Effectiveness of Minimally Invasive Total Knee Replacement in Improving Rehabilitation and Function

Functional Outcomes Following Minimally Invasive Total Knee Arthroplasty

Osteoarthritis (OA) is a long-term degenerative joint disease that disables about 10% of people over the age of 60 and compromises the quality of life of more than 20 million Americans. A procedure called total knee arthroplasty (TKA), in which the affected surface of the knee joint is replaced by plastic or metal, has been successful in restoring comfort and mobility to formerly arthritic joints. This study will compare quadriceps muscle strength, knee range of motion, and pain in people who have had a traditional TKA with those who have had a minimally invasive TKA.

Study Overview

• Status: Completed
• Conditions: Osteoarthritis
• Intervention / Treatment: Procedure: Minimally Invasive Total Knee Arthroplasty [TKA Min]; Procedure: Total Knee Arthroplasty (TKA) Traditional

Detailed Description

More than 400,000 TKAs are performed each year in the United States to alleviate pain and disability associated with knee OA. Although this procedure reliably reduces pain and improves function in people with knee OA, recovery of the strength of the quadriceps muscle to normal levels is rare. For years after a TKA, performance while walking or while doing a more physically demanding activity, such as stair climbing, is also significantly lower in people who have had a TKA than in healthy adults of the same age. Within the past few years, less invasive TKA surgical techniques have been developed as promising alternatives to traditional TKA. Minimally invasive TKA, or TKA(min), achieves the same surgical objectives, but possibly without doing as much damage to the quadriceps muscle as is seen with traditional TKA. No studies, however, have specifically investigated how TKA(min) might preserve quadriceps muscle function. This study will determine whether TKA(min) is better than TKA at improving quadriceps muscle force production and activation, increasing knee range of motion, and reducing post-operative pain to improve overall functional outcomes.

Participants who are scheduled to undergo knee replacement surgery will be randomly assigned to receive either traditional TKA or TKA(min). Prior to surgery, participants will attend a 30-minute orientation session and undergo certain tests to evaluate knee function. Functional testing will include timed walking, stair climbing, balance testing, and knee flexibility measurements. Other evaluations will include thigh muscle strength and activation testing, which uses brief electrical pulses to determine if the muscles are contracted as much as possible, and health status questionnaires. After the operation, participants will be instructed to use walking aids, such as a walker, crutches, or a cane, for a period of time. Participants will attend study visits for repeat testing 48 hours following surgery; at Months 1, 3, and 6; and at Years 1 and 2.

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Boulder, Colorado, United States, 80304
      • University of Colorado Health Sciences Center
    • Denver, Colorado, United States, 80262
      • University of Colorado Health Sciences Center
    • Denver, Colorado, United States, 80206
      • National Jewish Medical and Research Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of osteoarthritis
• Eligible for a unilateral or bilateral primary TKA to be performed by Dr. Michael Dayton (University of Colorado Hospital)
• Minimum of 110 degrees of active knee flexion
• No greater than 10 degrees of anatomic knee varus, 15 degrees anatomic valgus, and 10 degrees flexion contracture
• Body mass index less ≤ 40 kg/m2

Exclusion Criteria:

• Any brain, circulation, or heart problems that limit function
• Severe osteoarthritis or other orthopedic conditions that limit function in the lower extremity that is not undergoing the TKA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1	Procedure: Minimally Invasive Total Knee Arthroplasty [TKA Min]; TKA Min is a procedure in which diseased and painful joint surfaces of the knee are replaced by metal and plastic components shaped to allow continued motion of the knee. TKA Min, as opposed to TKA Traditional, employs smaller skin incisions and smaller instrumentation and avoids turning the knee cap out and dislocating the knee. This procedure also avoids disrupting the knee extensor mechanism and the suprapatellar pouch and minimizes extreme knee flexion during surgery.; Other Names: TKA Min
Active Comparator: 2	Procedure: Total Knee Arthroplasty (TKA) Traditional; TKA is a procedure in which diseased and painful joint surfaces of the knee are replaced by metal and plastic components shaped to allow continued motion of the knee.; Other Names: TKA Traditional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps Muscle Force		Measured pre-operatively; post-surgery at 4 weeks and 12 weeks
Knee Range of Motion	Knee Flexion Active Range of Motion (AROM)	Measured pre-operatively; post-surgery at 4 weeks and 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional Performance: 6 Minute Walk (6MW) Distance		Measured pre-operatively; post-surgery at 4 weeks and 12 weeks
Functional Performance: Stair Climb Test	This outcome measures the time (seconds) it takes to climb up and back down 12 steps.	Measured pre-operatively; post-surgery at 4 weeks and 12 weeks

Collaborators and Investigators

• Sponsor: University of Colorado, Denver
• Collaborators: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
• Investigators: Principal Investigator: Jennifer E. Stevens, MPT, PhD, University of Colorado, Denver; Principal Investigator: Michael Dayton, MD, University of Colorado, Denver; Principal Investigator: Wendy Kohrt, PhD, University of Colorado School of Medicine

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): February 1, 2011
• Study Completion (Actual): January 1, 2012

Study Registration Dates

• First Submitted: June 27, 2008
• First Submitted That Met QC Criteria: July 2, 2008
• First Posted (Estimate): July 4, 2008

Study Record Updates

• Last Update Posted (Estimate): June 10, 2015
• Last Update Submitted That Met QC Criteria: May 14, 2015
• Last Verified: March 1, 2015

More Information

Terms related to this study

• Keywords: Knee Replacement; OA; Knee OA
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis
• Other Study ID Numbers: 06-0183; R03AR054538 (U.S. NIH Grant/Contract); 1R03AR054538-01A2 (U.S. NIH Grant/Contract)