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Osteoarthritis of KneeNCT02577978

Stability of the Medial Pivot Total Knee Prosthesis

A study testing Medacta GMK posterior stabilized prosthesis and Medacta GMK Sphere prosthesis in people with Osteoarthritis of Knee, run by Northwestern University at 1 site in United States.

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

The purpose of this study is to compare objective and subjective measures of knee stability following total knee arthroplasty with a medial pivot design vs. a posterior stabilized design. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Osteoarthritis of Knee
What is being tested?
Medacta GMK posterior stabilized prosthesis and Medacta GMK Sphere prosthesis
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
61 participants
Where
1 siteUnited States
Study dates
Apr 2014to Jun 2017
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-85, regardless of gender, ethnicity, or pathology
  • Must require a total knee arthroplasty
  • All subjects must have given signed, informed consent prior to registration in study.

Who cannot join

  • Minors
  • Any patients that are unable to consent
  • Patients with active infection or osseous tumor of the operative extremity
  • Patients undergoing revision surgery

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Northwestern Medicine Department of Orthopaedic Surgery

    Chicago, Illinois, 60611

Other trials in United States

About this study

The purpose of this study is to compare objective and subjective measures of knee stability following total knee arthroplasty with a medial pivot design vs. a posterior stabilized design.

Read the detailed description

Several different prostheses are available for use in total knee arthroplasty (TKA). These designs aim to replicate the normal kinematics of the knee joint while maintaining stability throughout a full range of motion. The posterior cruciate ligament (PCL) contributes to these functions in the native knee, and if preserved it can function similarly in the prosthetic knee. Prostheses in which the PCL is sacrificed, and its function not replaced by other means, have poorer outcomes. However, various problems with preserving the PCL, including PCL deterioration in arthritic knees and difficulties with proper tensioning, have led to the development of alternative ways to emulate normal femoral rollback and sagittal plane stability. These posterior-substituted (PS) designs substitute for the PCL with either a cam and post mechanism or a symmetrical ultra-congruent tibial insert.

The cruciate-retaining (CR) and PS designs, together with advances in surgical techniques and component materials, have achieved excellent implant survivorship with rates of > 90% at 20 years. Reports of functional outcomes, however, have been variable. One potential area for improvement in TKA is optimization of implant design to better approximate native knee kinematics. In the normal knee, the medial condyle remains stable in the sagittal plane, functioning like a ball-and-socket, whereas the lateral condyle translates anterior to posterior during flexion. The designs of the CR and PS knees do not allow for this medial-centered rotation. Analysis has revealed paradoxical anterior sliding of the femur during flexion, abnormal axial rotation, and condylar lift-off. Edge loading and increased sagittal plane motion may predispose to accelerated polyethylene wear. The posterior stabilized design uses a cam-and-post mechanism in which one piece of the prosthesis has a plastic post that fits into a slot in the other piece of the prosthesis.

A newer design that attempts to address these issues is the medial pivot knee (MP). This design is characterized by an asymmetrical tibial insert in which the medial compartment is ultra-congruent, providing antero-posterior stability and the lateral compartment allows for rollback around a medial axis of rotation i.e uses a ball-and-socket mechanism. This design more accurately recreates normal knee kinematics, reduces anteroposterior instability, and avoids condylar lift-off. Early studies indicate improved polyethylene wear characteristics. Midterm studies report excellent implant survivorship and clinical outcomes.

Several randomized trials have compared the MP knee favorably with other designs. Patients with bilateral TKAs with a different prosthesis on each side preferred their medial pivot knee to a PS, CR, or mobile-bearing (MB) design. A trial comparing the MP and PS designs found greater range of motion (ROM) and better patient-reported outcomes in the MP group at 2 years. There also exists literature reporting poorer outcomes with the MP design. A trial involving 96 patients who had received both an MP knee and an MB knee on contralateral sides found lower ROM, higher complication rates, and worse patient reported outcomes in the MP knee.

Given the lack of consensus in the literature, further investigation is warranted to determine the impact of the MP design on outcomes following TKA.

Being tested
Medacta GMK posterior stabilized prosthesis, Medacta GMK Sphere prosthesis
Medical subject headings
Osteoarthritis, Knee

What participants receive

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

  • Medacta GMK posterior stabilized prosthesisDevice

  • Medacta GMK Sphere prosthesisDevice

Study groups in NCT02577978
Study groupRoleWhat they receive
Medacta SphereOtherBall-and-socket
Receives: Device: Medacta GMK Sphere prosthesis
Medacta PSOtherCam-and-post
Receives: Device: Medacta GMK posterior stabilized prosthesis

What is being measured

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

  1. Oxford Knee Score (OKS) Pre-operative Through 2 Years Post-operative

    Patient completed Oxford Knee Score questionnaire used to assess the patient's perspective of outcome following Total Knee Arthroplasty (TKA); score range is reported between 0-48 with improvement in outcomes reflected as a higher numerical value (e.g. a 'complete' return to pre-disease functionality would be reported as a score of 48)

    Measured: Pre-operatively on day of surgery, 6 weeks, 3 months, 6 months, 12 months and 24 months post-operatively

  2. Veteran's RAND 12 (VR-12) Mental Composite Score (MCS) Through 2 Years Post Operative

    Veteran's RAND 12 Item Health Survey used to assess health-related quality of life, to estimate disease burden, and to evaluate disease-specific benchmarks. Scores for the Mental Composite Score (MCS) range from 5.2 to 76.3 and are evaluated as a summative T-score with population mean of 50 (Standard Deviation = 10);higher scores indicate improved mental wellness/function as reported by patients.

    Measured: Pre-operatively, 6 weeks post-operatively, 3 months post-operatively, 6 months post-operatively, 12 months post-operatively, and 2 years post-operatively.

  3. Veteran's RAND 12 (VR-12) Physical Composite Score (PCS) Through 2 Years Post Operative

    Veteran's RAND 12 Item Health Survey used to assess health-related quality of life, to estimate disease burden, and to evaluate disease-specific benchmarks. Scores for the Physical Composite Score (MCS) range from 6.3 to 71.8 and are evaluated as a summative T-score with population mean of 50 (Standard Deviation = 10);higher scores indicate improved physical wellness/function as reported by patients.

    Measured: Pre-operatively, 6 weeks post-operatively, 3 months post-operatively, 6 months post-operatively, 12 months post-operatively, and 2 years post-operatively.

  4. PROMIS Computerized Adaptive Tests (CATs) for Physical Function Through 2 Years Post-operative

    Patient-reported outcome (PRO) measures use answers that patients provide to questions to produce numeric values which indicate patients' state of wellbeing or suffering as well as their ability or lack of ability to function. Values are reported as T-scores with a reference population mean of 50 (SD=10); for the Physical Function domain higher scores indicated improved physical function as reported by the patient

    Measured: Pre-operatively, 6 weeks post-operatively, 3 months post-operatively, 6 months post-operatively, 12 months post-operatively, and 2 years post-operatively.

  5. PROMIS Computerized Adaptive Tests (CATs) for Pain Interference Through 2 Years Post-operative

    Patient-reported outcome (PRO) measures use answers that patients provide to questions to produce numeric values which indicate patients' state of wellbeing or suffering as well as their ability or lack of ability to function. Values are reported as T-scores with a reference population mean of 50 (SD=10); for the Pain Interference domain an increased value indicates greater severity/frequency of pain reported by the patient.

    Measured: Pre-operatively, 6 weeks post-operatively, 3 months post-operatively, 6 months post-operatively, 12 months post-operatively, and 2 years post-operatively.

  6. PROMIS Computerized Adaptive Tests (CATs) for Pain Behavior Through 2 Years Post-operative

    Patient-reported outcome (PRO) measures use answers that patients provide to questions to produce numeric values which indicate patients' state of wellbeing or suffering as well as their ability or lack of ability to function. Values are reported as T-scores with a reference population mean of 50 (SD=10); for the Pain Behavior domain an increased value indicates greater severity/frequency of pain reported by the patient

    Measured: Pre-operatively, 6 weeks post-operatively, 3 months post-operatively, 6 months post-operatively, 12 months post-operatively, and 2 years post-operatively.

  7. Total Score Calculated Using the Forgotten Joint Score in Order to Assess the Subject's Ability to Forget the Artificial Joint in Everyday Life

    Patient completed questionnaire used to assess the patients' ability to forget about a joint as a result of successful treatment. Every question is scored 1 (never) to 5 (mostly) according to the selected response categories. Thus, the raw score ranges from 12 to 60 where a high score indicates an improved outcome. The raw score is linearly transformed to a 0-100 scale and then reversed to obtain the final score with higher scores indicating improved physical function/reduced impact of symptoms on activity:

    Final score = 100 - ((sum(item01 to item12) - 12)/48*100)

    Measured: 12 months post-operatively

  8. International Knee Documentation Committee (IKDC) Questionnaire Assessed Through 2 Years Post-op

    The International Knee Documentation Committe (IKDC) Questionnaire is a subjective scale that provides patients with an overall function score based on a summative score for 3 sub categories (knee function, sports activities, pain/symptoms). A score between 0-100 is obtained as the sum of scores for each individual question, with increasing composite scores correlating positively with patient functional status/quality of life.

    Measured: Pre-operatively, 6 weeks post-operatively, 3 months post-operatively, 6 months post-operatively, 12 months post-operatively, and 2 years post-operatively.

  9. Score for the Knee Society Score (KSS) Knee Component at 1 Year Post-operatively

    Physician completed Knee Society Score questionnaire used to measure a patient's functional ability before and after total knee arthroplasty (TKA); score range is reported between 0-100 with improvement in outcomes reflected as a higher numerical value (e.g. a 'complete' return to pre-disease functionality would be reported as a score of 100)

    Measured: 12 months post-operatively

  10. Score for the Knee Society Score (KSS) Function Component at 1 Year Post-operatively

    Physician completed Knee Society Score questionnaire used to measure a patient's functional ability before and after total knee arthroplasty (TKA); score range is reported between 0-100 with improvement in outcomes reflected as a higher numerical value (e.g. a 'complete' return to pre-disease functionality would be reported as a score of 100)

    Measured: 12 months post-operatively

Secondary outcomes (3)
  1. Assessing Knee Stability Using the KT-1000 Arthrometer (at 30 Degrees)

    Used for grading the stability of the knee in various degrees of flexion according to section 4 of the International Knee Documentation Committee's Knee Ligament Standard Evaluation Form where normal (-1 to 2 mm); nearly normal (3 to 5 mm); abnormal (6 to 10 mm); severely abnormal (>10 mm)

    Measured: 1 year post-operatively

  2. Assessing Knee Stability Using the KT-1000 Arthrometer (at 90 Degrees)

    Used for grading the stability of the knee in various degrees of flexion according to section 4 of the International Knee Documentation Committee's Knee Ligament Standard Evaluation Form where normal (-1 to 2 mm); nearly normal (3 to 5 mm); abnormal (6 to 10 mm); severely abnormal (>10 mm)

    Measured: 1 year post-operatively

  3. Get-up-and-Go Test

    Used to assess a person's mobility and requires both static and dynamic balance. It uses the time that a person takes to rise from a chair, walk three metres, turn around, walk back to the chair, and sit down.

    Measured: Between 6 months and 1 year post-operatively

Timeline

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

  1. First posted16 Oct 2015 (estimated)
  2. Study startApr 2014
  3. Primary completionApr 2017
  4. Study completionJun 2017

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
Single group
Masking
Single blind
Who is masked
Participant
Enrolment
61 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02577978
Sponsor's protocol ID
STU00090745
Status last verified
May 2023
First submitted
13 Oct 2015
Last updated
19 May 2023
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A study testing Medacta GMK posterior stabilized prosthesis and Medacta GMK Sphere prosthesis in people with Osteoarthritis of Knee, run by Northwestern University at 1 site in United States.

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 3 inclusion and 4 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 19 May 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

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?

Yes. Results are posted in the registry (first posted 29 May 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Oxford Knee Score (OKS) Pre-operative Through 2 Years Post-operative (time frame: Pre-operatively on day of surgery, 6 weeks, 3 months, 6 months, 12 months and 24 months post-operatively). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 19 May 2023.

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