Does the Use of Patient Specific Instrumentation Improve Outcomes in Knee Arthroplasty Surgery for Osteoarthritis When Compared to Standard Posterior Referenced Instrumentation?

NCT ID: NCT06720012

Last Updated: 2024-12-17

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-03

Study Completion Date

2024-12-31

Brief Summary

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The goal of this randomized study is to see if using patient-specific instruments (PSI) during total knee replacement surgery improves outcomes compared to standard instruments. The study focuses on adults with knee osteoarthritis who need knee replacement surgery. Specifically, it aims to answer the following questions:

Does using PSI improve knee function and stability as experienced by the patient? Does PSI lead to more normal knee motion during bending and straightening? Does PSI result in at least as good tibial (shin bone) component fixation as standard instruments? Is PSI more cost-effective than standard instruments? Researchers will compare PSI with standard instruments in 70 patients. Half will receive knee replacement surgery using PSI, and the other half with standard instruments. Patients will be randomly assigned to each group.

Participants will:

Undergo knee replacement surgery with either PSI or standard instruments. Have a series of follow-ups, including assessments of knee function, satisfaction, and alignment of the knee implant, conducted before surgery and at 3 months, 1 year, 2 years, and 5 years after surgery.

The study will include patients aged 40-75 with primary osteoarthritis, a body mass index (BMI) below 35, and no other major medical conditions that could impact surgery. Patients will also need to be willing to undergo necessary imaging, such as magnetic resonance imageing (MRI) scans and standing X-rays.

Outcomes will be measured using various assessment tools, including the Oxford Knee Score, Knee Society Score, and a patient satisfaction survey. Researchers will also record surgery details, such as operating time, blood loss, and knee implant size. Imaging methods, including MRI, computed tomgraphy (CT) scans, and specialized X-rays, will be used to evaluate knee alignment and stability over time.

The results of this study are expected to provide insights into whether patient-specific instruments offer clinical or economic advantages over traditional tools in knee replacement surgery.

Detailed Description

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Conditions

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Primary Osteoarthritis Patients Scheduled for Total Knee Replacement Surgery Osteoarthritis (OA) of the Knee

Keywords

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Patient Specific Instrumentation Total Knee Arthroplasty Zimmer PSI NexGen Materialise

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Patient Specific Instrumentation (PSI)

PSI cutting guides modeled from a MRI preoperatively and based on the patients unique anatomy.

Group Type EXPERIMENTAL

Patient specific instrumentation (PSI)

Intervention Type DEVICE

Cutting guides that are manufactured using advanced imaging and modelling techniques to create instruments that align more closely with the unique anatomy of each patient. Custom guides were created based on a preoperative MRI protocol (Zimmer Patient Specific Instrumentation for NexGen® Complete Knee Solution, Zimmer Biomet, Warsaw, Indiana, United States in collaboration with Materialise NV, Leuven, Belgium) to optimize the placement of the components without the need for intramedullary alignment.

Cemented Total Knee Arthroplasty

Intervention Type PROCEDURE

A cemented TKA (NexGen® Complete Knee Solution, Zimmer Biomet, Warsaw, Indiana, United States) is used in all cases with a cruciate retaining (CR) or posterior stabilized (LPS) prosthesis as determined by the surgeon.

Conventional Instrumentation

Conventional jig-based intra- and extramedullary instrumentation for the NexGen Knee System.

Group Type ACTIVE_COMPARATOR

Conventional instruments

Intervention Type DEVICE

Instruments specific to the implant that are used to guide bone cutting in reference to the intramedullary canal or using an extramedullary jig.

Cemented Total Knee Arthroplasty

Intervention Type PROCEDURE

A cemented TKA (NexGen® Complete Knee Solution, Zimmer Biomet, Warsaw, Indiana, United States) is used in all cases with a cruciate retaining (CR) or posterior stabilized (LPS) prosthesis as determined by the surgeon.

Interventions

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Patient specific instrumentation (PSI)

Cutting guides that are manufactured using advanced imaging and modelling techniques to create instruments that align more closely with the unique anatomy of each patient. Custom guides were created based on a preoperative MRI protocol (Zimmer Patient Specific Instrumentation for NexGen® Complete Knee Solution, Zimmer Biomet, Warsaw, Indiana, United States in collaboration with Materialise NV, Leuven, Belgium) to optimize the placement of the components without the need for intramedullary alignment.

Intervention Type DEVICE

Conventional instruments

Instruments specific to the implant that are used to guide bone cutting in reference to the intramedullary canal or using an extramedullary jig.

Intervention Type DEVICE

Cemented Total Knee Arthroplasty

A cemented TKA (NexGen® Complete Knee Solution, Zimmer Biomet, Warsaw, Indiana, United States) is used in all cases with a cruciate retaining (CR) or posterior stabilized (LPS) prosthesis as determined by the surgeon.

Intervention Type PROCEDURE

Other Intervention Names

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Patient specific cutting guides Patient-specific guides Custom instrumentation Extramedullary femoral cutting system Patient-matched instruments Traditional jig-based instruments Traditional cutting guides Jig-based instrumentation Intra- and extramedullary cutting guides

Eligibility Criteria

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Inclusion Criteria

* Medial or lateral primary osteoarthritis (OA) Ahlbäck Grade 2-4
* Varus or valgus deformity ≤10 degrees, extension defect ≤10 degrees
* Age 40-75 years
* BMI \<35
* American Society of Anesthesiologists (ASA) score 1-3.
* Coming from independent living in own home
* Able and willing to undergo MRI scan (for custom patients), full-leg standing radiographs and follow up with RSA
* Written informed consent.

Exclusion Criteria

* Cortisone treatment during the last 6 months before operation
* Neurological diseases with symptoms, stroke with sequel
* Endocrine diseases with symptoms
* OA secondary to trauma, infection, inflammatory disease or congenital and acquired deformities
* BMI \>=35
* OA of the hip with symptoms
* Ongoing infection
* Any metal within 150 mm from the joint line on the side to become operated
* Unable or unwilling to participate in the follow-up.
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zimmer Biomet

INDUSTRY

Sponsor Role collaborator

Ingabritt och Arne Lundbergs Forskningsstiftelse

UNKNOWN

Sponsor Role collaborator

Vastra Gotaland Region

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Sahlgrenska University Hospital

Mölndal, Västra Götalandsregionen, Sweden

Site Status

Countries

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Sweden

References

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Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res. 2012 Mar;470(3):895-902. doi: 10.1007/s11999-011-2222-2. Epub 2011 Dec 20.

Reference Type BACKGROUND
PMID: 22183477 (View on PubMed)

Ast MP, Nam D, Haas SB. Patient-specific instrumentation for total knee arthroplasty: a review. Orthop Clin North Am. 2012 Nov;43(5):e17-22. doi: 10.1016/j.ocl.2012.07.004. Epub 2012 Sep 10.

Reference Type BACKGROUND
PMID: 23102417 (View on PubMed)

Other Identifiers

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210-13

Identifier Type: OTHER

Identifier Source: secondary_id

53

Identifier Type: -

Identifier Source: org_study_id