Compare Antimicrobial to Conventional Suture in Patients Receiving Primary Total Knee Replacement (Vicryl-Plus)

August 24, 2015 updated by: Mel Shiuann-Sheng Lee

Compare the Results of Antimicrobial to Conventional Suture Materials in Patients Receiving Primary Total Knee Replacement: A Prospective Double-blinded Randomized Controlled Trial

Total knee replacement is now one of the most popular reconstructive procedures for the elderly people to regain their functional capacity and life quality. However the reported incidence of postoperative infection or surgical site infection after total knee replacement has been around 1 to 2 percent. The cost and expenditure for treating periprosthetic infection are high and the results are often detrimental to the patients who suffered from the complication. To decrease the wound healing complication related to the contamination of bacteria, an antibacterial suture was used successfully in some clinical settings and in animal experiments. Whether the antibacterial suture material could be used in patients with total knee replacement has not been addressed in the past. The investigators therefore propose a prospective randomized double-blinded study to investigate the efficacy of an antibacterial suture material in total knee replacement. The inclusion criteria are patients with degenerative osteoarthritis without previous surgery to the index knee. Patients who have inflammatory arthritis such as rheumatoid arthritis, who have neurovascular disease of the lower extremities, who have history of liver cirrhosis or under hemodialysis for renal failure are excluded. One hundred and two patients will be randomized to study group (51 knees) and control group (51 knees) in a period of 12 months. All cases will follow the standard protocol based on clinical pathway. Antibacterial suture material (Vicryl Plus, Ethicon) will be used in the study group and regular suture material (Vicryl, Ethicon) will be used in the control group. Preoperatively, the skin condition (digital photo and image analysis),laser Doppler study, inflammatory markers (CRP/ESR/IL-6), functional score (KSS: Knee Society Score; SF-12: Short Form 12), and VAS score will be assessed. Operative data of operation time, blood loss and wound classification are recorded. Postoperatively, the skin condition (digital photo and image analysis), skin temperature, inflammatory markers, KSS, and VAS will be assessed on 1st and 3rd postoperative day, 2 weeks, 4 weeks, and 3 months.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Title of study:

Compare the results of Antimicrobial with Conventional suture materials in patients receiving primary total knee replacement: a prospective double-blinded randomized controlled trial

Objectives:

Primary Objective: To investigate whether the surgical site infection rate after total knee replacement will be different with two different suture materials.

Secondary Objective: To investigate the surrogating markers for inflammatory response and functional outcomes with two different suture materials.

Rationale:

The reported rate of deep infection following contemporary total knee replacement has been about two percent. The prevalence of prolonged wound drainage of soft tissue complications is between 17 to 50% of patients in whom 1.3% of them eventually developed culture-proved prosthetic infection. Total knee infections typically require complete removal of the prosthesis and prolonged antibiotic treatment. Re-infection rate following revision surgery for infected total knee cases is also significantly higher than those without infection complications. Total knee infections are devastating and associated with prolonged hospital stays, increased co-morbidity, and utilization of medical resources. Measures to reduce the infection rate extensively implemented clinically. However the use of antibacterial suture materials to reduce the wound complications has not yet been investigated before. Clinical trials including this issue only had been discussed in animal studies for minimal series. The effectiveness of the new material should be checked.

This study is designed to investigate the wound conditions and deep infection incidence following total knee replacement performed using either antimicrobial or conventional sutures. A prospective, double-blinded, randomized controlled trial with 102 patients evenly distributed into two groups is proposed. Each group has 51 patients scheduled for unilateral total knee replacement. Randomization is by envelope-drawing to minimize confounding risk factors. One hundred and two sets of suture materials (51 sets of Vicryl Plus and 51 sets of Vicryl) will be separately put into sealed envelopes. The envelopes are randomly assigned with consecutive numbers from 1 to 102. The envelopes are randomly given to the patients for wound closure. Finally, one group of patients will receive antibacterial sutures (VICRYL Plus, Ethicon, Johnson and Johnson, Taipei, Taiwan) following total knee replacement for the wound closure and the other group of patients will receive conventional sutures (VICRYL, Ethicon, Johnson and Johnson, Taipei, Taiwan) following total knee replacement for the wound closure. Group sample sizes of 51 and 51 achieve 81% power to detect a difference of -4% between the null hypothesis that both group means are 9.0 and the alternative hypothesis that the mean is 13.0 with estimated group standard deviations of 6.0 and 8.0 and with a significance level (alpha) of 0.05 using a two-sided two-sample t-test. The primary outcome measure is the incidence of prosthetic infection within three months of surgery. The secondary outcome measures include hospital stay, duration of antibiotics use, pain scale (VAS), wound conditions (wound drainage, extent of erythema, local heat, temperature), and serum parameters during hospitalization and within three months after operation.

Study Type

Interventional

Enrollment (Actual)

102

Phase

  • Phase 4

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

  • Taiwan
    • Taoyuan
      • Kweishan, Taoyuan, Taiwan, 333
        • Chang Gung Memorial Hospital

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

Ages Eligible for Study

  • ADULT
  • OLDER_ADULT
  • CHILD

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Degenerative osteoarthritis
  • Any age
  • Varus/valgus deformity knee

Exclusion Criteria:

  • Inflammatory arthritis
  • Systemic diseases with coagulopathy
  • Immune compromise(ESRD, liver cirrhosis)
  • PAOD or DVT history
  • Pre-OP INR >1.5
  • ASA score >3

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: QUADRUPLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Vicryl
Vicryl suture for wound closure after total knee replacement
Device: vicryl
wound closure with vicryl suture
Other Names:
  • polyglactin
Experimental: vicryl plus
Vicryl plus suture for wound closure after total knee replacement
Device: Vicryl plus
wound closure with vicryl plus suture
Other Names:
  • triclosan-coated polyglactin

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
wound infection
Time Frame: 3 months
3 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
serum inflammatory marker
Time Frame: 3 months
ESR, CRP, interleukin-6
3 months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Physiological parameter (skin temperature)
Time Frame: 3 months
skin temperature
3 months

Collaborators and Investigators

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

Sponsor

Mel Shiuann-Sheng Lee

Collaborators

Johnson & Johnson

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

June 1, 2011

Primary Completion (Actual)

December 1, 2012

Study Completion (Actual)

December 1, 2012

Study Registration Dates

First Submitted

August 20, 2015

First Submitted That Met QC Criteria

August 24, 2015

First Posted (Estimate)

August 26, 2015

Study Record Updates

Last Update Posted (Estimate)

August 26, 2015

Last Update Submitted That Met QC Criteria

August 24, 2015

Last Verified

August 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 98-2933a3

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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