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Osteoarthritis, KneeNCT02516280

Effects of Gaseous Cryotherapy on Knee ROM After TKA: A Feasibility Study

A study testing Cryoton ™ in people with Osteoarthritis, Knee, run by Centre Hospitalier de Verdun.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A pilot study was performed to investigate the feasibility of a large randomized controlled trial (RCT) to assess the effects of hyperbaric gaseous cryotherapy (HGC) on the change in knee flexion range of motion in the first two days after total knee arthroplasty. Read more about this study

Who is it for?
Ages 35 to 79 years
Conditions the study is for
Osteoarthritis, Knee
What is being tested?
Cryoton ™
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
65 participants
Where
No sites listed yet
Study dates
Jan 2012to Oct 2012
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 35 to 79 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Planned unilateral TKA done at Verdun Hospital.
  • Capacity to communicate in French or English.

Who cannot join

  • Complications during or after the surgery.
  • Inability to perform the tests due to other diseases.
  • Contraindications to cryotherapy such as Raynaud's disease, cryoglobulinemia, hemoglobinopathy, polyneuropathy associated with temperature sensitivity deficits or allergy to cold.

About this study

Official title: Effects of Hyperbaric Gaseous Cryotherapy on Knee Flexion Range of Motion in the First Two Days After Total Knee Arthroplasty: A Feasibility Randomized Controlled Trial

A pilot study was performed to investigate the feasibility of a large randomized controlled trial (RCT) to assess the effects of hyperbaric gaseous cryotherapy (HGC) on the change in knee flexion range of motion in the first two days after total knee arthroplasty.

Read the detailed description

Background: After total knee arthroplasty (TKA), patients can be discharged from hospital as early as two days after surgery. However, patients often do not achieve functional knee flexion range of motion (ROM) in the first postoperative days. Early application of hyperbaric gaseous cryotherapy (HGC) at the operated knee within an hour after surgery and the next postoperative days might increase ROM by reducing inflammation, edema and pain. However, it is unclear whether such early application of HGC is feasible. Moreover, there is no data to allow calculation of the sample size required to conduct a randomized controlled trial to compare the effects of HGC to those of conventional cryotherapy on the increase of knee flexion in the first two days after TKA.

Objectives: To investigate the feasibility of applying HGC within an hour after TKA and twice a day the next postoperative days. To collect data on changes in knee flexion ROM in the first two postoperative days to calculate the sample size required for a large randomized controlled trial. To compare the effects of HGC to those of conventional cryotherapy on changes in knee flexion ROM in the first two postoperative days.

Design: A prospective, single-blinded, randomized, controlled pilot trial.

Setting: Orthopedic postoperative unit in an acute care hospital.

Interventions: Patients were randomly allocated to either hyperbaric gaseous cryotherapy (intervention group) or the ice bag cryotherapy (control group). In each group, participants received the specific cryotherapy intervention at the operated knee within an hour after the surgery (day 0) and twice the next two postoperative days (day 1 and day 2).

Outcome measures: Feasibility measures included the rate of eligible patients who were willing to participate, attrition, adherence to interventions and presence of adverse effects. Active and passive knee flexion range of motion (ROM) and knee pain intensity at rest were evaluated on postoperative days 1 and 2. Change in active and passive knee flexion ROM and in knee pain intensity at rest from postoperative day 1 to day 2 were assessed. Length of hospital stay was collected.

Being tested
Cryoton ™, Control ice bag
Keywords
Total knee replacement, Cold, Neurocryostimulation, CO2 cryotherapy, mobility
Medical subject headings
Osteoarthritis, Knee, Common Cold

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cryoton ™Device

    Also called Neurocryostimulation, Cryonic

    In the intervention group, participants received hyperbaric gaseous cryotherapy delivered with a Cryoton ™ device (Cryonic Médical, Salins-les-Bains, France) within an hour after the surgery and two times per day the next postoperative days. The tip of the nozzle was kept 10-15 cm above the dry skin as the gaseous CO2 was sprayed on three zones of 5 cm by 10 cm (medial, lateral and posterior, respectively) using a slow and regular sweeping movement for approximately 30 seconds after a skin temperature of 2°C is reached.

  • Control ice bagDevice

    Also called ice

    In the control group, participants received two 20-minute treatments of cryotherapy within an hour after the surgery and two times per day the next postoperative days. Cryotherapy was performed using an ice bag that was applied directly on the anterior aspect of the knee. The ice bag is a square latex bag of 30 cm by 30 cm filled with crushed ice and wrapped in a thin pillow case. The treatment assessor applied the intervention in a standardized manner by ensuring that the knee was fully extended while covering the surgical incision and both lateral and medial aspects of the knee with the iced bag.

Study groups in NCT02516280
Study groupRoleWhat they receive
Hyperbaric gaseous cryotherapy groupExperimentalConventional rehabilitation with Cryoton ™ hyperbaric cryotherapy
Receives: Device: Cryoton ™
Control ice bag groupActive comparatorConventional rehabilitation with ice bag cryotherapy. Application of a bag of crushed ice directly on the anterior aspect of the knee.
Receives: Device: Control ice bag

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in active and passive knee flexion ROM measured by analysis.

    The primary outcomes were changes in active and passive knee flexion ROM from postoperative day 1 to day 2. This outcome was calculated as the difference in active and passive ROM between day 2 and day 1

    Measured: Between post-operative day 1 and 2

Secondary outcomes (6)
  1. Active and passive knee flexion ROM measured using goniometry.

    Active and passive knee flexion ROMs were measured with a long-arm (35 cm) goniometer featuring a 360º and two 180º scales, with 1º increments that read in opposite directions (Baseline 360° 14" Goniometer, Fabrication enterprises Inc., NY, USA). Knee ROMs were measured in sitting position because levels of agreement between observers are higher in sitting position than in supine position.

    Measured: During the first 2 days after surgery.

  2. Knee pain measured by visual analog scale.

    Scale from 0 to 10 cm on a ruler where 0 represented no pain and 10 represented the worst pain imaginable.

    Measured: During the first 2 days after surgery.

  3. Change in pain from postoperative day 1 to day 2 measured by analysis of variation of the recorded pain between data of day2 and day 1 (Knee pain measured by visual analog scale)

    Calculated as the difference of pain between day 2 and day 1.

    Measured: Between day 1 and 2.

  4. Feasibility was assessed by analysis of presence of adverse effects.

    Determine if the patients where having or not adverse during thier stay.

    Measured: Participants will be followed for the duration of hospital stay, an expected average of 3 days.

  5. Feasibility was assessed by adherence to the intervention (attrition).

    Determine if the patients where adhering to treatment (drop-off).

    Measured: Participants will be followed for the duration of hospital stay, an expected average of 3 days.

  6. Length of the stay in hospital ward was measured by the length(in days) of inpatient episode of care.

    Length of stay in hospital ward.

    Measured: Participants will be followed for the duration of hospital stay, an expected average of 3 days.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Aug 2015 (estimated)
  2. Study startJan 2012
  3. Primary completionOct 2012
  4. Study completionOct 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
65 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02516280
Sponsor's protocol ID
CHV2012-01
Status last verified
Aug 2015
First submitted
27 Jul 2015
Last updated
5 Aug 2015
Results posted
No
Data monitoring committee
No

Publications

  • Abramson DI, Chu LS, Tuck S Jr, Lee SW, Richardson G, Levin M. Effect of tissue temperatures and blood flow on motor nerve conduction velocity. JAMA. 1966 Dec 5;198(10):1082-8. No abstract available.

    PubMed 5953385
  • Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007911. doi: 10.1002/14651858.CD007911.pub2.

    PubMed 22972114
  • Adie S, Naylor JM, Harris IA. Cryotherapy after total knee arthroplasty a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2010 Aug;25(5):709-15. doi: 10.1016/j.arth.2009.07.010. Epub 2009 Sep 2.

    PubMed 19729279
  • Alcelik I, Sukeik M, Pollock R, Misra A, Shah P, Armstrong P, Dhebar MI. Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012 Dec;20(12):2502-12. doi: 10.1007/s00167-012-1944-3. Epub 2012 Mar 15.

    PubMed 22419264
  • Ayalon O, Liu S, Flics S, Cahill J, Juliano K, Cornell CN. A multimodal clinical pathway can reduce length of stay after total knee arthroplasty. HSS J. 2011 Feb;7(1):9-15. doi: 10.1007/s11420-010-9164-1. Epub 2010 May 22.

    PubMed 22294952
  • Bade MJ, Kittelson JM, Kohrt WM, Stevens-Lapsley JE. Predicting functional performance and range of motion outcomes after total knee arthroplasty. Am J Phys Med Rehabil. 2014 Jul;93(7):579-85. doi: 10.1097/PHM.0000000000000065.

    PubMed 24508937
  • Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010 Sep;40(9):559-67. doi: 10.2519/jospt.2010.3317.

    PubMed 20710093
  • Basso DM, Knapp L. Comparison of two continuous passive motion protocols for patients with total knee implants. Phys Ther. 1987 Mar;67(3):360-3. doi: 10.1093/ptj/67.3.360.

    PubMed 3823150
  • Belitsky RB, Odam SJ, Hubley-Kozey C. Evaluation of the effectiveness of wet ice, dry ice, and cryogenic packs in reducing skin temperature. Phys Ther. 1987 Jul;67(7):1080-4. doi: 10.1093/ptj/67.7.1080.

    PubMed 3602101
  • Bonutti PM, Mont MA, Kester MA. Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach. Orthop Clin North Am. 2004 Apr;35(2):217-26. doi: 10.1016/j.ocl.2004.02.001.

    PubMed 15062707
  • Chatap G, De Sousa A, Giraud K, Vincent JP; Acute Pain in the Elderly Study Group. Pain in the elderly: Prospective study of hyperbaric CO2 cryotherapy (neurocryostimulation). Joint Bone Spine. 2007 Dec;74(6):617-21. doi: 10.1016/j.jbspin.2006.10.011. Epub 2007 Jul 19.

    PubMed 17897861
  • Cheng T, Liu T, Zhang G, Peng X, Zhang X. Does minimally invasive surgery improve short-term recovery in total knee arthroplasty? Clin Orthop Relat Res. 2010 Jun;468(6):1635-48. doi: 10.1007/s11999-010-1285-9. Epub 2010 Mar 13.

    PubMed 20229136
  • Chesterton LS, Foster NE, Ross L. Skin temperature response to cryotherapy. Arch Phys Med Rehabil. 2002 Apr;83(4):543-9. doi: 10.1053/apmr.2002.30926.

    PubMed 11932859
  • Chiu KY, Ng TP, Tang WM, Yau WP. Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong). 2002 Dec;10(2):194-202. doi: 10.1177/230949900201000215.

    PubMed 12493934
  • Ciolek JJ. Cryotherapy. Review of physiological effects and clinical application. Cleve Clin Q. 1985 Summer;52(2):193-201. doi: 10.3949/ccjm.52.2.193. No abstract available.

    PubMed 3896574

Questions about this trial

What is this clinical trial studying?

A study testing Cryoton ™ in people with Osteoarthritis, Knee, run by Centre Hospitalier de Verdun.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Aug 2015. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in active and passive knee flexion ROM measured by analysis. (time frame: Between post-operative day 1 and 2). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02516280, which also lists 58 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Aug 2015.

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