Parabens Flocculation on the Anti Inflammatory Effects of Corticosteroid Injections for Total Knee Arthroplasty (5160373)

June 1, 2021 updated by: Loma Linda University

Clinical Significance of Parabens Flocculation on the Anti Inflrammmatory Effects of Corticosteroid Injection Osteoarthritic Knees

The purpose of this study is to identify whether corticosteroid use with anesthetics containing preservatives (parabens) reduces clinical effectiveness of the anti-inflammatory agent Up to 100 patients, both male and female, between the ages of 18-89 will be enrolled and randomized into either of the following groups; Group 1: These patients will receive a corticosteroid solution with lidocaine containing parabens.

Group 2: These patients will receive corticosteroid solution with paraben free lidocaine.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Withdrawn

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Corticosteroid injections have been used to treat inflammatory conditions for many decades (Storz 1973; Roszental, Zurakowski and Blazar 2008). In order to maximize the effectiveness on the synovial tissue, the concentrated form of corticosteroids is typically mixed with an anesthetic preparation. The corticosteroid suspension in a large volume of anesthetic can then disperse throughout the entire joint more effectively, especially in larger joints such as the knee (Centeno and Moore 1994). In addition, the anesthetic provides immediate relief to the area and can help verify that the injected site was the source of pain (Cole and Schumacher 2005). Typical preparations of anesthetic medications are sold in multi-use vials. The anesthetic solution usually contains a paraben preservative, except in the single vials used for spinal injections, because the use of paraben preservatives is contraindicated in spinal injections (Centeno and Moore 1994).

Celestone and Kenalog are two corticosteroid products that are commonly used for intra-articular injections. If co-administration of a local anesthetic is desired, the suspension of Celestone or Kenalog is commonly mixed with 1% or 2% Lidocaine hydrochloride from multi-use vials containing parabens in Orthopedic and Rheumatology clinics.

The orthopedic literature relating to injections rarely addresses the use of the anesthetic commonly used in injections. Flocculation occurs significantly when parabens are present, but the influence on the efficacy of the corticosteroid is unknown (Philipose et al. 2011; Hwang et al. 2016). There is abundant evidence that flocculation occurs when steroids are mixed with anesthetic solutions containing parabens however, the clinical significance of this phenomenon has not been reported. (Skedros and Pitts 2008b; Andreson, Deodhar and O'Rourke 2005; Skedros and Pitts 2008; Lutt, O'Rouke and Deodhar 2007; Cole and Schumacher 2005).

Cole and Schumacher (2005) suggest that flocculation can result from a chemical incompatibility between corticosteroid and other agents. Flocculation that occurs when corticosteroid is mixed with an anesthetic containing parabens may reduce the anti-inflammatory effect of the steroid. There are two possible mechanisms in which the corticosteroid preparation may be less effective. Flocculation may cause the corticosteroid to precipitate, thus reducing dispersal within the injected area (Centeno and Moore 1994). Additionally, flocculation may result from corticosteroid bonding with another molecule (such as methylparaben) within the anesthetic preparation, making it chemically less effective. The purpose of this study is to identify whether corticosteroid use with anesthetics containing parabens reduces clinical effectiveness relative to paraben-free preparations.

STUDY DESIGN:

OBJECTIVES:

The purpose of this study is to identify whether corticosteroid use with anesthetics containing parabens reduces clinical effectiveness relative to para-free preparations.

Hypothesis Alternate: Flocculation due to lidocaine containing parabens decreases the anti-inflammatory effects of corticosteroids when compared to paraben-free lidocaine.

Procedure:

The investigator will enroll up to 100 patients, both male and female, between the ages of 18-89. Once the patient has been consented, They will be randomized into group 1 or group 2. The randomization is a 1 to 1 ratio. Subsequent follow-up via phone call will take place on week 1, week 2, week 4, week 8, and week 16.

Group 1: These patients will receive a corticosteroid solution with lidocaine containing parabens.

Group 2: These patients will receive corticosteroid solution with paraben free lidocaine.

Corticosteroid injections will be given with or without ore-aspiration of synovial fluid. Patient will be in supine position with superior-lateral injection.

Material identification: Celestone soluspan or Kenalog 1% 50mL multiuse vials without epinephrine, 1% 5mL lidocaine vials, 10mL syringes with 21mm x 1 ¼ inch needles, alcohol swabs, exam gloves, betadine solution.

DATA COLLECTION:

The investigator will collect the patients age, sex, BMI, Medical history, along with the WOMAC survey, which asks about the patients knee and activity level and VAS, pain sale (0-10) 0 being the lease amount of pain and 10 being the worst.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Early Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Loma Linda, California, United States, 92354
        • Loma Linda University Health, Department of Orthopaedic Surgery

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

19 years to 89 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Diagnosis of symptomatic primary knee osteoarthritis according to the American Rheumatism Association classification criteria for knee osteoarthritis, ability to understand study protocol and agreement to participate

Exclusion Criteria:

  • History of any knee injection in the past 6 months, History of more than 2 injections in the knee under study, previous fracture or surgical procedure of knee under investigation, any benign or malignant tumor in knee, chemotherapy, hemearthosis, current infection in the affected limb.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: PREVENTION
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
EXPERIMENTAL: Group 1
These patients will receive a corticosteroid solution with lidocaine containing parabens.
Drug: corticosteroid solution with lidocaine containing parabens.
To identify whether corticosteroid use with anesthetics containing parabens reduces clinical effectiveness relative to para-free preparations.
ACTIVE_COMPARATOR: Group 2
These patients will receive corticosteroid solution with paraben free lidocaine.
Drug: corticosteroid solution with lidocaine containing no paraben
To identify whether corticosteroid use with anesthetics containing parabens reduces clinical effectiveness relative to para-free preparations.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
WOMAC-Western Ontario and McMaster Universities Osteoarthritis Index
Time Frame: 6 months
This is a survey that asks your view about your knee. This information will help track how you feel about your knee and how well you are able to do your usual activities
6 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
VAS-Visual Analogue Scale
Time Frame: 6 months
This is a Scale used to measure pain intensity. It is a continuous scale comprised of a horizontal line, usually 10cm or 100mm in length, the patient will mark a line between the two end-points, indicating there pain level.
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Loma Linda University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ANTICIPATED)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 15, 2019

Primary Completion (ANTICIPATED)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
October 15, 2019

Study Completion (ANTICIPATED)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
October 30, 2019

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 19, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 22, 2018

First Posted (ACTUAL)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
February 26, 2018

Study Record Updates

Last Update Posted (ACTUAL)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 3, 2021

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 1, 2021

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2021

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 5160373

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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