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NCT Number: NCT04378049

Robot-Assisted Partial Knee Replacement Versus Standard Total Knee Replacement

This is a pilot randomized trial to assess the feasibility of a definitive trial to determine the effect of robot-assisted partial knee replacements versus standard total knee replacements.

Active, Not Recruiting

This study is active but is not currently recruiting participants.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

St. Joseph's Healthcare Hamilton

Hamilton, Ontario, L8N 4A6, Canada

About this study

Knee osteoarthritis (OA) pain is an important source of morbidity and cost to the health care system. Over 60,000 knee replacement surgeries are performed in Canada every year, making it the second most common surgery. Our institution (St. Joseph's Healthcare Hamilton) is the first hospital in Canada to purchase a Mako RIO orthopaedic robot to assist with performing knee replacements. The knee is divided into three compartments, and one, two, or all three compartments can become arthritic. Over 90% of patients with end-stage knee OA receive a total knee replacement (also known as total knee arthroplasty or TKA) even if they have one or two healthy knee compartments. Partial knee replacements are an option for these patients but these procedures are very technically demanding and associated with a higher risk of implant failure. For this reason, few surgeons are experts at partial knee replacements. We believe that we can use robotic technology to make it easier for surgeons to perform partial replacements more accurately, thereby increasing the quality and survivorship of partial knee replacements. This may lead to better patient-important outcomes like return to activity, pain, and satisfaction, and eventually better access to high-quality partial knee replacements for Canadians. This will be the first study to evaluate total knee replacements (standard care) versus robot-assisted partial knee replacements, and could lead to greater uptake of robotic technology in orthopaedics and a shift toward anatomy-sparing partial knee replacements.

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Adult (18+)
  • Unicompartmental knee OA with or without concomitant patellofemoral OA, requiring surgical treatment
  • Two study surgeons independently agree that the patient is eligible for either treatment group

Exclusion criteria

  • Inability to provide informed consent (e.g. cognitive disability, language barrier)
  • Revision knee surgery
  • Simultaneous bilateral knee surgery
  • Previous major knee surgery or trauma
  • The robot or required components are unavailable (e.g. technical difficulties, robot-specific disposables out of stock)
  • A CT scan cannot be obtained prior to surgery
  • Patient does not wish to participate

Treatment and study plan

Total knee arthroplasty

Procedure

Surgeon will perform a total knee arthroplasty procedure according to local standard of care

Other names: Total knee replacement

Robot-assisted partial knee arthroplasty

Procedure

Surgeon will perform a robot-assisted unicompartmental or bicompartmental knee arthroplasty procedure

Other names: MakoPlasty

Primary outcomes

  1. Feasibility- Recruitment

    Time frame: 12 months

    The number of patients recruited during a 12 month period

  2. Feasibility- Participant retention

    Time frame: 12 months

    Number of patients completing the study

  3. Feasibility- Treatment compliance

    Time frame: 12 months

    The number of crossovers during a 12 month period

Secondary outcomes

  1. Return to function questionnaire

    Time frame: 12 months post-surgery

    We will use the 5-item Return To Function (RTF) questionnaire to determine when a trial participant returns to work, leisure, and activities around the home after an injury or surgery (measured as time to return to unrestricted activities).

  2. Oxford knee score

    Time frame: 12 months post-surgery

    We will measure knee function using the Oxford Knee Score (OKS), which is a validated and well-used 12 item questionnaire used to measure knee function when performing daily activities after total knee replacement surgery. The OKS is scored on a 0-48 scale with higher scores representing a better outcome.

  3. Forgotten joint score

    Time frame: 12 months post-surgery

    We will use the Forgotten Joint Score (FJS-Knee) to measure how natural the replaced knee feels. The FJS-Knee is a 12 item questionnaire that aims to assess both function and feeling by asking about patients' awareness of their artificial knee while doing various daily activities. The FJS is scored on a 0-100 scale with higher scores representing a better outcome.

  4. Gait walking mechanics analysis

    Time frame: 12 months post-surgery

    Overground walking kinematic gait analysis will be performed in the clinic environment using a ten-camera optoelectronic motion capture system. Primary gait outcomes will include the knee joint flexion and adduction angle magnitudes and range during the stance phase of gait. Secondary gait outcomes will include stride characteristics as defined above, knee transverse rotation during stance, knee flexion during swing, hip and ankle range of motion and peak magnitudes during stance.

  5. Quality of life- EQ-5D

    Time frame: 12 months post-surgery

    We will use the Euro-Qol 5 Dimensions (EQ-5D) questionnaire, a widely used and well-validated quality of life tool, to measure participant quality of life. The EQ-5D is a comprehensive, 5-item compact health status classification and health state preference questionnaire.

  6. Persistent post-surgical pain (PPSP)

    Time frame: 12 months post-surgery

    We will use a modified version of the WHO's definition of PPSP, to include a minimum threshold of pain severity:

    • Pain that began after surgery or a tissue trauma;
    • Pain is in an area of preceding surgery or tissue trauma;
    • Pain has persisted for at least three months after surgery; and
    • The pain is not better explained by an infection, malignancy, a pre-existing pain condition or any other alternative cause.
    • ≥4 out of 10 on the numeric rating scale (NRS) from the Brief Pain Inventory (BPI-SF) for "average pain over the last week". The scale ranges from 0 (no pain) to 10 (pain as bad as you can imagine)
  7. Patient global impression of change score

    Time frame: 12 months post-surgery

    We will use The Patient Global Impression of Change (PGIC) scale to assess patients' beliefs about the efficacy of treatment. The PGIC is one item and asks patients to rate the effectiveness of the treatment of interest on a 7-point ordinal scale ranging from "very much improved" to "very much worse

  8. Healthcare resource use (for cost-effectiveness)

    Time frame: 12 months post-surgery

    We will collect healthcare resource utilization information (e.g. hospitalization, physician visits) and information on productivity (e.g. time missed from work) to assist with health economic analyses.

  9. Rage of motion (ROM)

    Time frame: 6 weeks post-surgery

    We will measure knee ROM using a goniometer at in-clinic visits according to standard practice

  10. Knee alignment

    Time frame: Post-surgery

    We will measure mechanical alignment on pre-operative and post-operative weightbearing x-rays

  11. Adverse events

    Time frame: 12 months post-surgery

    We will collect all serious adverse events and surgery-related non-serious adverse events throughout the trial for safety monitoring purposes

  12. Short-term implant survival

    Time frame: 12 months post-surgery

    We will report the number of revision surgeries within the study period including cases of periprosthetic joint infection, aseptic loosening, instability, poly wear, intractable pain, periprosthetic fracture etc.

Sponsors and collaborators

Lead sponsor

McMaster University

Other

Collaborators

  • Canadian Institutes of Health Research (CIHR)
  • Hamilton Academic Health Sciences Organization
  • St. Joseph's Healthcare Hamilton

Registry information

Official study title

Robot-Assisted Partial Knee Replacement Versus Standard Total Knee Replacement: A Pilot Randomized Controlled Trial

Acronym: RoboKnees

Important dates

Study start
2020
Primary completion
2026
Study completion
2026
First posted
May 7, 2020
Registry last updated
May 9, 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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