This study will determine whether a drug called sodium nitrite helps improve pain and post-operative recovery associated with knee replacement surgery.
The goal of this study is to examine the potential for oral sodium nitrite supplementation to reduce postoperative pain and inflammation and improve functional recovery in individuals undergoing unilateral revision total knee replacement. A sustained release formulation of sodium nitrite (40 mg) administered twice daily will be compared with placebo for a 30-day treatment period. Primary objectives are to evaluate pain and markers of functional improvement.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Opioid Requirements
Patients
Time frame: 30 days
Short-form McGill Pain Questionnaire (SF-MPQ)
The SF-MPQ is a validated test for the measurement of pain. The measure is calculated by summing the point values for responses to 15 questions. Questions 1-11 deal with the sensory dimension of pain (i.e., the quality of the pain). Questions 12-15 deal with the affective dimension of pain (i.e., how the pain affects you). Subscores for the sensory and affective dimensions are calculated, in addition to a total McGill Pain Score. In addition, there is a visual analogue scale for pain and a final question about pain intensity. Higher scores generally correspond to a worse subjective experience of pain.
Time frame: 30 days
Brief Pain Inventory (BPI) short form
The BPI is a questionnaire used to assess the severity of pain (intensity) and its impact on functioning (interference). It uses a 0-10 numeric rating scale for item rating and has no scoring algorithm. Pain severity can be measured as the arithmetic mean of the four severity items, with a lower score indicating less pain. Pain interference can be measured from arithmetic mean of the seven interference items, with a lower score indicating less interference.
Time frame: 30 days
Pain ratings
Ratings of pain intensity (PI) and pain unpleasantness (PU) will be obtained. A description of the difference between PI (ie, "how strong the pain feels") and PU (ie, "how unpleasant or disturbing the pain is for you") will be read to all participants. Following this, PI and PU will be assessed by asking participants for verbal self-reports on a 0-100 scale, with 0 = "No pain" or "Not at all unpleasant" and 100 = "Pain as intense as I can imagine" or "Pain as unpleasant as I can imagine". Numeric rating scales of PI and PU have demonstrated validity through their ability to detect treatment effects, as well as their strong association with other measures of sensory and affective components of pain.
Time frame: 30 days
Quality of Recovery (QoR-15) questionnaire
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The QoR-15 scale is a measurement of the quality of recovery from surgery and anesthesia measured in five domains: physical comfort, pain, physical independence, psychological support, and emotional state. The QoR-15 scale provides a score ranging from 0 to 150, with a high score indicating a good quality of recovery.
Time frame: 30 days
Physical function
Performance-based measure of physical function will be obtained using a goniometer to measure range of motion (ROM), in degrees from 0-180, at the knee joints. A lower numeric ROM indicates worse physical function.
Time frame: 30 days
Leg girth measurement
Girth measurements of both legs will be made while participants are in a reclined position. Knee joint circumference will be measured (in cm), and thigh circumference will be measured (in cm) at 5 cm and 10 cm above the kneecap while thigh muscles are contracted. Measurements will be used to calculate a Limb Symmetry Index (\[circumference of injured leg / circumference of uninjured leg\] \* 100).
Time frame: 30 days
White blood cell count
Blood will be drawn for the measurement of white blood cell (WBC) count in # of WBCs per microliter.
Time frame: 30 days
Immune cell markers
CD11b/CD18 is a member of the leukocyte integrin family of heterodimeric adhesion molecules expressed on hematopoietic cells and are regarded as immune cell markers. Blood content of CD11b/CD18 expressing cells will be measured using flow cytometry with relative staining and optical density.
Time frame: 30 days
Blood markers v1
Soluble P-selectin, F2-isoprostanes, protein carbonyls, tumor necrosis factor (TNF) alpha, CC chemokine ligand 2 (CCL2), protaglandin E2 (PGE2), and pentraxin 3 (PTX3) will be measured in blood plasma as indices of infection, oxidative stress, and inflammation. They will be quantified in units of pg/ml, where lower levels indicate less infection, oxidative stress, and inflammation.
Time frame: 30 days
Blood markers v2
8-OH-deoxyguanine, nitrate, and nitrite will be measured in blood plasma as indices of oxidative damage and nitric oxide homoeostasis. They will be quantified in micromolar (uM) concentration, where lower levels indicate less oxidative damage.
Time frame: 30 days
Timed-Up-and-Go test
This is a test for measuring the functional mobility. Participants will be timed during rising from an armchair, walking 3 meters, turning around, walking back, and sitting down again. Participants will be allowed to use the armrests and will be wearing their shoes.
Time frame: 30 days