Multicenter Perspective Study: Clinical Evaluation of the Persona MC® With Preservation or Sacrifice of the PCL

Clinical Evaluation of the Total Knee Prosthesis Persona Medial Congruent® With Preservation or Sacrifice of the Posterior Cruciate Ligament: a Multicentric Perspective Study

Prospective, multicenter study on the Total Knee Prosthesis available on the market "Persona Medial Congruent® knee".

Primary endpoint

-Evaluation of the survival of the implant after 5 years of follow-up

Secondary endpoints

• Evaluation of the survival of the implant at 10 years of follow up.
• Evaluation of clinical and radiographic outcomes in Italian patients undergoing total knee replacement with the Persona Medial Congruent® implant with sacrifice or retention of the posterior cruciate ligament (PCL)

Study Overview

• Status: Completed
• Conditions: Prosthesis Survival
• Intervention / Treatment: Procedure: Total knee arthroplasty; Device: Persona Medial Congruent Knee Prosthesis implantation with Posterior Cruciate Ligament sacrifice; Device: Persona Medial Congruent Knee Prosthesis implantation with Posterior Cruciate Ligament retaining

Detailed Description

Prospective, multicenter study on the Total Knee Prosthesis available on the market "Persona Medial Congruent® knee" Up to 10 Italian centers will provide a maximum of 200 patients undergoing total knee replacement with Persona prosthesis and Medial Congruent® insert.

20 cases per center will be performed, 10 with posterior cruciate ligament sacrifice, 10 with posterior cruciate ligament preservation.

Patients will be recruited and enrolled in the study according to the inclusion and exclusion criteria specified below. In order to minimize the selection bias, patients will be enrolled consecutively; the first 10 patients will constitute a treatment group and the remaining 10 the complementary group.

Each patient will sign an informed consent for participation in the prospective study. The patients will be recruited at the Orthopedic and Traumatological Clinic 2nd of the Rizzoli Orthopedic Institute on an outpatient or hospitalization basis.

After the surgical treatment, the patient will continue his hospitalization at the Orthopedic and Traumatological Clinic 2nd of the Rizzoli Orthopedic Institute and, if deemed appropriate by the medical team, he will be discharged by planning the subsequent post-operative checks and diagnostic evaluations.

The data will be collected by investigators and provided to the Promoter center.

The Co-investigator who will evaluate the results will be blind to the assignment to the treatment group of the subjects in the study. The promoter of the study is the owner of the data and therefore responsible for data management. Study participants are identified with an identification code. All sensitive personal data will be stored in accordance with the current data privacy guidelines. All information will be treated with strict compliance with professional confidentiality standards. Participants will receive oral and written information relating to the processing of sensitive personal data.

The study is designed to have an alpha error of no more than 0.05. Based on an assumed 95% five-year survival, a sample size of n = 89 was calculated using SAS 9.4, Proc Power.

Assuming a 20% follow-up loss rate over five years, the study will enroll 100 patients in each patient group, then a total of 200 patients. The data collected from 200 patients (100 in each subgroup) will be archived in a descriptive way and will be the basis of all published study reports.

The categorical data (for example, gender) will be summarized using counts, percentages and the 95% confidence interval (CI), in the periods of interest. Continuous data, such as age, will be summarized using means, medians, standard deviation, minimum, maximum and 95% CI in the periods of interest. Implant survival and return to function will be summarized using the Kaplan-Meier method and presented as percentages and confidence intervals.

The expected duration of the study is 11 years, which corresponds to the time dedicated to the approval of the Ethics Committee, the enrollment of all patients, the completion of the 10-year follow-up, data analysis and preparation of the final report. The first 12 months will focus on patient enrollment. The study subjects will be involved from the moment of the intervention until the end of the 10-year follow-up (as per the current protocol 10 years FU ± 2 months).

• Study Type: Interventional
• Enrollment (Actual): 7
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • Bologna, Italy, 40136
    • IRCCS Istituto Ortopedico Rizzoli

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient qualifies for a primary total knee arthroplasty based on physical exam and medical history, including diagnosis of severe knee pain and disability due to at least one of the following:

  1. Rheumatoid arthritis, osteoarthritis, traumatic arthritis, polyarthritis
  2. Collagen disorders and/or avascular necrosis of the femoral condyle
  3. Post-traumatic loss of joint configuration, particularly when there is patellofemoral erosion, dysfunction or prior patellectomy
  4. Moderate valgus, varus, or flexion deformities
  5. The salvage of previously failed surgical attempts that did not include partial or total knee arthroplasty of the ipsilateral knee
• Patient is willing and able to complete scheduled study procedures and follow-up evaluations
• Independent of study participation, patient is a candidate for commercially available Persona MC knee implants. Patient is willing and able to complete scheduled follow-up evaluations as described in the Informed Consent.
• Patient has participated in the Informed Consent process and has signed the Ethics Committee approved 'Informed Consent'.

Exclusion Criteria:

• Patient is currently participating in any other surgical intervention studies or pain management studies
• Patient is unwilling or unable to give consent or to comply with the follow-up program.
• Patient meets exclusion criteria of the Instruction for Use Patients who have any condition which would in the judgement of the Investigator place the patient at undue risk or interfere with the study. Any patient who is institutionalized, or is a known drug abuser, a known alcoholic or anyone who cannot understand what is required of them.
• Previous history of infection in the affected joint and/or other local/systemic infection that may affect the prosthetic joint
• Insufficient bone stock on femoral or tibial surfaces
• Skeletal immaturity
• Neuropathic arthropathy
• Osteoporosis or any loss of musculature or neuromuscular disease that compromises the affected limb
• Stable, painless arthrodesis in a satisfactory functional position
• Severe instability secondary to the absence of collateral ligament integrity
• Rheumatoid arthritis accompanied by an ulcer of the skin or a history of recurrent breakdown of the skin
• Patient has a known or suspected sensitivity or allergy to one or more of the implant materials

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PCL removal; Patients will undergo surgery by sacrificing the PCL	Procedure: Total knee arthroplasty; Total knee arthroplasty using standard anterior approach.; Device: Persona Medial Congruent Knee Prosthesis implantation with Posterior Cruciate Ligament sacrifice; Patients will be implanted with this medial pivoting knee prosthesis. Posterior Cruciate Ligament will be sacrificed
Active Comparator: PCL preservation; Patients will undergo surgery with retaining the PCL	Procedure: Total knee arthroplasty; Total knee arthroplasty using standard anterior approach.; Device: Persona Medial Congruent Knee Prosthesis implantation with Posterior Cruciate Ligament retaining; Patients will be implanted with this medial pivoting knee prosthesis. Posterior Cruciate Ligament will be retained

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluate the safety based on implant survivorship at 5 years follow up	Implant survival will be evaluated by radiographic parameters on standard and long leg standing radiographs that indicate prosthesis mobilization (radiolucency lines, fracture, osteolysis)	72 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluate the safety based on implant survivorship at 10 years follow up	Implant survival will be evaluated by radiographic parameters on standard and long leg standing radiographs that indicate prosthesis mobilization (radiolucency lines, fracture, osteolysis)	132 months
Evaluation of pain	Clinical evaluation addresses the state of the studied knee before and after the surgery with respect to pain (VAS scale).	132 months
Evaluation of medication taken by the patient	Clinical evaluation addresses the state of the studied knee before and after the surgery with respect to medications.	132 months
Evaluation of muscle strength	Clinical evaluation addresses the state of the studied knee before and after the surgery with respect to muscle strength, evaluated with a subjective scale by the investigator	132 months
Return to work	Additional information regarding the returning of the patient to work is collected at 3 or 6 months follow up	132 months
Patient Satisfaction Questionnaire	It is a patient-reported short questionnaire for evaluating patient satisfaction with the knee replacement surgery	132 months
Euro Quality of Life-5 Dimensions-5 Levels Health Questionnaire	It is completed by the patient and assesses his/her general health status. The EQ-5D is used to derive a quality of life index used for health economics considerations	132 months
Oxford Knee Score	It is a patient-reported form and consists of 12 questions on the influence of the knee (surgical side) on daily activities or pain.	132 months
American Knee Society Score	It is used to assess knee functionality by investigator. It consists of both a clinical and a functional score	132 months
Forgotten Joint Score	is completed by the patient and assesses his/her ability to forget about his/ her knee joint prior and after treatment	132 months
Adverse Event Report	is completed as needed for each complication which is noted. Each complication shall be examined again at the next follow-up visit and further documented on a separate form for each visit.	132 months
Explanted Device Form	collects information on revision surgeries for study subjects.	132 months

Collaborators and Investigators

• Sponsor: Istituto Ortopedico Rizzoli
• Investigators: Principal Investigator: Giulio Maria Marcheggiani Muccioli, MD, PhD, IRCCS Istituto Ortopedico Rizzoli

Publications and helpful links

General Publications

• Sabatini L, Risitano S, Parisi G, Tosto F, Indelli PF, Atzori F, Masse A. Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience. Clin Med Insights Arthritis Musculoskelet Disord. 2018 Jan 4;11:1179544117751431. doi: 10.1177/1179544117751431. eCollection 2018.
• Van Overschelde PP, Fitch DA. Patient satisfaction at 2 months following total knee replacement using a second generation medial-pivot system: follow-up of 250 consecutive cases. Ann Transl Med. 2016 Sep;4(18):339. doi: 10.21037/atm.2016.08.41.
• Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010 Jan;468(1):57-63. doi: 10.1007/s11999-009-1119-9.
• Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J. 2014 Nov;96-B(11 Supple A):96-100. doi: 10.1302/0301-620X.96B11.34152.

Study record dates

Study Major Dates

• Study Start (Actual): December 20, 2019
• Primary Completion (Actual): December 20, 2020
• Study Completion (Actual): March 1, 2021

Study Registration Dates

• First Submitted: January 20, 2020
• First Submitted That Met QC Criteria: January 24, 2020
• First Posted (Actual): January 28, 2020

Study Record Updates

• Last Update Posted (Actual): May 31, 2023
• Last Update Submitted That Met QC Criteria: May 29, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Prosthesis Failure
• Other Study ID Numbers: Persona-MC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• 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.: Yes