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Kinematic Alignment vs Mechanical Alignment for Total Knee Arthroplasty (KA vs MA)

Primary Purpose

Knee Osteoarthritis, Knee Pain Chronic

Status
Withdrawn
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Mechanical Alignment and Unrestricted Kinematic Alignment using Medacta GMK Sphere with MyKnee Custom guides
Mechanical Alignment and Restricted Kinematic Alignment using Medacta GMK Sphere with custom cutting guides
Sponsored by
Medacta USA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Knee Osteoarthritis

Eligibility Criteria

21 Years - 80 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Must be able to read, understand and provide written informed consent on the Institutional Review Board (IRB) approved Informed Consent Form (ICF).

    • Ability to understand and provide written authorization for use and disclosure of personal health information.
    • Subject who are able and willing to comply with the study protocol and follow-up visits.
    • Must be 21 years or older to participate, and less than 80 years old.
    • Subjects must have osteoarthritis knee disease in the affected knee compliant with the FDA-approved indications for use of GMK Sphere knee system and MyKnee cutting blocks.
    • Patients who are candidates for Total Knee Arthroplasty and are determined to undergo a TKA using the Medacta GMK Sphere implant and MyKnee cutting blocks will be offered enrollment.
    • Subjects must be able to return for the follow-up appointments, and have the mental capacity to cooperate and complete PRO questionnaires, physical exam and radiographs.

Exclusion Criteria:

  • • Cases of extreme bone loss requiring an augmented femoral or tibial implant and chronic ligamentous laxity requiring a constrained implant

    • The patient has a fixed flexion deformity of ≥15°
    • The patient has less than 90° of flexion
    • Patient is morbidly obese (BMI ≥40)
    • Patient with inflammatory arthritis
    • History of prior deep knee infection
    • History of alcoholism or drug abuse
    • Currently on chemotherapy or radiation therapy for neoplastic disease
    • Patient currently on immunosuppressive medications including steroids except when, (a) steroid use is less than 10mg daily, (b) other immunosuppressive medications are held for appropriate time, for example Adalimumab is held 2 weeks prior and 2 weeks after surgery
    • History of known sensitivity or allergy to materials used in orthopedic implants, specifically Titanium and Cobalt-Chrome alloys
    • Habitual use of narcotic pain medications prior to surgery (more than 2 doses daily and chronic use of a minimum 3 months)
    • History of metabolic disorder affecting the skeletal system other than osteoarthritis or osteoporosis (e.g., Osteomalacia, Ricketts)
    • History of chronic pain issues for reasons other than knee joint pain. If the type of pain affects activities of daily living, do not enroll. If the pain is intermittent and does not affect activities of daily living, it is OK to enroll. Fibromyalgia is exclusionary.
    • Women who are pregnant
    • Patient with unstable psychiatric illness or psychosis is excluded. (Patients with stable anxiety or depression can be enrolled if PI determines that the condition does not adversely affect study outcomes & requirements)
    • Any patient, in the opinion of the investigator, is unable to fully comply with the surgical, rehabilitation, or follow-up aspects of this procedure.
    • Prior surgery on the target knee other than arthroscopy and/or arthroscopically-assisted ligament reconstruction
    • Prior high tibial osteotomy (HTO) or femoral osteotomy
    • Malunion of fracture of a tibia or femur
    • Patient with a neuromuscular or neurosensory deficiency
    • Patient with history of knee fusion in the affected joint

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Active Comparator

    Arm Label

    Unrestricted Kinematic Alignment

    Restricted Kinematic Alignment

    Arm Description

    Mechanical Alignment and Unrestricted Kinematic Alignment using Medacta GMK Sphere with custom cutting guides

    Mechanical Alignment and restricted Kinematic Alignment using Medacta GMK Sphere with custom cutting guides

    Outcomes

    Primary Outcome Measures

    Change from baseline in Forgotten Joint Score
    Assessment of the improvement of joint specific outcomes following knee replacement surgery using the Knee Forgotten Joint Score

    Secondary Outcome Measures

    Change from baseline in Knee Osteoarthritis Outcome Score (KOOS)
    Assessment of improvement of activity levels following knee replacement surgery using the KOOS
    Change from baseline in Knee Society Score
    Patient specific patient outcomes scoring
    Change from baseline in Knee Society Score
    Clinical Exam Range of Motion, Stability and Alignment
    Change from baseline in PROMIS
    Pain Intensity, Pain Interference, and physical function scoring
    Change in Baseline in Knee Alignment
    Determined by radiographic analysis measured by angle of degrees
    Change from Baseline of Implant Position Fixation
    Determined by radiographic analysis by measure radio lucent lines in millimeters

    Full Information

    First Posted
    March 30, 2022
    Last Updated
    July 13, 2022
    Sponsor
    Medacta USA
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05461638
    Brief Title
    Kinematic Alignment vs Mechanical Alignment for Total Knee Arthroplasty
    Acronym
    KA vs MA
    Official Title
    A Prospective, Randomized, Single-Blinded, Multi-Center, Clinical Trial Comparing Kinematic Alignment vs. Mechanical Alignment Using Medially-Stabilized Knee (GMK Sphere) And Patient-Specific Cutting Guides (MyKnee) For Total Knee Arthroplasty
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2022
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    No viable sites
    Study Start Date
    January 5, 2020 (Anticipated)
    Primary Completion Date
    April 5, 2022 (Actual)
    Study Completion Date
    April 5, 2022 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Medacta USA

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    This is a prospective, randomized, single-blinded, multi-center trial comparing Kinematic Alignment vs Mechanical Alignment in TKA patients using patient reported outcomes, clinical and functional performance tests and radiographic analyses.
    Detailed Description
    This is a prospective, randomized, single-blinded, multi-center trial comparing Kinematic Alignment vs Mechanical Alignment in TKA patients with Medacta GMK Sphere knee system using patient specific instrumentation Medacta MyKnee. Patients will be assessed a pre-operative, operative and interim post-operative visits, week 6, month 6 and 1,2,5 & 10 years. There will be a phone survey follow up at year 3,4,6,7,8,& 9.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Knee Osteoarthritis, Knee Pain Chronic

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    Participant
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Unrestricted Kinematic Alignment
    Arm Type
    Active Comparator
    Arm Description
    Mechanical Alignment and Unrestricted Kinematic Alignment using Medacta GMK Sphere with custom cutting guides
    Arm Title
    Restricted Kinematic Alignment
    Arm Type
    Active Comparator
    Arm Description
    Mechanical Alignment and restricted Kinematic Alignment using Medacta GMK Sphere with custom cutting guides
    Intervention Type
    Procedure
    Intervention Name(s)
    Mechanical Alignment and Unrestricted Kinematic Alignment using Medacta GMK Sphere with MyKnee Custom guides
    Intervention Description
    MA places the implant in an average position for all patients based on pre-determined definition of acceptable knee alignment and has become the most common surgical approach for TKA and Unrestricted KA places the implant in a custom position for each patient, completely matching individual anatomy and restoring natural alignment to that of the prearthritic knee.
    Intervention Type
    Procedure
    Intervention Name(s)
    Mechanical Alignment and Restricted Kinematic Alignment using Medacta GMK Sphere with custom cutting guides
    Intervention Description
    MA places the implant in an average position for all patients based on pre-determined definition of acceptable knee alignment and has become the most common surgical approach for TKA and Restricted KA places the implant in a custom position for each patient, closely matching with anatomy and natural alignment of the individual's knee.
    Primary Outcome Measure Information:
    Title
    Change from baseline in Forgotten Joint Score
    Description
    Assessment of the improvement of joint specific outcomes following knee replacement surgery using the Knee Forgotten Joint Score
    Time Frame
    Post operative 4-132 months
    Secondary Outcome Measure Information:
    Title
    Change from baseline in Knee Osteoarthritis Outcome Score (KOOS)
    Description
    Assessment of improvement of activity levels following knee replacement surgery using the KOOS
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Change from baseline in Knee Society Score
    Description
    Patient specific patient outcomes scoring
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Change from baseline in Knee Society Score
    Description
    Clinical Exam Range of Motion, Stability and Alignment
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Change from baseline in PROMIS
    Description
    Pain Intensity, Pain Interference, and physical function scoring
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Change in Baseline in Knee Alignment
    Description
    Determined by radiographic analysis measured by angle of degrees
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Change from Baseline of Implant Position Fixation
    Description
    Determined by radiographic analysis by measure radio lucent lines in millimeters
    Time Frame
    Baseline to Post operative 4-132 months
    Other Pre-specified Outcome Measures:
    Title
    Number of implant failures, implant survival status
    Description
    Re-operations, revisions, removals, and device related adverse events
    Time Frame
    Post operative 4-132 months
    Title
    Age of patient
    Description
    Date of birth
    Time Frame
    Baseline
    Title
    Number of male or female patients
    Description
    Gender description male or female
    Time Frame
    Baseline
    Title
    Demographics
    Description
    Height in inches, weight in pounds to determine BMI
    Time Frame
    Baseline
    Title
    Occurrence of prior medical and surgical history
    Description
    Medical and surgical history of patient prior to knee surgery
    Time Frame
    Baseline
    Title
    Pain medication associated with study knee
    Description
    Pain medication and use of narcotics for the study knee
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Return to Work/Activity questionnaire
    Description
    Assessment of ability to return to work or other activities following surgery
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Anesthetic
    Description
    type of anesthesia used during surgery
    Time Frame
    day of surgery
    Title
    Estimated Blood Loss
    Description
    Volume of blood loss during surgery
    Time Frame
    day of surgery
    Title
    Implant demographics
    Description
    Implant femoral and tibial size and poly thickness
    Time Frame
    day of surgery
    Title
    Type of Surgical Technique
    Description
    Mechanical, Restricted Kinematic, Unrestricted Kinematic and tendon release
    Time Frame
    day of surgery
    Title
    Length of Surgery
    Description
    Time in minutes skin to skin
    Time Frame
    day of surgery
    Title
    Length of Hospital Stay
    Description
    Length of stay in hours
    Time Frame
    day of surgery
    Title
    Tourniquet Time
    Description
    Tourniquet time in minutes
    Time Frame
    day of surgery
    Title
    Frequency of Facility type used for knee surgery
    Description
    Type of facility used for knee surgery
    Time Frame
    day of surgery
    Title
    Complications
    Description
    Assess adverse events and Serious Adverse Events
    Time Frame
    Baseline to Post operative 4-132 months
    Title
    Assisted device usage
    Description
    Cessation of assisted device usage by date
    Time Frame
    Post operative 4-14 months
    Title
    Pain, Satisfaction, Narcotics and Function expectations
    Description
    Custom Health Survey
    Time Frame
    36-108 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    21 Years
    Maximum Age & Unit of Time
    80 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Must be able to read, understand and provide written informed consent on the Institutional Review Board (IRB) approved Informed Consent Form (ICF). Ability to understand and provide written authorization for use and disclosure of personal health information. Subject who are able and willing to comply with the study protocol and follow-up visits. Must be 21 years or older to participate, and less than 80 years old. Subjects must have osteoarthritis knee disease in the affected knee compliant with the FDA-approved indications for use of GMK Sphere knee system and MyKnee cutting blocks. Patients who are candidates for Total Knee Arthroplasty and are determined to undergo a TKA using the Medacta GMK Sphere implant and MyKnee cutting blocks will be offered enrollment. Subjects must be able to return for the follow-up appointments, and have the mental capacity to cooperate and complete PRO questionnaires, physical exam and radiographs. Exclusion Criteria: • Cases of extreme bone loss requiring an augmented femoral or tibial implant and chronic ligamentous laxity requiring a constrained implant The patient has a fixed flexion deformity of ≥15° The patient has less than 90° of flexion Patient is morbidly obese (BMI ≥40) Patient with inflammatory arthritis History of prior deep knee infection History of alcoholism or drug abuse Currently on chemotherapy or radiation therapy for neoplastic disease Patient currently on immunosuppressive medications including steroids except when, (a) steroid use is less than 10mg daily, (b) other immunosuppressive medications are held for appropriate time, for example Adalimumab is held 2 weeks prior and 2 weeks after surgery History of known sensitivity or allergy to materials used in orthopedic implants, specifically Titanium and Cobalt-Chrome alloys Habitual use of narcotic pain medications prior to surgery (more than 2 doses daily and chronic use of a minimum 3 months) History of metabolic disorder affecting the skeletal system other than osteoarthritis or osteoporosis (e.g., Osteomalacia, Ricketts) History of chronic pain issues for reasons other than knee joint pain. If the type of pain affects activities of daily living, do not enroll. If the pain is intermittent and does not affect activities of daily living, it is OK to enroll. Fibromyalgia is exclusionary. Women who are pregnant Patient with unstable psychiatric illness or psychosis is excluded. (Patients with stable anxiety or depression can be enrolled if PI determines that the condition does not adversely affect study outcomes & requirements) Any patient, in the opinion of the investigator, is unable to fully comply with the surgical, rehabilitation, or follow-up aspects of this procedure. Prior surgery on the target knee other than arthroscopy and/or arthroscopically-assisted ligament reconstruction Prior high tibial osteotomy (HTO) or femoral osteotomy Malunion of fracture of a tibia or femur Patient with a neuromuscular or neurosensory deficiency Patient with history of knee fusion in the affected joint
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Rena Mandino
    Organizational Affiliation
    Associate Director, Clinical Research Medacta USA
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Learn more about this trial

    Kinematic Alignment vs Mechanical Alignment for Total Knee Arthroplasty

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