- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04600583
A Trial of Mechanical Axis With Soft Tissue Release Balancing vs Functional Alignment With Bony Release Balancing in Total Knee Replacement Using Stryker's Mako Robot
October 19, 2020 updated by: Stryker South Pacific
A Prospective, Randomized, Controlled Trial of Mechanical Axis With Soft Tissue Release Balancing vs Functional Alignment With Bony Release Balancing in Total Knee Replacement - A Study Using Stryker Mako Robotic-Arm Assisted Technology®.
This study is a prospective, randomized, longitudinal study of the clinical outcomes of osteoarthritis patients treated by two different alignment philosophies for total knee replacement.
All patients will be treated with the same knee system, implanted using MAKO robotic-arm assisted technology.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
240
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: David Fulker, PhD
- Phone Number: +61 94671072
- Email: david.fulker@stryker.com
Study Locations
-
-
Auckland
-
Takapuna, Auckland, New Zealand, 0622
- North Shore Hospital
-
Contact:
- Simon Young, Dr
- Phone Number: +64 1616183
- Email: simon.young@auckland.ac.nz
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Sub-Investigator:
- Matthew Walker, Dr
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Sub-Investigator:
- Bill Farrington, Dr
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Sub-Investigator:
- Ali Bayan, Dr
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Sub-Investigator:
- Rupert Van Rooyen, Dr
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Principal Investigator:
- Simon Young, Dr
-
-
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
38 years to 78 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- The patient is a male or non-pregnant female between the ages of 40-80 years.
- The patient requires a primary total knee replacement and is indicated for robotic-assisted surgery.
- Patient is deemed appropriate for a cruciate retaining knee replacement.
- The patient has a primary diagnosis of osteoarthritis (OA).
- The patient has intact collateral ligaments.
- The patient is able to undergo CT scanning of the affected limb.
- The patient has signed the study specific, ethics-approved, Informed Consent document.
- The patient is willing and able to comply with the specified pre-operative and post-operative clinical and radiographic evaluations.
Exclusion Criteria:
- The patient has a history of total, unicompartmental reconstruction or fusion of the affected joint.
- Patient has had a previous osteotomy around the knee.
- The patient is morbidly obese (BMI ≥ 40).
- The patient has a deformity which will require the use of stems, wedges or augments in conjunction with the Triathlon Total Knee System.
- The patient has a varus/valgus deformity ≥ 15°.
- The patient has a fixed flexion deformity ≥ 15°.
- The patient has a neuromuscular or neurosensory deficiency, which would limit the ability to assess the performance of the device.
- The patient has a systemic or metabolic disorder leading to progressive bone deterioration.
- The patient is immunologically suppressed or receiving steroids in excess of normal physiological requirements.
- Patient has a cognitive impairment, an intellectual disability or a mental illness.
- The patient is pregnant.
- The patient has metal hardware present in the region of the hip, knee or ankle (as this is known to create geometrical distortion in the region of the implant).
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: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Alignment according to Functional Alignment philosophy
Patients randomized to this group will undergo a TKA (total knee arthroplasty) to receive a Triathlon Total Knee System aligned according to Functional Alignment philosophy.
This method of implant alignment is defined by a patient's native joint line as well as the soft tissue envelope.
Triathlon Total Knee System components will be positioned relative to intra-operative soft tissue laxity assessment.
A mobile application (KneeBalancer) will be used to assist surgeon decision making during the dynamic joint balancing surgical step.
|
All patients, regardless of the alignment arm they are randomized to will undergo a primary total knee arthroplasty with the Triathlon® Total Knee System using Mako Robotic-Arm Assisted Technology.
The surgical intervention will be administered by a physician wherein the expected duration of surgery is approximately 1.5 hours.
|
Active Comparator: Alignment to the patient's natural Mechanical axis
Patients randomized to this group will undergo a TKA (total knee arthroplasty) to receive a Triathlon Total Knee System neutrally aligned to the Mechanical axis.
More specifically, the femoral component and tibial component are aligned 0° to the mechanical axis of each respective limb.
Femoral component rotation is fixed to the trans-epicondylar axis.
Soft tissue releases are performed at the discretion of the surgeon to achieve balance and full range of motion.
|
All patients, regardless of the alignment arm they are randomized to will undergo a primary total knee arthroplasty with the Triathlon® Total Knee System using Mako Robotic-Arm Assisted Technology.
The surgical intervention will be administered by a physician wherein the expected duration of surgery is approximately 1.5 hours.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Joint feeling and Forgotten Joint Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months (primary timepoint) and 24 months
|
To evaluate differences in joint feeling assessed via the Forgotten Joint Score.
This newly-developed 12-item score ranges from 0 to 100 and assesses how aware recipients are of their joint in everyday life.
Higher scores indicate a good outcome i.e. a high degree of forgetting the joint.
For the purpose of this study a change in score of 14 points for the Forgotten Joint Score has been identified.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months (primary timepoint) and 24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Function and Oxford Knee Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
To evaluate differences in function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: Oxford Knee Score.
This score ranges from 0 to 48 where a higher score indicates a better outcome.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
Function and The International Knee Society Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 12 months and 24 months
|
To evaluate differences in function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: The International Knee Society Score.
This score ranges from 0 to 100 where a higher score correlates to a better outcome.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 12 months and 24 months
|
Function and Knee Injury and Osteoarthritis Outcome Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
To evaluate differences in function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: Knee Injury and Osteoarthritis Outcome Score.
This score ranges from 0 to 100 where 0 indicates the worst possible knee symptoms and 100 signifies no knee symptoms.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
Pain and Oxford Knee Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
To evaluate differences in pain between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: Oxford Knee Score.
This score ranges from 0 to 48 where a higher score indicates a better outcome.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
Pain and The International Knee Society Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 12 months and 24 months
|
To evaluate differences in pain between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: The International Knee Society Score.
This score ranges from 0 to 100 where a higher score correlates to a better outcome.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 12 months and 24 months
|
Pain and Knee Injury and Osteoarthritis Outcome Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
To evaluate differences in pain between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: Knee Injury and Osteoarthritis Outcome Score.
This score ranges from 0 to 100 where 0 indicates the worst possible knee symptoms and 100 signifies no knee symptoms.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
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Pain and Visual Analogue Scale
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
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To evaluate differences in pain between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following graphic measurement instrument: Visual Analogue Scale.
This scale is a continuum between no pain and the worst possible pain imaginable.
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Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
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Satisfaction and Net Promoter Score
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
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To evaluate differences in satisfaction between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: Net Promoter.
This score ranges from -100 to 100 where the upper end indicates the patient's recommendation of the healthcare they received.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
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Health related quality of life and Euro-Qol (EQ-5D-3L)
Time Frame: Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
To evaluate differences in health-related quality of life between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This will be achieved by employing the following instrument: Euro-Qol (EQ-5D-3L).
This score ranges from 0 to 100 where 0 correlates to the worst imaginable health state whilst 100 indicates the best.
|
Pre-operative (2 weeks prior to surgery), Post-operative - 6 weeks, 6 months, 12 months and 24 months
|
Early pain
Time Frame: In-patient setting (< 5 days post-operation), Post-operative - 6 weeks and 6 months
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To evaluate differences in early pain (i.e. from in-patient setting to 6-months post operation) between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved through the use of a patient pain inventory form.
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In-patient setting (< 5 days post-operation), Post-operative - 6 weeks and 6 months
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Early function
Time Frame: In-patient setting (< 5 days post-operation)
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To evaluate differences in early function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved by utilizing functional tests conducted by physiotherapists.
The following functional test will be carried out on the knee joint: Range of motion
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In-patient setting (< 5 days post-operation)
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Early function
Time Frame: In-patient setting (< 5 days post-operation)
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To evaluate differences in early function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved by utilizing functional tests conducted by physiotherapists.
The following functional test will be employed: 9 step stair climb
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In-patient setting (< 5 days post-operation)
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Early function
Time Frame: In-patient setting (< 5 days post-operation)
|
To evaluate differences in early function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved by utilizing functional tests conducted by physiotherapists.
The following functional test will be employed: fast paced 10m walk test
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In-patient setting (< 5 days post-operation)
|
Early function
Time Frame: In-patient setting (< 5 days post-operation)
|
To evaluate differences in early function between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved by utilizing functional tests conducted by physiotherapists.
The following functional test will be employed: 30 second chair stand test
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In-patient setting (< 5 days post-operation)
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Blood loss
Time Frame: Intra-operative
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To compare blood loss between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved through obtaining surgical data.
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Intra-operative
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Adjustments to balance
Time Frame: Intra-operative
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To compare adjustments to balance between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This objective will be achieved through obtaining the position from the Robotic system.
|
Intra-operative
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Ability to reach target knee balance as assessed by alignment angles and gaps
Time Frame: Pre-operative (2 weeks prior to surgery), intra-operative, Post-operative - 6 weeks, 12 months and 24 months
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To compare the ability to achieve soft tissue balance between Robotic Assisted Functional Alignment and Robotic Assisted Mechanical Alignment.
This object will be achieved by comparing pre-operative plan and pre-resection gaps with the final surgical plan and implanted gaps as derived from the robotic system.
The implant position is defined as the angulation of components and resected bone in each anatomical plane.
The soft tissue balance is defined as gaps created in extension and 90° of flexion when stressing the medial compartment (medial collateral ligament) and lateral compartment (lateral collateral ligament).
The overall limb alignment is assessed by comparing the Hip-Knee-Ankle angle from pre-operative to 1-year post-operative on a long leg weight bearing x-ray.
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Pre-operative (2 weeks prior to surgery), intra-operative, Post-operative - 6 weeks, 12 months and 24 months
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Simon Young, Dr, North Shore Hospital
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.
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)
October 1, 2020
Primary Completion (Anticipated)
October 1, 2023
Study Completion (Anticipated)
July 1, 2024
Study Registration Dates
First Submitted
September 29, 2020
First Submitted That Met QC Criteria
October 19, 2020
First Posted (Actual)
October 23, 2020
Study Record Updates
Last Update Posted (Actual)
October 23, 2020
Last Update Submitted That Met QC Criteria
October 19, 2020
Last Verified
October 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CAMELOT
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
Yes
product manufactured in and exported from the U.S.
Yes
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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