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Is It Possible to Obtain Reliable MPTA and LDFA Values Using Imageless Navigation in Total Knee Arthroplasty? Comparison Between Preoperative CT Scan Measurements and Intraoperative Bone Morphing Before and After Articular Cartilage Removal (CAR-NAV-AL)

11. maj 2026 opdateret af: Groupe Hospitalier Diaconesses Croix Saint-Simon

Is It Possible to Obtain Reliable MPTA and LDFA Values Using Imageless Navigation in Total Knee Arthroplasty? Comparison Between Preoperative CT Scan Measurements and Intraoperative Bone Morphing Before and After Articular Cartilage Removal.

Title: Evaluation of Image-less Navigation Accuracy in Total Knee Arthroplasty (CARNAVAL)

Summary:

The purpose of this study is to evaluate the accuracy of an imageless navigation system in measuring key anatomical angles (MPTA and LDFA) during Total Knee Arthroplasty (TKA). While preoperative CT scans are currently the gold standard for bone planning, imageless navigation uses a "bone morphing" technique during surgery to create a digital model of the knee.

The study aims to determine if the measurements obtained via bone morphing, both before and after cartilage removal, are consistent with the measurements obtained from preoperative CT scans. The investigators seek to confirm if imageless navigation can provide reliable anatomical data, potentially reducing the need for preoperative radiation and costs associated with CT imaging.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Background:

Accurate alignment is critical for the long-term success of Total Knee Arthroplasty (TKA). Newer robotic and navigated systems rely on bone morphing to define the patient's anatomy per-operatively. However, the impact of cartilage thickness and the intrinsic accuracy of these systems compared to 3D CT-based planning remain subjects of clinical interest.

Objectives:

The primary objective is to compare the Medial Proximal Tibial Angle (MPTA) and the Lateral Distal Femoral Angle (LDFA) measured by:

Preoperative CT scan (Reference standard).

Peroperative image-less navigation (bone morphing) with intact cartilage.

Peroperative image-less navigation (bone morphing) after cartilage removal.

Methodology:

This is a prospective, monocentric, interventional study. All included patients will undergo a standard preoperative 3D CT scan as part of the surgical planning. During the TKA procedure, the surgeon will use the navigation system to perform bone morphing at two specific stages:

Initial stage: On the joint surface with the cartilage still present.

Secondary stage: After the surgical removal of the articular cartilage.

Comparison:

The data collected peroperatively will be compared to the CT scan measurements. The study will evaluate the "fidelity" (accuracy) of the navigation system and analyze whether the presence or absence of cartilage significantly alters the reliability of the digital bone model created by the system.

Expected Outcomes:

The results will help determine the degree of confidence surgeons can place in imageless navigation for achieving precise anatomical alignment without the systematic use of preoperative 3D imaging.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

50

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Frankrig
      • Paris, Frankrig, 75020
        • Groupe Hospitalier Diaconesses Croix Saint Simon

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

Patients aged 18 years or older.

Patients with primary or secondary knee osteoarthritis requiring a Total Knee Arthroplasty (TKA).

Patients for whom the surgical planning requires a pre-operative 3D CT scan.

Patients who have been informed about the study and have signed the written informed consent.

Patients affiliated with or beneficiaries of a social security scheme.

Exclusion Criteria:

Revision Total Knee Arthroplasty (re-operation).

Major bone loss or significant bone deformity that prevents reliable anatomical landmarking.

History of prior knee surgery that could interfere with the navigation system trackers (e.g., retained hardware in the femur or tibia).

Pregnant or breastfeeding women.

Persons deprived of liberty or under legal guardianship.

Patients with a known allergy to any component used during the standard surgical procedure.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Sundhedstjenesteforskning
  • Tildeling: N/A
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Navigation and CT-scan Comparison Group)
All participants undergo Total Knee Arthroplasty (TKA) using an imageless navigation system. Anatomical measurements (MPTA and LDFA) are recorded via bone morphing at two stages: 1) on intact articular cartilage and 2) after cartilage removal.
Procedure: Non-image-based Computer-Assisted Navigation with Bone Morphing
Intraoperative surface morphing of the joint surfaces is performed to obtain LDFA and MPTA values. The procedure compares measurements taken on the residual cartilage versus measurements taken directly on the osseous surface after cartilage debridement. These values are then validated against preoperative 3D CT scan data.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Mean Difference in Medial Proximal Tibial Angle (MPTA) between CT scan and Imageless Navigation.
Tidsramme: At the time of surgery (intra-operative).
The mean difference (measured in degrees) between the MPTA calculated from the preoperative 3D CT scan and the MPTA measured intraoperatively via bone morphing after cartilage removal.
At the time of surgery (intra-operative).

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Mean Difference in Lateral Distal Femoral Angle (LDFA) between CT scan and Imageless Navigation.
Tidsramme: At the time of surgery (intraoperative)
The mean difference (measured in degrees) between the LDFA calculated from the preoperative 3D CT scan and the LDFA measured intraoperatively via bone morphing after cartilage removal.
At the time of surgery (intraoperative)
Correlation of MPTA and LDFA measurements before and after cartilage removal.
Tidsramme: At the time of surgery (intra-operative).
Evaluation of the measurement shift (in degrees) caused by the presence of articular cartilage during the bone morphing process. This assesses the system's ability to extrapolate the subchondral bone surface.
At the time of surgery (intra-operative).

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Groupe Hospitalier Diaconesses Croix Saint-Simon

Efterforskere

  • Ledende efterforsker: Antoine MOUTON, Orthopedic surgeon, Diaconesses Croix Saint Simon Hospital Group

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

7. juli 2025

Primær færdiggørelse (Faktiske)

30. oktober 2025

Studieafslutning (Faktiske)

30. oktober 2025

Datoer for studieregistrering

Først indsendt

28. april 2026

Først indsendt, der opfyldte QC-kriterier

5. maj 2026

Først opslået (Faktiske)

8. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

14. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

11. maj 2026

Sidst verificeret

1. maj 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 2025-A00825-44

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