Knee Osteoarthritis
Conditions
Brief summary
This is a 2-year double-blind randomized controlled trial in 287 community-dwelling individuals age 60 years or older undergoing uni-lateral total knee replacement due to severe OA of the knee.We compare an oral dose of 2000 IU vitamin D3 per day to 800 IU. The primary endpoints are pain and disability related to rehabilitation of the operated knee,and related to the expected high prevalence of OA in the contra-lateral knee. Secondary endpoints are change in 25(OH)D levels, muscle strength, balance, lower extremity function, the rate of falls, bone density and bone quality, bone metabolism, general pain, fall-related fractures, body composition, blood-pressure, major cardiovascular events, blood glucose-insulin levels, executive cognitive function, rate of upper respiratory tract infections / all infections, tooth loss, dental health, health care utilization, number and size of facial skin keratosis, and radiographic progression of the non-operated knee. Pain and disability will be assessed by the pain and function subscales of the Western Ontario- McMaster Universities Osteoarthritis Index (WOMAC). Randomization will be stratified by WOMAC function prior to surgery, radiological evidence for OA in the contra-lateral knee, and hospital. Clinical visits will take place at baseline (6-8 weeks after TKR), at 6, 12, 18 and 24 months of treatment. In addition, all individuals will receive a phone call every 2 month to assess adverse outcomes and compliance to treatment, supported by a hotline for immediate report of adverse events. Statistical power: We expect more than 80% power with 200 participants completing their 24 month follow-up, and 260 participants completing their 12 month follow-up. This is a trial with medicinal product.
Interventions
the intervention is a dietary supplement comparing the current standard (800 IU) to the current safe upper limit (2000 IU)
Sponsors
Study design
Eligibility
Inclusion criteria
* Unilateral knee replacement due to knee osteoarthritis * Age 60+ years * German language skills * community dwelling
Exclusion criteria
* Bi-lateral knee replacement or hip replacement planned in the trial period, or in the previous 6 months * Chronic steroid intake * Serum calcium corrected for serum albumin \> 2.6 mmol/l * GFR \< 30 ml/min * Severe visual or hearing impairment * Inflammatory arthritis * Malabsorption * High alcohol intake * Sarcoidosis, primary hyperparathyroidism * History of kidney stones, lymphoma * Chemotherapy for cancer in the previous 12 months * Hemiplegia * Morbus Parkinson * Unable to walk 3 meters prior to surgery * Bisphosphonate, parathyroid hormone , fluoride or calcitonine therapy in the last 6 months * Zolendronate in the last year * M. Paget (Ostitis deformans) * Vitamin D3 intake more than 800IU/d over more than 1 month * stay on a sunny location for more than 6 weeks per year * heart failure
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| pain and function of the operated and non-operated knee | 0, 6,12,18, 24 months |
| rate of falls | 0, 24 months |
Secondary
| Measure | Time frame |
|---|---|
| body composition | 0, 24 months |
| blood pressure | 0,12,24 months |
| number of teeth | 0, 24 months |
| cost, health care utilization | 0,6,12,18,24 months |
| facial skin keratosis (number and size) | 0, 24 months |
| cognitive function | 0, 24 months |
| strength, balance, function, physical activity | 0,6,12,18,24 months |
| fasting blood glucose - insulin levels | 0,12,24 |
| Number of upper respiratory infections and number of any infections | 0, 6,12,28,24 |
| bone metabolism | 0,6,12,18,24 |
| radiographic progression of the non-operated knee | 0, 24 months |
| general pain | 0,6,12,18,24 months |
| Quality of life | 0,6,12,18,24 |
| depression, mental health | 0,12,24 months |
| bone density, bone quality | 0, 24 months |
Countries
Switzerland