Patients with degenerative joint disease can effectively be treated with a primary total knee replacement to reduce pain and improve function in their daily lives. Theoretically, achievement of normal knee motion using a medial pivot design in total knee replacements can be recreated in comparison to single radius designs, which could lead to an improvement in post-surgical outcomes and satisfaction with the procedure. The aim of this study is to compare two types of implant designs (medial pivot and single radius) in a total knee replacement using clinical outcomes, patient reported outcomes, and overall function assessed by a specialized gait laboratory.
This is a single center, cohort study in 100 adult subjects undergoing primary total knee arthroplasty that will receive one of the two total knee device systems. Primary total knee replacement is an effective treatment for relieving pain and improving function for patients with degenerative joint disease. Recently, design of knee implants in a total knee replacement have received increased interest, particularly the medial pivot designs. Single-radius implants are designed to minimize instability throughout the functional range of movement. Medial pivot total knee designs theoretically recreate more normal knee motion when compared to single radius designs. Both implant designs are commonly used for total knee replacements. Outcomes of TKA are evaluated by multiple methods including implant/device survivorship, radiographic assessments, clinical examinations, and patient reported outcome measures (PROMS). Laboratory based gait analysis performed at a specialized research facility is not commonly conducted in patients with positive outcomes post-surgery as this is associated with high cost. There is currently not enough research comparing these two designs directly. Research is required to determine which design may provide better clinical outcomes and satisfaction with the procedure. In addition to your normal standard clinical care, there will be scheduled pre-operative, operative, 6-week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visits.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Medial Pivot Knee System
Single Radius Design Total Knee System
Sinai Hospital of Baltimore
Baltimore, Maryland, United States
RECRUITINGChange in Knee Mechanics
Knee flexion/extension, varus/valgus, and internal/external rotation will be measured (in degrees) and analyzed using the KneeKG system during incline and decline walking.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Anterior/Posterior Knee Translation
This parameter will be measured (in mm) and analyzed using the KneeKG system during incline and decline walking.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Initial Peak Loading Force
This parameter will be measured (in N) and analyzed using the KneeKG system during normal walking.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Active and Passive Range of Motion
Active and passive range of motion will be measured (in degrees) using a goniometer.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Quadriceps Lag
Quadriceps lag will be measured (in degrees) in both the sitting and supine positions.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Timed up and Go Test (TUG)
This parameter will be measured in seconds and requires a patient to rise from a chair walk three meters and return to the chair again as quickly as possible.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Five Times Sit to Stand Test
This parameter will be measured in seconds and will collect the amount of time it takes a patient to transfer from a seated to a standing position and back to sitting five times.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Single Limb Stance Test for Both Knees
This parameter will be measured in seconds and will collect the amount of time a patient is able to stand unassisted on one leg.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Timed Ascent and Descent of One Flight of Stairs Test
This parameter will be measured in seconds and will collect the amount of time it takes a patient to ascend and descend one flight of stairs (8-14 steps).
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Change in Quadriceps Muscle Strength
This parameter will be measured (in lbs/in) using a dynamometer for quadricep muscle strength assessment.
Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit
Implant Survivorship
Radiographic assessment using AP and lateral knee X-rays to analyze implant position, radiolucencies, fracture, and osteolysis.
Time frame: Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit
Post-surgical Complications
All complications related to the procedure will be documented.
Time frame: Operative visit; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit
Evidence of Osteolysis
X-rays will be evaluated to look for presence of a radiolucent area, especially \> 2mm, around implant or cement with sclerotic border.
Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit
Change in Knee Society Score (KSS) Short Form
25 question items assessing symptoms, patient satisfaction, patient expectation, and their level of functional activity of their knee. Scores range from 0-100 with higher scores representing better outcomes.
Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit
Change in Knee Injury and Osteoarthritis Outcome Score (KOOS)
42 question items assessing a patient's opinion about their health, symptoms, and function of their knee. Scores range from 0-100 with zero representing severe knee problems and 100 indicating no knee problems.
Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit
Change in Patient Reported Outcomes Measurement Information System (PROMIS-10)
10 question items assessing overall physical, mental, and social health of the patient. Each question item is scored separately on 1-5 scale and total scores are combined into 2 groups - Global Physical Health Score and Global Mental Health score. A T-score is calculated with the 2 previous scores against the general population with a higher T-score representing better outcomes.
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Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit
Change in Forgotten Joint Score FJS
12 question items evaluating how "aware" a patient is of their operative joint during daily activities. Scores range between 0-100 with higher scores indicating a patient is able to forget the joint on a daily basis or low joint awareness.
Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit