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Completed

NCT Number: NCT03974932

Total Knee Arthroplasty (TKA) Study of HTX-011 in an Multimodal Analgesic Regimen (MMA) Regimen

Phase 3b, open-label single-arm study in which all subjects receive HTX-011 as part of a scheduled non-opioid MMA regimen.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

Helen Keller Hospital, Sheffield, Alabama, United States

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Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Is scheduled to undergo primary unilateral TKA under spinal anesthesia.
  • Has not previously undergone TKA in either knee.
  • Has an American Society of Anesthesiologists (ASA) Physical Status of I, II, or III.
  • Is able to walk at least 20 feet with optional use of a 4-legged walker for balance.
  • Female subjects are eligible only if not pregnant, not lactating, not planning to become pregnant during the study, sterile; or is at least 2 years post-menopausal; or is in a monogamous relationship with a partner who is surgically sterile; or using acceptable contraceptives.

Exclusion criteria

  • Has a planned concurrent surgical procedure.
  • Has other pre-existing concurrent acute or chronic painful physical/restrictive condition expected to require analgesic treatment in the postoperative period for pain.
  • Has a contraindication or a known or suspected history of hypersensitivity or clinically significant idiosyncratic reaction to required study medications.
  • Using or expected to use Factor IX Complex or anti-inhibitor coagulant concentrates during the study.
  • Has known or suspected daily use of opioids for 7 or more consecutive days within the previous 6 months.
  • Has taken NSAIDs within 10 days prior to the scheduled surgery with the exception of subjects on low-dose (≤100 mg) daily acetylsalicylic acid for cardioprotection.
  • Has taken opioids within 24 hours prior to the scheduled surgery (3 days for long-acting).
  • Has been administered bupivacaine within 5 days prior to the scheduled surgery.
  • Has been administered any local anesthetic within 72 hours prior to the scheduled surgery.
  • Has initiated treatment with medications within 1 month prior to study drug administration that can impact pain control.
  • Has been administered systemic steroids within 5 half-lives or 10 days prior to administration of study drug.
  • Received an investigational product or device in a clinical trial within 30 days or within 5 elimination half lives.
  • Has a known or suspected history of drug abuse, a positive drug screen on the day of surgery, or a recent history of alcohol abuse.
  • Has a medical condition such that, in the opinion of the Investigator, participating in the study would pose a health risk to the subject or confound the postoperative assessments.
  • Is currently undergoing treatment for hepatitis B, hepatitis C, or HIV.
  • Has uncontrolled anxiety, psychiatric, or neurological disorder that, in the opinion of the Investigator, might interfere with study assessments.
  • Has acquired defective color vision or acute gastrointestinal ulcers, either of which could interfere with scheduled study medications.
  • Has any chronic neuromuscular deficit of either femoral nerve function or thigh musculature.
  • Has any chronic condition or disease that would compromise neurological or vascular assessments.
  • Had a malignancy in the last year, with the exception of nonmetastatic basal cell or squamous cell carcinoma of the skin or localized carcinoma in situ of the cervix.
  • Has undergone 3 or more surgeries within 12 months.
  • Has a body mass index (BMI) >39 kg/m2.

Treatment and study plan

HTX-011

Drug

Dual-acting local anesthetic. Dose 1.

Ibuprofen

Drug

NSAID.

Acetaminophen

Drug

Analgesic.

Celecoxib

Drug

NSAID.

+/- Bupivacaine HCl

Drug

Local anesthetic.

Luer Lock Applicator

Device

Applicator for instillation.

Primary outcomes

  1. Mean Area Under the Curve (AUC) of the Visual Analogue Scale (VAS).

    Time frame: 12 through 48 hours

    The Visual Analog Scale (VAS) consists of a straight 10-cm line that represents pain ranging from "no pain" to "pain as bad as it could be". Subjects were asked to mark their current pain level on the line.

Secondary outcomes

  1. Mean AUC of VAS Scores.

    Time frame: 72 hours

    The Visual Analog Scale (VAS) consists of a straight 10-cm line that represents pain ranging from "no pain" to "pain as bad as it could be". Subjects were asked to mark their current pain level on the line.

  2. Mean AUC of the NRS of Pain Intensity at Rest (NRS-R).

    Time frame: 72 hours

    Pain intensity scores are assessed using an 11-point Numeric Rating Scale (NRS) (0-10) where 0 represents "no pain" and 10 represents "worst pain". NRS scores are measured at rest.

  3. Percentage of Subjects With Severe Pain.

    Time frame: 24 hours, 48 hours, 72 hours

    Severe Pain defined as a VAS score ≥7.5 cm.

  4. Mean Total Postoperative Opioid Consumption (in IV Morphine Milligram Equivalents [MME]).

    Time frame: 72 hours

  5. Percentage of Subjects Who Are Opioid-free

    Time frame: 72 Hours to Day 11

  6. Percentage of Subjects Who Are Opioid-free Through 72 Hours Who Remain Opioid-free Through Day 11.

    Time frame: 72 hours through Day 11

  7. Median Time to First Opioid Rescue Medication.

    Time frame: Through 72 hours

  8. Percentage of Subjects Who do Not Receive an Opioid Prescription at Discharge.

    Time frame: 72 hours

  9. Percentage of Subjects Who do Not Receive an Opioid Prescription Between Discharge and the Day 11 Visit.

    Time frame: 72 hours through Day 11

  10. Percentage of Subjects Achieving a Score of "Good" or Better (>1) Pain Control Based on Patient Global Assessment (PGA).

    Time frame: 24 hours, 48 hours, 72 hours, Day 11

    Patient's Global Assessment (PGA) of pain control is a 4-point scale in which subjects rate how well their pain has been controlled (0 = Poor; 1 = Fair; 2 = Good; 3 = Excellent).

  11. Median Time to First Ambulation Postsurgery.

    Time frame: 72 hours

  12. Percentage of Subjects Unable to Participate in Each Rehabilitation Session Because of Pain.

    Time frame: 72 hours

  13. Percentage of Subjects Who First Achieve an MPADSS Score ≥9.

    Time frame: 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 24, hours, 36 hours, 48 hours, 60 hours, 72 hours

    Subjects were assessed for readiness for discharge using the Modified Post-Anesthesia Discharge Scoring System (MPADSS) that assesses 5 clinical variables: vital signs, ambulation, nausea/vomiting, pain, and surgical bleeding, each on a 3-point scale of 0, 1, or 2 with 0 being the worst score and 2 being the best score. Subjects with an MPADSS score of 9 or 10 were considered ready for discharge.

  14. Percentage of Subjects Who Are Discharged Home vs to a Skilled Nursing Facility.

    Time frame: 72 hours

    Number Analyzed represents Subjects who were discharged home.

  15. Mean Overall Benefit of Analgesia Score (OBAS).

    Time frame: 24 hours, 48 hours, 72 hours, Day 11

    Subjects were questioned about their overall benefit of analgesia. Overall benefit of analgesia score (OBAS) assesses current pain at rest, vomiting, itching, sweating, freezing, dizziness, and overall satisfaction with postoperative pain during the previous 24 hours. To calculate the OBAS score, each of the subscale scores (0=minimum; 4=maximum) are summed for a combined OBAS score. Possible scores could range from 0 to 28 with a lower score indicating greater benefit.

  16. Mean Total TSQM-9 Score

    Time frame: 72 hours through Day 11

    The Treatment Satisfaction Questionnaire for Medication (TSQM-9) contains 9 items assessing Effectiveness, Convenience, and Global Satisfaction domains. Responses to items are rated on a 5-point or 7-point rating scale. Scores for each domain are computed by adding the TSQM items in each domain and then transforming the values in to a composite score ranging from 0 to 100, with higher scores representing higher satisfaction.

  17. Maximum Concentration (Cmax)

    Time frame: 72 hours

  18. Time of Occurrence of Maximum Concentration (Tmax)

    Time frame: 72 hours

Sponsors and collaborators

Lead sponsor

Heron Therapeutics

Industry

Registry information

Official study title

A Phase 3b, Open-Label Study of HTX-011 as Part of a Scheduled Non-Opioid Multimodal Analgesic Regimen in Subjects Undergoing Total Knee Arthroplasty

Important dates

Study start
2019
Primary completion
2020
Study completion
2021
First posted
Jun 5, 2019
Registry last updated
Mar 2, 2026

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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