COntralateral CorticoSTeroid Injection in Total Knee Arthroplasty
NCT ID: NCT06809998
Last Updated: 2025-12-18
Study Results
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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RECRUITING
PHASE1/PHASE2
60 participants
INTERVENTIONAL
2025-01-24
2027-04-30
Brief Summary
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Detailed Description
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Some patients with knee OA have bilateral involvement and surgery may be needed in both knees. Having bilateral knee OA is a known risk factor for dissatisfaction, as there can be an overuse of the less affected, contralateral knee, in order to avoid symptoms from the more severely affected knee. Moreover, one of the principal determinants of patient-reported functional outcome after a unilateral TKA is residual pain and limited function in the contralateral, un-replaced knee.
One option to improve range of motion, pain, functional scores and reduce postoperative stiffness on both knees is a bilateral TKA; however, it has been previously reported to have a higher risk of serious cardiac complications, pulmonary complications, and mortality when compared with a unilateral TKA. A less invasive and widely available treatment option is intra-articular corticosteroids applied pre-/peri-operatively in the contralateral (un-replaced) knee to improve post-operative rehabilitation.
Intra-articular corticosteroids are extensively used to reduce inflammation and pain in inflamed arthritic joints. They are associated with a moderate improvement in pain and a small improvement in physical function usually up to 3 months after injection. The use of intra-articular corticosteroids in patients with symptomatic knee OA has been shown to improve Visual Analog Scale (VAS) scores at up to 3 months, as well as the WOMAC scores up to 6 months, compared with baseline scores. There is limited data on contralateral steroid injections and its impact on surgical site infection or PROMs.
It is estimated that from 6.5% to 20% of patients report early dissatisfaction after knee replacement surgery. Furthermore, having bilateral OA is a known risk factor for dissatisfaction among patients who undergo TKA. Residual pain, limited function and limited range of motion are primary factors in patient satisfaction after undergoing TKA. Therefore, improved pain control in the contralateral knee is hypothesized to play a role in improving patient satisfaction after a TKA on the opposite side, in addition to helping with the post-operative rehabilitation process.
Understanding whether contralateral steroid injections confer superior functional and/or patient reported outcome measures after a TKA is critical to enhance patient care and improve patient functional outcomes in OA patients. There is currently a lack of high-quality prospective trials investigating the use of contralateral corticosteroid injections for TKA outcomes.
The COSTI trial (Contralateral Steroid Injection in Total Knee Arthroplasty) was developed to fill this knowledge gap. We propose a prospective, triple-blinded (patient, surgeon and outcome assessor), randomized controlled trial comparing contralateral corticosteroid knee injections versus placing a band-aid (control) in patients with bilateral osteoarthritis undergoing a TKA for osteoarthritis.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
SUPPORTIVE_CARE
TRIPLE
Study Groups
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Group A - Corticosteroid Injection
Corticosteroid injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
The patient will be brought to the regional room where a fully licensed anaesthesiologist will perform standard of care anaesthesia followed by an ultrasound guided intra-articular knee injection with steroid AFTER the spinal neuraxial blockage has already been administered.
Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
Group B - Band-Aid Placement
The patient will be brought to the regional room where a fellowship trained interventional pain/regional anaesthesiologist will perform standard of care anaesthesia followed by the application of a band-aid.
Band-Aid
Band-Aid
Interventions
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Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
Band-Aid
Band-Aid
Eligibility Criteria
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Inclusion Criteria
* Primary osteoarthritis diagnosis with indication for primary elective unilateral TKA
* No previous contralateral knee injections (steroids/biologics) within one year of study
* Not scheduled for bilateral TKA or a subsequent staged contralateral TKA within the next six months
* No previous or active infection or trauma (osseous/ligamentous/extensor mechanism) on the contralateral knee
* Contralateral knee pain \& symptoms - defined as a VAS of \>4/10 at initial pre-op visit
* Contralateral knee OA quantified as: Kellgren and Lawrence grade \>2-4
* Assessed by PI (AK) who will not be contributing any patients to the study through examination of blinded knee radiographs (3 views: AP/lateral/Sunrise)
* Patient is able to read and understand English and provide informed consent to participation in the study
Exclusion Criteria
* Cognitive impairment (dementia, Alzheimer's, uncontrolled delirium) which will prevent patients from completing primary outcome measure or comply with follow-up requirements
* Previous TKA or ORIF or nailing on either knee
* Previous or active knee infection or extensor mechanism disruption
* Previous arthroscopy on either knee
* Medical contraindication to elective TKA surgery
18 Years
ALL
No
Sponsors
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Unity Health Toronto
OTHER
Responsible Party
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Principal Investigators
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Amir Khoshbin, MD, FRCS (C)
Role: PRINCIPAL_INVESTIGATOR
Unity Health Toronto
Locations
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St. Michael's Hospital
Toronto, Ontario, Canada
Countries
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Central Contacts
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Facility Contacts
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Amir Khoshbin, MD, FRCS (C)
Role: primary
Cassandra Tardif-Theriault, BKin
Role: backup
References
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Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg. 2017 Oct;25(10):703-714. doi: 10.5435/JAAOS-D-16-00541.
da Costa BR, Hari R, Juni P. Intra-articular Corticosteroids for Osteoarthritis of the Knee. JAMA. 2016 Dec 27;316(24):2671-2672. doi: 10.1001/jama.2016.17565.
Tian K, Cheng H, Zhang J, Chen K. Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Apr;97(15):e0240. doi: 10.1097/MD.0000000000010240.
Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty. 2013 Aug;28(7):1141-7. doi: 10.1016/j.arth.2012.09.023. Epub 2013 Mar 19.
Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007 Jun;89(6):1220-6. doi: 10.2106/JBJS.F.01353.
Sheth DS, Cafri G, Paxton EW, Namba RS. Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality. J Arthroplasty. 2016 Sep;31(9 Suppl):212-6. doi: 10.1016/j.arth.2016.03.018. Epub 2016 Mar 17.
Bagsby D, Pierson JL. Functional outcomes of simultaneous bilateral versus unilateral total knee arthroplasty. Orthopedics. 2015 Jan;38(1):e43-7. doi: 10.3928/01477447-20150105-59.
Meehan JP, Monazzam S, Miles T, Danielsen B, White RH. Postoperative Stiffness Requiring Manipulation Under Anesthesia Is Significantly Reduced After Simultaneous Versus Staged Bilateral Total Knee Arthroplasty. J Bone Joint Surg Am. 2017 Dec 20;99(24):2085-2093. doi: 10.2106/JBJS.17.00130.
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty. 2017 Dec;32(12):3854-3860. doi: 10.1016/j.arth.2017.07.021. Epub 2017 Jul 21.
Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. The rate and predictors of patient satisfaction after total knee arthroplasty are influenced by the focus of the question: a standard satisfaction question is required. Bone Joint J. 2018 Jun 1;100-B(6):740-748. doi: 10.1302/0301-620X.100B6.BJJ-2017-1292.R1.
Huang S, Li X, Tang Y, Stiphan S, Yan B, He P, Xu D. Different patient satisfaction levels between the first and second knee in the early stage after simultaneous bilateral total knee arthroplasty (TKA): a comparison between subjective and objective outcome assessments. J Orthop Surg Res. 2017 Jul 26;12(1):121. doi: 10.1186/s13018-017-0605-0.
Walmsley P, Murray A, Brenkel IJ. The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade. Data from the Scottish Arthroplasty Project. Knee. 2006 Mar;13(2):102-5. doi: 10.1016/j.knee.2006.01.003. Epub 2006 Feb 14.
Marmon AR, Zeni JA Jr, Snyder-Mackler L. Perception and presentation of function in patients with unilateral versus bilateral knee osteoarthritis. Arthritis Care Res (Hoboken). 2013 Mar;65(3):406-13. doi: 10.1002/acr.21825.
Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006 Nov;452:35-43. doi: 10.1097/01.blo.0000238825.63648.1e.
Lim JB, Chou AC, Chong HC, Lo NN, Chia SL, Tay KJ, Yeo SJ. Are patients more satisfied and have better functional outcome after bilateral total knee arthroplasty as compared to total hip arthroplasty and unilateral total knee arthroplasty surgery? A two-year follow-up study. Acta Orthop Belg. 2015 Dec;81(4):682-9.
Other Identifiers
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24-158
Identifier Type: -
Identifier Source: org_study_id