcome
Timeframe: Post Op day 1, 2 Week and 6 Week Post OPThe strength testing will be calculated using a handheld dynamometer
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Quadriceps Strength Measure With a Handheld Dynamometer
Change from Preop to Post Op Day1
|
-10.4 KG
Standard Deviation 7.6
|
-11.2 KG
Standard Deviation 7.1
|
|
Quadriceps Strength Measure With a Handheld Dynamometer
Change from Preop to 2 weeks post op
|
-9.0 KG
Standard Deviation 6.5
|
-9.6 KG
Standard Deviation 7.2
|
|
Quadriceps Strength Measure With a Handheld Dynamometer
Change from Preop to 6 weeks post op
|
-3.2 KG
Standard Deviation 5.8
|
-3.8 KG
Standard Deviation 6.5
|
SECONDARY outcome
Timeframe: preoperative appointment and once again at their 2 and 6 weeks postoperativelytimed up and go (TUG)
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Time up and GO
Change from Preop to 2 weeks Post op
|
4.4 Seconds
Standard Deviation 4.8
|
3.3 Seconds
Standard Deviation 3.7
|
|
Time up and GO
Change from Preop to 6 weeks Post op
|
-4.7 Seconds
Standard Deviation 3.5
|
-4.0 Seconds
Standard Deviation 3.9
|
SECONDARY outcome
Timeframe: preoperative appointment and once again at their 2 and 6 weeks postoperatively30 second sit-to-stand tests
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
30 Second STS Test
Change from Preop to 2 weeks Post op
|
-5.3 sit-to-stand events
Standard Deviation 4.0
|
-4.4 sit-to-stand events
Standard Deviation 4.6
|
|
30 Second STS Test
Change from Preop to 6 weeks Post op
|
-0.4 sit-to-stand events
Standard Deviation 4.1
|
0.3 sit-to-stand events
Standard Deviation 3.0
|
SECONDARY outcome
Timeframe: Daily up to 2 days while hospitalizedLength of time the patient is Hospitalized after their total knee replacement.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Length of the Hospitalization
1 Day
|
56 Participants
|
63 Participants
|
|
Length of the Hospitalization
2 Days
|
9 Participants
|
2 Participants
|
SECONDARY outcome
Timeframe: up to 6 weeks post opNumber of patients re-admitted post TKA
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Number of Patients Re-admitted Post TKA
|
1 Participants
|
0 Participants
|
SECONDARY outcome
Timeframe: Every 4 hours, averaged daily, reported at Post op day 1 and 2 (while in the hospital), weeks 1, 2, 3, and 4 (3 times a day)Population: Some of the patients did not complete their pain log for the study, which is why the numbers are different below.
Pain will be assessed using a pain Visual Analog scale(VAS), the scale is from 1 to 10, the higher the score the worse the pain.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Postoperative Pain Assessment Using Visual Analog Scale
Average Post Op Day 1
|
2.6 units on a scale
Standard Deviation 1.4
|
2.3 units on a scale
Standard Deviation 1.4
|
|
Postoperative Pain Assessment Using Visual Analog Scale
Average Post Op Day 2
|
4.4 units on a scale
Standard Deviation 1.5
|
4.5 units on a scale
Standard Deviation 1.6
|
|
Postoperative Pain Assessment Using Visual Analog Scale
Average Week 1
|
4.3 units on a scale
Standard Deviation 1.6
|
4.1 units on a scale
Standard Deviation 1.6
|
|
Postoperative Pain Assessment Using Visual Analog Scale
Average Week 2
|
3.6 units on a scale
Standard Deviation 1.8
|
3.4 units on a scale
Standard Deviation 1.5
|
|
Postoperative Pain Assessment Using Visual Analog Scale
Average Week 3
|
3.0 units on a scale
Standard Deviation 1.7
|
3.2 units on a scale
Standard Deviation 1.7
|
|
Postoperative Pain Assessment Using Visual Analog Scale
Average Week 4
|
2.7 units on a scale
Standard Deviation 1.6
|
2.6 units on a scale
Standard Deviation 1.4
|
SECONDARY outcome
Timeframe: Daily up to 2 days while hospitalizedpatients will be asked about Nausea: None, Mild, Moderate or Severe
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
PONV (Post-operative Nausea and Vomiting)
None
|
51 Participants
|
46 Participants
|
|
PONV (Post-operative Nausea and Vomiting)
Mild
|
9 Participants
|
12 Participants
|
|
PONV (Post-operative Nausea and Vomiting)
Moderat
|
3 Participants
|
3 Participants
|
|
PONV (Post-operative Nausea and Vomiting)
Severe
|
2 Participants
|
4 Participants
|
SECONDARY outcome
Timeframe: 2 week and 6 week follow up appointmentsPatient Reported Outcomes- Veterans Rand(VR-12), there is an algorithm to calculate this score, not a specific range. The higher the number the more positive the output. The score has two components a mental score (MCS) and Physical Score (PCS). Higher values represent a better outcome. MCS Scale 35.089613 to 46.341715 PCS Scale 14.957554 to 63.235672
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Veterans Rand -12
Change from Preop - 2 Weeks Post Op Mental Score
|
-4.7 score on a scale
Standard Deviation 12.2
|
-1.2 score on a scale
Standard Deviation 10.4
|
|
Veterans Rand -12
Change from Preop - 2 Weeks PostOp Physical Score
|
-8.3 score on a scale
Standard Deviation 10
|
-4.5 score on a scale
Standard Deviation 11.2
|
|
Veterans Rand -12
Change from Pre op - 6 Weeks Post Op Mental Score
|
-2.5 score on a scale
Standard Deviation 11.5
|
-3.2 score on a scale
Standard Deviation 11.4
|
|
Veterans Rand -12
Change from Preop - 6 Weeks PostOp Physical Score
|
-0.5 score on a scale
Standard Deviation 10.6
|
2.2 score on a scale
Standard Deviation 12.2
|
SECONDARY outcome
Timeframe: pre-operatively as well as at their 2 week and 6 week follow up appointmentsKnee injury and Osteoarthritis Outcome Score (KOOS), the scale is 0 to 100, 100 being the best score possible.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Patient Reported Outcomes - Knee Injury and Osteoarthritis Outcome Score (KOOS)
Change is score from pre op to 2 weeks
|
-1.6 score on a scale
Standard Deviation 16.2
|
3.1 score on a scale
Standard Deviation 13.8
|
|
Patient Reported Outcomes - Knee Injury and Osteoarthritis Outcome Score (KOOS)
Change is score from pre op to 6 weeks
|
9.4 score on a scale
Standard Deviation 14.5
|
12.3 score on a scale
Standard Deviation 14.1
|
SECONDARY outcome
Timeframe: pre-operatively as well as at their 2 week and 6 week follow up appointmentsKnee Society Score(KSS), the total scores range from 0 - 200, 200 being the best.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Patient Reported Outcomes - Knee Society Score(KSS)
Change from Preop to 2 weeks Post op
|
-14.6 score on a scale
Standard Deviation 39.9
|
-0.2 score on a scale
Standard Deviation 36.2
|
|
Patient Reported Outcomes - Knee Society Score(KSS)
Change from pre op to 6 weeks
|
31.9 score on a scale
Standard Deviation 36.3
|
40.5 score on a scale
Standard Deviation 35.4
|
SECONDARY outcome
Timeframe: Duration of IV intervention, up to 2 daysTotal amount of IV fluids that the patients received while in the hospital
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Total IV Fluids Received
|
3895 ML
Interval 1500.0 to 5322.0
|
350 ML
Interval 177.0 to 1466.0
|
SECONDARY outcome
Timeframe: pre-op visit, Post Op Day #1 as well as their 2 week and 6 week visitbody composition before and after surgery to measure swelling. Lower numbers represent more swelling.
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Bioimpedence
Change from Preop to Post Op Day1
|
-17.8 ohms
Standard Deviation 30.3
|
4.2 ohms
Standard Deviation 29.7
|
|
Bioimpedence
Change from Preop to 2 weeks post op
|
-41.4 ohms
Standard Deviation 34.2
|
-38.5 ohms
Standard Deviation 45.7
|
|
Bioimpedence
Change from Preop to 6 weeks post op
|
-30.9 ohms
Standard Deviation 25.6
|
-31.0 ohms
Standard Deviation 31.4
|
OTHER_PRE_SPECIFIED outcome
Timeframe: While in hospital until the 6 week follow up appointmentepisodes such as symptomatic hypotension (light-headedness, syncope), emesis, the need the IV fluid boluses, and other hospital and post-discharge events will be recorded
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Number of Participants With Adverse Events
|
3 Participants
|
2 Participants
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Daily up to 2 days while hospitalizedBlood Pressure (Diastolic/ Systolic)
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Blood Pressure
Change in mmHg Pre Op to Recovery Room (Systolic)
|
21.5 Change in mmHg
Standard Deviation 15.9
|
26.0 Change in mmHg
Standard Deviation 16.7
|
|
Blood Pressure
Change in mmHg Pre Op to Recovery Room (Diastolic)
|
18.4 Change in mmHg
Standard Deviation 12.2
|
17.2 Change in mmHg
Standard Deviation 11.9
|
|
Blood Pressure
Change in mmHg Pre Op to Arrival on 4th floor (Systolic)
|
10.6 Change in mmHg
Standard Deviation 12.8
|
19.4 Change in mmHg
Standard Deviation 13.5
|
|
Blood Pressure
Change in mmHg Pre Op to Arrival on 4th floor (Diastolic)
|
10.5 Change in mmHg
Standard Deviation 10.3
|
9.3 Change in mmHg
Standard Deviation 10.8
|
|
Blood Pressure
Change in mmHg Pre Op to 08:00 on floor (Systolic)
|
17.0 Change in mmHg
Standard Deviation 12.9
|
23.4 Change in mmHg
Standard Deviation 13.3
|
|
Blood Pressure
Change in mmHg Pre Op to 08:00 on floor (Diastolic)
|
16.5 Change in mmHg
Standard Deviation 9.3
|
16.0 Change in mmHg
Standard Deviation 9.6
|
|
Blood Pressure
Change in mmHg Pre Op to 16:00 on floor (Systolic)
|
20.9 Change in mmHg
Standard Deviation 14.0
|
25.8 Change in mmHg
Standard Deviation 13.8
|
|
Blood Pressure
Change in mmHg Pre Op to 16:00 on floor (Diastolic)
|
16.3 Change in mmHg
Standard Deviation 11.2
|
18.7 Change in mmHg
Standard Deviation 11.8
|
|
Blood Pressure
Change in mmHg Pre Op to 24:00 on floor (Systolic)
|
12.5 Change in mmHg
Standard Deviation 14.7
|
12.5 Change in mmHg
Standard Deviation 12.9
|
|
Blood Pressure
Change in mmHg Pre Op to 24:00 on floor (Diastolic)
|
14.6 Change in mmHg
Standard Deviation 9.9
|
11.1 Change in mmHg
Standard Deviation 10.2
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Up to Day 1 Post optotal amount of any pressor drugs given intraoperatively (e.g. Ephedrine and Phenylephrine)
Outcome measures
| Measure |
Traditional Fluid
n=65 Participants
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 Participants
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Total Number of Patients That Received Any Pressor Drugs
Yes
|
23 Participants
|
22 Participants
|
|
Total Number of Patients That Received Any Pressor Drugs
No
|
42 Participants
|
43 Participants
|
Adverse Events
Traditional Fluid
Oral Fluid
Serious adverse events
| Measure |
Traditional Fluid
n=65 participants at risk
* NPO Clears and Food after midnight.
* 2 Liters of lactated ringers administered by anesthesia intraoperatively.
* Postoperatively - 2 Liters of Crystalloid while in PACU and Inpatient Room for a Total of 4 Liters of Crystalloid within 24 hours. (Patient will receive 500 milliliters while in PACU and 1500 milliliters while in their Inpatient Room, for a total of 2 Liters).
* Normal diet postoperatively.
|
Oral Fluid
n=65 participants at risk
* Pre Operative Oral Fluids (Patients encouraged to drink a minimum of 60 ounces of clear liquid per day for the 3 days prior to procedure.)
* NPO Food/Milk: none beginning 8 hours prior to procedure time.
* Pre Operative Oral Fluids (Patients are asked to drink 10 ounces of clear liquid 4 hours prior to their scheduled procedure time.)
* Preoperative holding area, IV is started in the patient with Lactated Ringers IV fluid at a rate of 75ml/hr. IV fluids will be stopped and hep-locked in the PACU when the patient is taking PO fluid; the total amount of IV fluids is not to exceed 500ml total.
* PO fluid protocol: a minimum of 60 ounces of liquid per day for 3 days.
Pre Operative Oral Fluids: Patients will be self hydrating prior to their total knee replacement.
|
|---|---|---|
|
Respiratory, thoracic and mediastinal disorders
acute pulmonary embolism
|
1.5%
1/65 • Number of events 1 • 6 Weeks Post Operatively
|
0.00%
0/65 • 6 Weeks Post Operatively
|
Other adverse events
Adverse event data not reported
Additional Information
Rose Johnson, CCRP Research Lead
Colorado Joint Replacement
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place