Comprehensive Shoulder System Nano IDE (Nano)

A Study of the Comprehensive Shoulder System With Nano Humeral Component in Total Shoulder Arthroplasty

The purpose of this clinical study is to determine the safety and efficacy of the Comprehensive® Shoulder System with Nano Humeral Component in Total Shoulder Arthroplasty (TSA).

Study Overview

• Status: Completed
• Conditions: Joint Disease
• Intervention / Treatment: Device: Mini Stem; Device: Nano

Detailed Description

The purpose of this clinical investigation is to establish the safety and efficacy of the Comprehensive® Shoulder System with Nano Humeral Component in Total Shoulder Arthroplasty. Safety and efficacy of the device will be measured by collection and analysis of the following data at the two-year or greater time point (22 months post-operative or longer):

1. American Shoulder and Elbow Surgeons (ASES) Score
2. Single Assessment Numeric Evaluation (SANE)
3. Constant Score
4. Radiographic assessment of osteolysis, radiolucencies, migration, and subsidence
5. Comparison of overall adverse event rates including rates of removal/revision and other serious adverse events.

• Study Type: Interventional
• Enrollment (Actual): 258
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Scottsdale, Arizona, United States, 85255
      • Arizona Institute for Sports, Knees, and Shoulders
  • Florida
    • Fort Lauderdale, Florida, United States, 33308
      • Holy Cross Hospital
  • Indiana
    • Fort Wayne, Indiana, United States, 46825
      • Ortho NorthEast
  • Louisiana
    • Shreveport, Louisiana, United States, 71105
      • Orthopedic Clinic
  • Maryland
    • Towson, Maryland, United States, 21204
      • Towson Orthopaedic Associates
  • Michigan
    • Royal Oak, Michigan, United States, 48073
      • William Beaumont Hospital
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic
  • New York
    • Buffalo, New York, United States, 14214
      • University of Buffalo
  • Ohio
    • New Albany, Ohio, United States, 43054
      • Joint Implant Surgeons
  • Tennessee
    • Germantown, Tennessee, United States, 38138
      • Campbell Clinic Orthopaedics
  • Virginia
    • Charlottesville, Virginia, United States, 22903
      • University of Virginia
    • Midlothian, Virginia, United States, 23114
      • Bon Secours St. Francis Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 90 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients for whom the surgeon has confirmed intraoperatively, has no cyst > 1cm and not more than one cyst at the implantation site
• Patients with non-inflammatory degenerative joint disease including osteoarthritis.
• Patients where the device will be used in the correction of a functional deformity (deformities preventing congruent articulation of the glenohumeral joint)
• Patients with pain and/or loss of function in the shoulder for whom other treatment modalities have been unsuccessful.
• Patients requiring unilateral or staged bilateral shoulder arthroplasty
• Patient must be anatomically and structurally suited to receive the implants (humeral neck must be of sufficient diameter to implant at least the smallest nano humeral component and the humeral neck is intact).
• Patients who are 21-90 years of age at the time of surgery and have reached skeletal maturity.
• Patients with an ASES score ≤ 40.

Exclusion Criteria:

• Patients diagnosed with avascular necrosis or post-traumatic arthritis of the humeral head
• Patients found at the time of intraoperative examination to have a single cyst >1 cm in size or multiple cysts at the implantation site
• Patient presents with shoulder joint infection, sepsis, osteomyelitis or distant foci of infections which may spread to the implant site.
• Patients with cuff tear arthropathy.
• Patients who have undergone a Hemi-, Total, or Reverse Total Shoulder arthroplasty in the affected shoulder.
• Patient presents with a malunion or non-union of the tuberosities of the proximal humerus.
• Patients with osteoporosis, osteomalacia, rheumatoid arthritis, metabolic disorders of bone, muscle or connective tissue, gross deformity or any other condition of the proximal humerus (defined as severe destruction or deformity of the proximal humerus that precludes placement of the device) that in the Investigator's medical judgment could compromise implant fixation or bone healing.
• Rapid bone destruction, marked bone loss or bone resorption apparent on roentgenogram.
• Patients with neurologic or other disorders that would either affect the stability of the shoulder prosthesis, i.e., Charcot's joint, uncontrolled seizures, etc., or would affect their capability or willingness to return to the clinic for assessments and/or follow directions.
• Bone cancer, either primary or secondary, that affects the shoulder.
• Patients presenting with symptoms of chronic steroid use. (oral steroids for a chronic condition for 12 months prior to and including the date of surgery)
• Patients with a life expectancy of less than three years.
• Patients diagnosed with severe shoulder instability
• Patients diagnosed with subscapularis incompetence
• Patients diagnosed with any condition that may limit their ability to complete the consent form or would affect their capability or willingness to return to the clinic for assessments and/or follow directions (i.e. mental illness)
• Patients with known metal allergy
• Patients who refuse to sign the Institutional Review Board (IRB) approved consent form
• Patients who are found intraoperatively to require a specific treatment and are unable to be randomized.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Comprehensive Mini Humeral Stem; The Comprehensive® Shoulder System with mini stem component, which will be the control device for this clinical investigation and was 510(k) cleared under K060692 on May 30, 2006. The humeral stem component is manufactured from Ti6Al4V alloy. The taper has a machine finish and accepts the taper adaptor of the humeral head component. The proximal region of the bone-contacting outer surface features a porous coating of plasma-sprayed titanium alloy, while the distal portion is polished. Seventeen stem diameters are available - 4 mm to 20 mm, in 1-mm increments.	Device: Mini Stem; The humeral stem component is manufactured from Ti6Al4V alloy. The taper has a machine finish and accepts the taper adaptor of the humeral head component. The proximal region of the bone-contacting outer surface features a porous coating of plasma-sprayed titanium alloy, while the distal portion is polished. Seventeen stem diameters are available - 4 mm to 20 mm, in 1-mm increments.
EXPERIMENTAL: Comprehensive Nano Humeral Component; The stemless humeral component is manufactured from Ti6Al4V alloy. It consists of a central tapered region and six outer wings. The taper has a machine finish and accepts the taper adaptor of the humeral head component. A small groove is included just below the taper to accept an inserter/impactor. The bone-contacting outer surface features a porous coating of plasma-sprayed titanium alloy for cementless fixation in the proximal humerus. Six sizes are available - 30 mm, 32 mm, 34 mm, 36 mm, 38 mm, and 40 mm.	Device: Nano; The stemless humeral component is manufactured from Ti6Al4V alloy. It consists of a central tapered region and six outer wings. The taper has a machine finish and accepts the taper adaptor of the humeral head component. A small groove is included just below the taper to accept an inserter/impactor. The bone-contacting outer surface features a porous coating of plasma-sprayed titanium alloy for cementless fixation in the proximal humerus. Six sizes are available - 30 mm, 32 mm, 34 mm, 36 mm, 38 mm, and 40 mm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
American Shoulder and Elbow Surgeon's Score (ASES)	The American Shoulder and Elbow Surgeon's (ASES) Score is a tool used to measure shoulder function. The ASES score is on a scale of 0 to 100, with 0 being the worst possible score and 100 the best. The score consists of two components - pain and activities of daily living.	22+ Months
Number of Shoulders With Absence of Revision/Removal/UADE/Fracture/Dislocation	This outcome measure calculates the proportion of subjects meeting a success criteria defined in the protocol as "No unanticipated device-related adverse event, and no fracture, perforation of the bone or joint dislocation, and no fracture, perforation or dissociation of the device, and no revision or removal of any component." All subject records were evaluated for each of the disqualifying factors, and all subjects that failed at least one of the endpoint measures were identified. The success rate is defined as the number of subjects at two years not meeting any of the disqualifying factors compared to the total number of cases present at two years plus all subjects considered failures without two year data.	2 years
Number of Shoulders With Radiographic Success	This outcome measure calculates the proportion of subjects meeting a success criteria defined in the protocol as "Subsidence of the humeral component <5 mm, and migration of the humeral component <5 mm, and no progressive lucency around the humeral component >2 mm in two or more contiguous zones, and migration of the glenoid component <5 mm, and no progressive lucency >2 mm around the entire glenoid component." All subject records were evaluated by an Independent Radiographic Reviewer (IRR) at each time point for radiographic success based on these criteria.	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
American Shoulder and Elbow Surgeon's Score (ASES)	The American Shoulder and Elbow Surgeon's (ASES) Score is a tool used to measure shoulder function. The ASES score is on a scale of 0 to 100, with 0 being the worst possible score and 100 the best. The score consists of two components - pain and activities of daily living.	Pre-operative, 6 Weeks, 3 Months, 1 Year, 2 Years, 3 Years, 4 Years
Single Assessment Numeric Evaluation (SANE) Score	The Single Assessment Numeric Evaluation (SANE) Score is a tool used to assess the subject's perception of their affected joint. Participants are requested to rate their shoulder function on a scale of 0 to 100, with 0 as the worst option and 100 being normal shoulder function.	6 Weeks, 3 Months, 1 Year, 2 Years, 3 Years, 4 Years
Constant Score Adjusted for Age and Gender	The Constant-Murley Shoulder Score is a scoring method used by clinicians to assess function of the shoulder. The standard score is on a scale of 0 to 100, with 0 being no shoulder function and 100 being excellent function. The age- and gender-adjusted Constant score normalizes the raw Constant score based on the subject's age and gender. The worst score on the adjusted scale is still 0, but the greatest scores can exceed 100 based on the calculations used for normalization. The scale used in this study was described by Katolik et al.	Pre-operative, 3 Months, 1 Year, 2 Years, 3 Years, 4 Years
Number of Shoulders Passing Radiographic Assessment of Radiolucencies and Subsidence	All radiographs collected at all follow-up time points were analyzed by the Independent Radiographic reviewer. Subjects were assessed for the presence of radiolucencies considered to be failures of the radiographic co-primary endpoint (No progressive lucency around the humeral component >2 mm in two or more contiguous zones OR no progressive lucency >2 mm around the entire glenoid component) and for the presence of component subsidence. Subjects with the absence of failing radiolucencies and subsidence were considered successes.	2+ years

Collaborators and Investigators

• Sponsor: Zimmer Biomet

Study record dates

Study Major Dates

• Study Start (ACTUAL): August 1, 2013
• Primary Completion (ACTUAL): November 21, 2018
• Study Completion (ACTUAL): September 27, 2019

Study Registration Dates

• First Submitted: August 23, 2013
• First Submitted That Met QC Criteria: September 3, 2013
• First Posted (ESTIMATE): September 6, 2013

Study Record Updates

• Last Update Posted (ACTUAL): January 13, 2020
• Last Update Submitted That Met QC Criteria: January 7, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Keywords: Osteoarthritis; Shoulder; Joint
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases
• Other Study ID Numbers: ORTHO.CA.GE1.12; G110207 (OTHER: FDA)

Drug and device information, study documents

• Studies a U.S. FDA-regulated device product: Yes