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NCT Number: NCT04814082

Prospective Functional, Gait, and Outcome Comparison Study of Medial Pivot Versus Single Radius Design for Total Knee Arthroplasty

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.

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Key information

Age range

18 year–75 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Sinai Hospital of Baltimore

Baltimore, Maryland, 21215, United States

Location status: Recruiting

Location contact

James Nace, DO

PRINCIPAL_INVESTIGATOR

Martin Gesheff

CONTACT

[email protected]

Nirav Patel

CONTACT

[email protected]

Ronald Delanois, MD

PRINCIPAL_INVESTIGATOR

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Subject is male or non-pregnant female aged between 18 and 75 years of age.
  • Subject is willing to provide informed consent to participate in the research study.
  • Subject is indicated for a primary total knee arthroplasty (TKA) based on the approved labeling of knee implant, either a medial pivot or single radius design, specifically: MicroPort Evolution Medial-Pivot Knee System, Cruciate Retaining (CS) or Stryker Triathlon Tritanium (CS)
  • Subject does not have a history of previous prosthetic replacement device on the operative knee.
  • Subject is currently ambulating and does not have a condition on the contralateral limb in the opinion of the investigator that would interfere with the gait laboratory evaluations.
  • Subject is willing and able to comply with the schedule of events for the study and is available to return to the clinic for all required follow-up visits.

Exclusion criteria

  • Subject has a Body Mass Index (BMI) >40
  • Subject has a diagnosis of avascular necrosis or inflammatory arthritis.
  • Subject has any mental or neuromuscular disorder that would create an unacceptable risk of prosthesis instability, prosthesis fixation failure, or complications in postoperative care.
  • Subject is a prisoner
  • Subject has any condition, in the opinion of the Investigator that might interfere with the evaluation of the study objectives.

Treatment and study plan

MicroPort Evolution Medial-Pivot Knee System (Cruciate-substituting)

Device

Medial Pivot Knee System

Stryker Triathlon Tritanium Knee System (Condylar Stabilizing)

Device

Single Radius Design Total Knee System

Primary outcomes

  1. Change in Knee Mechanics

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    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.

  2. Change in Anterior/Posterior Knee Translation

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    This parameter will be measured (in mm) and analyzed using the KneeKG system during incline and decline walking.

  3. Change in Initial Peak Loading Force

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    This parameter will be measured (in N) and analyzed using the KneeKG system during normal walking.

  4. Change in Active and Passive Range of Motion

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    Active and passive range of motion will be measured (in degrees) using a goniometer.

  5. Change in Quadriceps Lag

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    Quadriceps lag will be measured (in degrees) in both the sitting and supine positions.

  6. Change in Timed up and Go Test (TUG)

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    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.

  7. Change in Five Times Sit to Stand Test

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    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.

  8. Change in Single Limb Stance Test for Both Knees

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    This parameter will be measured in seconds and will collect the amount of time a patient is able to stand unassisted on one leg.

  9. Change in Timed Ascent and Descent of One Flight of Stairs Test

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    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).

  10. Change in Quadriceps Muscle Strength

    Time frame: Pre-operative; Post-operative - 3 month and 12 month follow-up visit

    This parameter will be measured (in lbs/in) using a dynamometer for quadricep muscle strength assessment.

Secondary outcomes

  1. Implant Survivorship

    Time frame: Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    Radiographic assessment using AP and lateral knee X-rays to analyze implant position, radiolucencies, fracture, and osteolysis.

  2. Post-surgical Complications

    Time frame: Operative visit; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    All complications related to the procedure will be documented.

  3. Evidence of Osteolysis

    Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    X-rays will be evaluated to look for presence of a radiolucent area, especially > 2mm, around implant or cement with sclerotic border.

  4. Change in Knee Society Score (KSS) Short Form

    Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    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.

  5. Change in Knee Injury and Osteoarthritis Outcome Score (KOOS)

    Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    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.

  6. Change in Patient Reported Outcomes Measurement Information System (PROMIS-10)

    Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    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.

  7. Change in Forgotten Joint Score FJS

    Time frame: Pre-operative; Post-operative - 6 week, 6 month, 12 month, 24 month, 36 month, and 60 month follow-up visit

    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.

Study contacts

Contact information is provided by the study sponsor or research team.

Martin Gesheff

CONTACT

[email protected]

410-601-9467

Nirav Patel

CONTACT

[email protected]

410-601-8860

Sponsors and collaborators

Lead sponsor

LifeBridge Health

Other

Collaborators

  • MicroPort Orthopedics Inc.
  • Rubin Institute for Advanced Orthopedics

Registry information

Official study title

Prospective Functional, Gait, and Outcome Comparison Study of Medial Pivot

Important dates

Study start
2021
Primary completion
2030
Study completion
2030
First posted
Mar 24, 2021
Registry last updated
Jan 22, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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