Difference in Patellar Tracking Before and After Journey II BCS Total Knee Arthroplasty, Evaluated With 4D CT Imaging

Last updated: April 9, 2024
Sponsor: Sebastiaan van de Groes
Overall Status: Terminated

Phase

N/A

Condition

Orthopedics

Treatment

Conventional procedure; NO onlay patella button

onlay patella button

Clinical Study ID

NCT05824533
4DCT-tracking-TKA
  • Ages 50-80
  • All Genders

Study Summary

The current proposal aims to investigate the patellar tracking in adult patients receiving Journey II Bi-Cruciate Stabilized (BCS) total knee arthroplasty (TKA) before and one year after surgery, positioned with the CORI Robotics System instrumentation. The hypothesis is that less change in patella tracking before and after surgery will lead to less anterior knee pain complaints. Patella tracking is investigated using 4Dimensional Computer Tomography (4D CT) imaging.

Researchers will compare the group of participants that will receive a patella onlay button with the group that will not receive a patella onlay button with their TKA to see if there is a difference in motion and pain experienced by the participants.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Non-inflammatory knee osteoarthritis, which is confirmed by radiology.
  • Osteoarthritis is unilateral or bilateral with the contralateral knee functioningproperly, not operated on in the last 6 months.
  • Set to receive a primary cemented total knee arthroplasty.
  • Aged between 50 and 80 years, inclusive, on the day of the operation.
  • This age limit of 50 is based on the desire to include exclusively patients withprimary osteoarthritis. As osteoarthritis is an age-related disorder, itgenerally involves adults over the age of 50 years. Patients under the age of 50years who present with osteoarthritis usually have osteoarthritis due to asecondary cause (e.g. post-traumatic osteoarthritis).
  • A maximum age of 80 years will be employed. This age limit will be adoptedbecause patients should be well able to perform an extension-flexion movementwhile a dynamic CT scan is made.
  • In stable health (American Society of Anesthesiology (ASA)-score ≤ 3) and is free ofor treated for cardiac, pulmonary, haematological, or other conditions that would poseexcessive operative risk.
  • Patient has a correctable or <10° rigid (non-correctable) varus deformity of the knee.
  • Participants must be able to give informed consent.
  • Patient plans to be available for follow-up until two years post-operative.
  • Ability to walk for 2 minutes without walking aid

Exclusion

Exclusion Criteria:

  • Valgus deformity
  • Body MAss Index (BMI) > 35.
  • Previous hip /knee/ankle replacement surgery in the last 12 months, or is planned tohave a hip replacement in the next 6-12 months.
  • Patient has had major, non-arthroscopic surgery to the study knee, including HighTibial Osteotomy (HTO).
  • Patient has an active, local infection or systemic infection
  • Incomplete or insufficient tissue surrounding the knee.
  • Severe damage to the medial or collateral knee ligaments and popliteal tendon
  • Documented osteoporosis with patient in active medical treatment.
  • Patient has physical, emotional or neurological conditions that impacts gait orbalance, or would compromise compliance with post-operative rehabilitation andfollow-up.
  • Bone quality compromised by disease or infection which cannot provide adequate supportand/or fixation to the prosthesis
  • Knee flexion < 90 degrees
  • > 30 degrees extension deficit (active restraint to extension)
  • Patient does not have a proper functioning patella tendon on the affected side;measured as inability of active extension of the knee
  • Patient has active rheumatoid arthritis, any auto-immune disorder, immunosuppressivedisorder or a terminal illness.

Study Design

Total Participants: 5
Treatment Group(s): 2
Primary Treatment: Conventional procedure; NO onlay patella button
Phase:
Study Start date:
April 08, 2022
Estimated Completion Date:
February 21, 2024

Study Description

Rationale: Pain at the anterior side of the knee after total knee arthroplasty is still a common phenomenon with an incidence reported to be as high as 49 percent. The aetiology is poorly understood and several mechanisms have been postulated. Next to the influence of alignment on retinacular stresses, overstuffing of the patellofemoral joint and instability also lead to higher retinacular stresses and are shown to lead to anterior knee pain. These mechanisms are all related to surgical technique and implant positioning. There are also mechanisms related to prosthesis design, like the sagittal curve, trochlear depth and trochlea shape.

New implant designs like the Journey II prothesis are designed to replicate optimal geometry and optimal tibiofemoral and patellofemoral kinematics. Therefore, the Journey II Bi-Cruciate Stabilized (BCS) seems the optimal implant to reduce anterior knee pain. However, large registry studies show that a higher revision rate is seen when no patellar button is used in case of the Journey II BCS. The use of a patellar button is still under debate, but using an onlay patella button has clear influence on the patella tracking. Therefore, there might be a relation between the use of an onlay patella button and the retinacular balance and thus clinical results.

With current surgical instrumentation the positioning of the prosthesis based on the kinematics of the natural knee is challenging, and a small error can completely counteract the normal motion defined by the implant design/geometry. Therefore, comparative studies are only leading to new evidence when the surgical technique is including objective and accurate tools, like the CORI robotic platform. With the CORI, component positioning can be set based on constitutional alignment and ligament functioning. Furthermore, the patellofemoral compartment can be taken into account during the surgery to enable optimal geometry replication of the trochlea in the sagittal plane. This enables the surgeon to position the components accurately within the envelop of motion of a specific joint.

With new emerging imaging techniques, the investigators are able to investigate in vivo patella tracking. One of these promising techniques is the 4D CT imaging. This technique is proven to be accurate within 1 mm and 1° and therefore useful to investigate the patellofemoral compartment.

The current proposal aims to investigate the patellar tracking in patients receiving Journey II BCS total knee arthroplasty (TKA) before and one year after surgery, positioned with the CORI Robotics System instrumentation. The hypothesis is that less change in patella tracking before and after surgery will lead to less anterior knee pain complaints. Patella tracking is investigated using 4Dimensional Computer Tomography (4D CT) imaging.

Research participants/locations:

A total of 100 participants will be included in the study from two sites in the Netherlands (Radboudumc and Treant medical centers). Half of the participants will undergo TKA placed with the CORI Robotics and a patella onlay button and the other half (50 participants) will undergo a TKA placed with the CORI Robotics System and without a patella onlay button.

Connect with a study center

  • Treant, the Netherlands

    Groningen,
    Netherlands

    Site Not Available

  • RadboudUMC

    Nijmegen,
    Netherlands

    Site Not Available

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