Effect of Tergase Injection on Reducing Edema After Bilateral Total Knee Arthroplasty (ALT-TKA)

Inclusion Criteria:

1. Adult males and females aged 60 years or older and 85 years or younger.
2. Patients scheduled for bilateral total knee arthroplasty due to degenerative knee osteoarthritis with a Kellgren-Lawrence grade of III or IV confirmed by imaging within the last 4 weeks.
3. Patients experiencing knee joint pain of 5 or higher on a 10-point Visual Analogue Scale (VAS) during daily activities, such as walking on flat ground.
4. Patients with the willingness and ability to follow the physician's instructions, including joint exercises.
5. Patients classified as American Society of Anesthesiologists (ASA) Physical Status Class I or II.
6. Patients who have received a full explanation of the clinical trial and have voluntarily provided written informed consent to participate.

Exclusion Criteria:

1. Participants or their family members with ongoing or a history of autoimmune diseases.
2. Patients with secondary osteoarthritis of the knee.
3. Patients with inflammatory arthritis (such as rheumatoid arthritis, lupus arthropathy, psoriatic arthritis) or crystal-induced arthropathy.
4. Patients with a serum protein level of 5.5 g/dL or less.

5. Patients with clinical laboratory results that are contraindications for total knee arthroplasty:

   1. WBC <3,000/μL or >12,000/μL
   2. CRP >10 mg/L
   3. Hb <10 g/dL
   4. Platelet count <100,000/μL
   5. INR >1.5
   6. eGFR <30 mL/min/1.73 m²
   7. AST or ALT >3 times the upper limit of normal
   8. Fasting blood glucose >200 mg/dL
6. Patients with a history of drug abuse or dependence.
7. Presence of local infection or sepsis in the affected lower limb, or a history of neurological abnormalities within the past 6 months.
8. History of major joint surgery within 90 days.
9. Patients who received systemic steroid treatment within 3 months prior to surgery.
10. Patients who sustained a serious injury or received an injection in the target knee that may interfere with evaluation within 3 months prior to the screening visit.
11. Patients with infections requiring hospitalization and administration of antibiotics or antimicrobics.

12. Patients with any clinically significant medical condition that may interfere with study completion or outcome assessment, including but not limited to:

    1. Congenital heart disease, clinically significant cardiovascular disease, renal dysfunction, or uncontrolled diabetes.
    2. Neuromuscular disorders affecting the lower limbs.
    3. Severe bleeding or coagulation disorders.
    4. Severe knee instability that cannot be corrected with cruciate-retaining total knee arthroplasty.
    5. Severe knee deformity, defined as flexion contracture ≥30 degrees or varus/valgus deformity ≥30 degrees.
    6. Opioid dependence, defined as consumption of ≥100 mg morphine-equivalent opioids per week for more than 3 months before surgery.
    7. Inability to assess pain using the Visual Analogue Scale, including cognitive or language impairment.
    8. Venous congestion of the lower extremity.
    9. Morbid obesity, defined as body mass index >40 kg/m².
13. History of shock or hypersensitivity to Tergase inj. or its components.
14. Patients deemed unsuitable for this study by the investigator, such as those with psychiatric disorders.
15. Patients currently participating in another clinical trial.