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Randomized Clinical Trial for Ewing Amputation in the VA

NCT ID: NCT05437562

Last Updated: 2025-11-10

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

NOT_YET_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-12-01

Study Completion Date

2030-12-01

Brief Summary

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This study follows the Pilot Investigation of Ewing Amputation for Veterans with PAD Undergoing a Below Knee Amputation. The 2 year pilot feasibility phase has concluded recruitment and enrollment.

The current phase is a 5 year randomized study of Ewing Below Knee Amputation vs. Standard Below Knee Amputation. If Veterans participate, they will be randomized to either Ewing Amputation or Standard Below Knee Amputation.

The scientific premise motivating this proposal is that Ewing Amputation is a promising surgical technique that may improve walking metrics in dysvascular Veterans by providing a better residual limb and improving pain and balance.

In preparation of this proposal, we have formed multi-disciplinary surgical teams at each site, and we have been supported by a clinical trial planning meeting to garner the considerable expertise in rehabilitation and amputee assessment from VA and DOD experts to assist in the design of this proposal, testing the overall hypothesis that: Ewing Amputation can help Veterans walk.

Detailed Description

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Major amputations lead to significant challenges for Veterans and their loved ones. Thus, amputations and the care of amputees are a major focus of the VHA. Hence, the tripartite goals of the VHA Amputation System of Care (ASoC) are to: provide state of the art care, maximize health and independence, and to be the provider of choice for amputated Veterans. Veterans undergo \~1000 transtibial amputations (TTA) annually, making TTA a commonly performed operation in the VA. Almost all Veterans requiring TTA are dysvascular with peripheral artery disease (PAD) and/or diabetes. TTA is a safe operation with a low 30-day mortality rate, and ambulation with prosthesis rates are much better for TTA versus transfemoral amputations (TFA). Since \~50% of Veterans are satisfied with their ambulation after major amputation, improving ambulation is an important benchmark forward in the care of Veterans. Importantly, the lower ambulation rates in Veterans are attributed to modifiable sequelae of major amputation, including: slower wound healing9,10; chronic pain, imbalance, and falls. Excitingly, new techniques can improve pain and balance and may improve wound healing/prevent falls. Ewing amputation (EA) recreates the agonist-antagonist myoneural interface (AMI) maintaining muscle tension, proprioception and limiting fibrofatty muscle degeneration of muscle flaps. EA also creates regenerative peripheral neural interfaces (RPNI) to improve pain control. Thus, EA may have a significant benefit to Veterans undergoing TTA.

Conditions

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Peripheral Arterial Disease

Keywords

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amputation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

This study is evaluating an intervention in surgical technique for below knee amputation. The Veterans will be randomized to either Ewing amputation, which is a nuanced approach that incorporates RPNI and AMI to the standard below knee amputation. The standard below knee amputation is the comparison technique.
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Ewing Amputation

Randomized 1:1 clinical trial.

Group Type EXPERIMENTAL

Ewing Below Knee Amputation

Intervention Type PROCEDURE

Ewing Below Knee Amputation

Standard Below Knee Amputation

Intervention Type PROCEDURE

Standard Below Knee Amputation

Interventions

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Ewing Below Knee Amputation

Ewing Below Knee Amputation

Intervention Type PROCEDURE

Standard Below Knee Amputation

Standard Below Knee Amputation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Veterans who have reasonable blood flow to heal a TTA (defined as palpable popliteal pulse or palpable femoral pulse with popliteal artery signal)
* Veterans with an expectation of participating in rehabilitation and resuming ambulation after amputation (defined by the Veteran interest, recent ambulation by the Veteran, ability to participate in physical therapy as deemed by the investigators' physical therapy team)
* Veterans who will be undergoing below knee amputation for reasons other than infection (uninfected patients) or Veterans who have had foot infection localized below the ankle (retinaculum uninfected) that has been adequately debrided and treated with appropriate antibiotic course.

Exclusion Criteria

* Veterans with end-stage renal disease (ESRD)
* Veterans requiring major amputation due to infection that includes the ankle retinaculum
* Veterans deemed to have inadequate blood flow to heal a TTA
* Veterans who cannot participate in rehabilitation or are not expected to be able to ambulate with a prosthesis for any reason
* Veterans who were randomized for their other limb (to prevent Veteran from the possibility of having 2 different amputations)
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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VA Office of Research and Development

FED

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Luke P Brewster, MD

Role: PRINCIPAL_INVESTIGATOR

Atlanta VA Medical and Rehab Center, Decatur, GA

Locations

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Atlanta VA Medical and Rehab Center, Decatur, GA

Decatur, Georgia, United States

Site Status

Tennessee Valley Healthcare System Nashville Campus, Nashville, TN

Nashville, Tennessee, United States

Site Status

Michael E. DeBakey VA Medical Center, Houston, TX

Houston, Texas, United States

Site Status

Countries

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United States

Central Contacts

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Luke P Brewster, MD

Role: CONTACT

Phone: (404) 321-6111

Email: [email protected]

Madhur Sancheti, MS

Role: CONTACT

Phone: (404) 321-6111

Email: [email protected]

Facility Contacts

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Luke P Brewster, MD

Role: primary

Ashley N Scales, PhD

Role: backup

John A Curci, MD

Role: primary

Neal R Barshes, MD

Role: primary

Other Identifiers

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CX002366-01A1

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

SURG-001-21F

Identifier Type: -

Identifier Source: org_study_id