Primary objective: The primary objective of this study is to evaluate postsurgical pain control, after presurgical iovera° treatment plus EXPAREL® and standardized multimodal therapy compared with presurgical sham iovera° treatment plus EXPAREL and standardized multimodal therapy in subjects undergoing primary unilateral total knee arthroplasty (TKA). Secondary objectives: The secondary objectives of this study are to compare postsurgical pain control or postsurgical total opioid consumption, opioid-free status, physical function, sleep quality, and safety of presurgical iovera° treatment plus EXPAREL and standardized multimodal therapy with presurgical sham iovera° treatment plus EXPAREL and standardized multimodal therapy, in subjects undergoing primary unilateral TKA
This is a multicenter, double-blind, randomized, sham-controlled study in adult subjects undergoing TKA. Approximately 200 subjects are planned for enrollment and will be randomized 1:1 to receive presurgical ioveraº treatment or sham ioveraº treatment. An unblinded interim analysis will be performed when approximately 60 randomized and treated subjects have completed the Day 30 assessments. Based on the results of the interim analysis, sample size re-estimation will be performed and one of the following will occur: (1) the study will proceed to the final analysis without additional interim analysis, (2) the study will proceed to the second interim analysis once a defined number of additional subjects have completed Day 30 assessments, at which time, the study may be stopped for success or futility or proceed to the final analysis (3) the study will be stopped for futility. The detailed decision rules are defined in response to the interim analysis statistical analysis plan (IA SAP). This study is designed to investigate whether presurgical iovera° cryoneurolysis treatment leads to less postsurgical opioid consumption, decreased pain after surgery, improved function, and improved postsurgical outcomes compared with subjects who undergo presurgical sham iovera° treatment. All subjects will receive postsurgical multimodal pain medications and intraoperative local infiltration with EXPAREL (bupivacaine liposome injectable suspension). Subjects may be screened within 60 days prior to TKA. No procedures other than the site's standard of care will be performed before signed informed consent is obtained. When screening test results are received and the subject is deemed eligible for the study, the subject will be notified that he or she can be enrolled in the study. Subjects may be rescreened upon sponsor approval for administrative reasons. Randomization to treatment groups and treatment with the iovera° system according to the randomization assignment will be performed prior to TKA. The treatment groups are: * Group 1: subjects will receive iovera° cryoneurolysis treatment of superficial genicular nerves of the target knee * Group 2: subjects will receive sham iovera° treatment of superficial genicular nerves of the target knee At the subsequent TKA, all subjects in both groups will receive intraoperative local infiltration with EXPAREL and postsurgical multimodal pain medications. After discharge, subjects will be followed for 90 days. Subjects will be assessed for safety, efficacy, and health outcomes parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
79
Cryoneurolysis
ioveraº sham
Sah Orthopaedic Associates at the Institute for Joint Restoration
Fremont, California, United States
Lotus Clinical Research
Pasadena, California, United States
Phoenix Clinical Research
Tamarac, Florida, United States
Towson Orthopaedic Associates
Towson, Maryland, United States
Northwell Health
New York, New York, United States
First Surgical Hospital
Bellaire, Texas, United States
Legent Orthopedic Hospital
Carrollton, Texas, United States
NRS "worst pain" intensity scores from first pain assessment post-TKA (Day 1) to Day 30.
Time frame: Day 1 to Day 30
Change of KOOS scores (English version LK 1.0) from TKA Pre-Surgery visit to Day 30 visit post-TKA
Time frame: Day -3 to Day 30
NRS "worst pain" intensity scores from first pain assessment post-TKA (Day 1) to Day 15, Day 42, and Day 90.
Time frame: Day 1 to Day 90
NRS "average pain" intensity scores from first pain assessment post-TKA (Day 1) to Day 15, Day 30, Day 42, and Day 90
Time frame: Day 1 to Day 90
Change of NRS current pain intensity scores (pain "right now") from pre-treatment to post-treatment at the iovera/sham treatment visit
Time frame: Day 1 to Day 90
Total postsurgical opioid consumption in oral morphine equivalents through Day 15, Day 30, Day 42, and Day 90
Time frame: Day 1 to Day 90
Percentage of subjects who are opioid free from post-TKA through Day 30
Time frame: Day 1 to Day 30
Change of KOOS scores from screening visit to each of the following visits: TKA Pre-Surgery, Day 15, Day 30, Day 42, and Day 90
Time frame: Day -3 to Day 90
Physical function (pain with 10 M walk, pain with passive range of motion (ROM) to 90° or 110° and active ROM maximum degrees of flexion) at the following visits: Day 15, Day 30, Day 42, and Day 90.
Time frame: Day 15 to Day 90
Acute postoperative sleep quality by NRS daily through the first 7 days post TKA
Time frame: Day 1 to Day 8
Change of extended postoperative sleep quality by PROMIS 8A scores from screening visit to each of the following visits: TKA Pre-Surgery, Day 15, Day 30, Day 42, and Day 90.
Time frame: Screening to Day 90
NRS "worst pain" itensity scores from 72 hours post-TKA (Day 4) to Day 30
Time frame: Day 4 to Day 30
NRS "average pain" intensity scores from 72 hours post-TKA (Day 4) to Day 30
Time frame: Day 4 to Day 30
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