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Total Knee Arthroplasty: Functional and Clinical Outcomes

Clinical and Functional Outcomes Following Total Knee Replacement Using Two Different Implants

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01811563
Enrollment
60
Registered
2013-03-14
Start date
2013-02-28
Completion date
2016-02-26
Last updated
2017-06-02

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Knee Osteoarthritis

Keywords

Total Knee Replacement, Lower Quarter Y-Balance Test, Functional Outcomes, Patient Reported Outcomes

Brief summary

The purpose of this study is to assess the differences in functional and patient reported outcomes between total knee replacement (TKA) implants. In addition, this work will examine the correlation between functional assessments and patient reported outcomes following surgery. All subjects will complete assessments preoperatively, 4-6 weeks following TKA and then one year following TKA. Subjects will complete a series of patient reported outcomes as well as a series of functional outcomes at each of the time points of interest. The analysis will include a repeated measures design to determine differences between groups across time as well as correlations between the functional and patient reported outcomes. This work will hopefully determine the importance of using objective functional outcomes following TKA as well as determining the need for patient assessments out to one year following surgery.

Detailed description

The number differences in subjects analyzed from baseline to 6 weeks to 52 weeks are due to the fact that we did not use the 6 week time point in the final analysis based on the clinical decision that 6 weeks was too early in recovery to provide accurate information for clinical decision making. Therefore the patients used in the final analysis were those subjects who were able to and completed the assessment at pre-op and 1 year post-op which is how we get to the 20 subjects per group.

Interventions

DEVICEZimmer
DEVICEStryker

Sponsors

Duke University
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No

Inclusion criteria

1. Patients requiring primary total knee replacement 2. Patients willing and able to comply with the follow-up visits and evaluations 3. Patients willing to sign informed consent approved by the Institutional Review Board

Exclusion criteria

1. Patients with inflammatory arthritis 2. Patients with diabetic neuropathy 3. Patients unable to ambulate without the use of an assistive device prior to surgery 4. Patients unable to stand in single limb stance on each foot prior to surgery.

Design outcomes

Primary

MeasureTime frameDescription
Change in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 6 Weeks Following Total Knee ReplacementBaseline (Pre-Operative) to 6 weeks following total knee replacementThe lower quarter y-balance test (YBT-LQ) is a test of dynamic balance in unilateral stance that has been deemed to be reliable and valid. The YBT-LQ consists of each patient standing on one leg and reaching as far as they can with their non-stance leg in the anterior, posteromedial and posterolateral direction while standing on the other foot on a centralized stance platform. The composite score is calculated as the sum of the three reach directions divided by 3 time the limb length and will be reported as a percentage of limb length.
Change in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 52 Weeks Following Total Knee ReplacementBaseline (Pre-Operative) to 52 weeks following total knee replacementThe lower quarter y-balance test (YBT-LQ) is a test of dynamic balance in unilateral stance that has been deemed to be reliable and valid. The YBT-LQ consists of each patient standing on one leg and reaching as far as they can with their non-stance leg in the anterior, posteromedial and posterolateral direction while standing on the other foot on a centralized stance platform. The composite score is calculated as the sum of the three reach directions divided by 3 time the limb length and will be reported as a percentage of limb length.

Secondary

MeasureTime frameDescription
Change in Walking Speed From Baseline to 52 Weeks Following Total Knee Replacement.Baseline and 52 weeks following total knee replacementEach subject will complete three walking trials at a self-selected comfortable walking speed along a 5 meter walkway in order to record walking speed at each time point.
Walking Speed at 6 Weeks Following Total Knee Replacement.6 weeks following total knee replacementEach subject will complete three walking trials at a self-selected comfortable walking speed along a 5 meter walkway in order to record walking speed at each time point.

Other

MeasureTime frameDescription
Knee Society Score (KSS)Baseline (Pre-Operative), 6 weeks and 52 weeks following total knee replacementThe KSS is a patient reported measure of knee function that is specific to patients who are scheduled to receive or have previously had a total knee replacement. This outcome measures both patient reported pain and function changes from prior to surgery through recovery. The score range is from 0 to 100. The highest score of 100 points will be obtained by a well-aligned knee with no pain, 125 degrees of motion, and negligible anteroposterior and mediolateral instability.
Change in University of California, Los Angeles (UCLA) Activity Score From Baseline to 52 Weeks Following Total Knee Replacement.Baseline and 52 weeks following total knee replacementThe UCLA activity score is a validated patient reported outcome of overall physical activity. Results on a scale of 1 to 10, 1 is Wholly Inactive, dependent on others, and can not leave residence and 10 is Regularly participates in impact sports.
Timed Get up and goBaseline (Pre-Operative), 6 weeks and 52 weeks following total knee replacementThe timed up and go requires a patient to rise from a chair walk three meters around a piece of tape and return to the chair again as quickly as possible.
Sit to Stand TimeBaseline (Pre-Operative), 6 weeks and 52 weeks following total knee replacementThe sit to stand test requires patients to stand up and sit down as many times as possible in 10 seconds from a standard arm chair.
University of California, Los Angeles (UCLA) Activity Score at 6 Weeks Following Total Knee Replacement.6 weeks following total knee replacementThe UCLA activity score is a validated patient reported outcome of overall physical activity. Results on a scale of 1 to 10, 1 is Wholly Inactive, dependent on others, and can not leave residence and 10 is Regularly participates in impact sports.
Change in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total From Baseline to 52 Weeks Following Total Knee Replacement.Baseline (Pre-Operative) and 52 weeks following total knee replacementThe KOOS is a standardized and validated patient outcome score that assesses functional limitation in patient with knee problems. KOOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and knee related Quality of life (QOL). The previous week is the time period considered when answering the questions. Standardized answer options are given (5 Likert boxes) and each question is assigned a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.
Change in Forgotten Joint Score (FJS) From 6 Weeks to 52 Weeks Following Total Knee Replacement.6 weeks and 52 weeks following total knee replacementThe FJS is a patient reported measure of how bothersome the total joint replacement is for them, how much it affects daily activity and how much they are aware of the implant. The FJS is a 12-question survey regarding functional outcome, pain, stability, daily living, activity and sport. Scoring is from 0 to 4 with 0 as the best outcome; a low score means high satisfaction. Not all questions must be answered to score, all responses are summed and the total is divided by number of completed items multiplied by 25, with the final result subtracted from 100. The score range is from 0 to 100 with the highest score of 100 indicating the best outcome (the joint is completely forgotten) and 0 indicating the worst outcome.

Countries

United States

Participant flow

Recruitment details

60 patients signed consent form but 12 were withdrawn at the time of surgery because they required a different implant not included in the study.

Participants by arm

ArmCount
Stryker
Subjects will be receiving the Stryker Triathlon total knee replacement Stryker
25
Zimmer
Subjects will be receiving a Zimmer NexGen total knee replacement Zimmer
23
Total48

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyIncorrect Randomization procedure01
Overall StudyLost to Follow-up52

Baseline characteristics

CharacteristicStrykerZimmerTotal
Age, Continuous61.9 years
STANDARD_DEVIATION 8
63.1 years
STANDARD_DEVIATION 7.3
62.5 years
STANDARD_DEVIATION 7.6
Region of Enrollment
United States
25 participants23 participants48 participants
Sex: Female, Male
Female
14 Participants10 Participants24 Participants
Sex: Female, Male
Male
11 Participants13 Participants24 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 250 / 23
other
Total, other adverse events
1 / 250 / 23
serious
Total, serious adverse events
0 / 250 / 23

Outcome results

Primary

Change in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 52 Weeks Following Total Knee Replacement

The lower quarter y-balance test (YBT-LQ) is a test of dynamic balance in unilateral stance that has been deemed to be reliable and valid. The YBT-LQ consists of each patient standing on one leg and reaching as far as they can with their non-stance leg in the anterior, posteromedial and posterolateral direction while standing on the other foot on a centralized stance platform. The composite score is calculated as the sum of the three reach directions divided by 3 time the limb length and will be reported as a percentage of limb length.

Time frame: Baseline (Pre-Operative) to 52 weeks following total knee replacement

Population: Subjects used in the final analysis were those subjects who completed the assessment at pre-op and 1 year post-op (20 subjects per arm).

ArmMeasureGroupValue (MEAN)Dispersion
StrykerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 52 Weeks Following Total Knee ReplacementYBT-LQ Composite Pre-Operative79.45 % of limb lengthStandard Deviation 10.46
StrykerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 52 Weeks Following Total Knee ReplacementYBT-LQ Composite Post-Op 52 Weeks70.44 % of limb lengthStandard Deviation 9.31
ZimmerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 52 Weeks Following Total Knee ReplacementYBT-LQ Composite Pre-Operative79.24 % of limb lengthStandard Deviation 7.89
ZimmerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 52 Weeks Following Total Knee ReplacementYBT-LQ Composite Post-Op 52 Weeks69.42 % of limb lengthStandard Deviation 13.39
p-value: 0.856ANOVA
p-value: <0.001ANOVA
p-value: 0.822ANOVA
Primary

Change in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 6 Weeks Following Total Knee Replacement

The lower quarter y-balance test (YBT-LQ) is a test of dynamic balance in unilateral stance that has been deemed to be reliable and valid. The YBT-LQ consists of each patient standing on one leg and reaching as far as they can with their non-stance leg in the anterior, posteromedial and posterolateral direction while standing on the other foot on a centralized stance platform. The composite score is calculated as the sum of the three reach directions divided by 3 time the limb length and will be reported as a percentage of limb length.

Time frame: Baseline (Pre-Operative) to 6 weeks following total knee replacement

Population: Only subjects that were able to complete all of the YBT assessments at 6 weeks post total knee replacement were included in the analyses.

ArmMeasureGroupValue (MEAN)Dispersion
StrykerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 6 Weeks Following Total Knee ReplacementYBT-LQ Composite Pre-Operative69.98 % of limb lengthStandard Deviation 8.18
StrykerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 6 Weeks Following Total Knee ReplacementYBT-LQ Composite 6 weeks73.25 % of limb lengthStandard Deviation 7.95
ZimmerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 6 Weeks Following Total Knee ReplacementYBT-LQ Composite Pre-Operative67.52 % of limb lengthStandard Deviation 12.22
ZimmerChange in Lower Quarter Y-Balance Test (YBT-LQ) (Dynamic Balance) From Baseline to 6 Weeks Following Total Knee ReplacementYBT-LQ Composite 6 weeks73.32 % of limb lengthStandard Deviation 9.15
p-value: 0.661ANOVA
p-value: <0.001ANOVA
p-value: 0.27ANOVA
Secondary

Change in Walking Speed From Baseline to 52 Weeks Following Total Knee Replacement.

Each subject will complete three walking trials at a self-selected comfortable walking speed along a 5 meter walkway in order to record walking speed at each time point.

Time frame: Baseline and 52 weeks following total knee replacement

ArmMeasureGroupValue (MEAN)Dispersion
StrykerChange in Walking Speed From Baseline to 52 Weeks Following Total Knee Replacement.Walking Speed Pre-Operative1.22 miles per hourStandard Deviation 0.21
StrykerChange in Walking Speed From Baseline to 52 Weeks Following Total Knee Replacement.Walking Speed Post-Op 52 Weeks1.41 miles per hourStandard Deviation 0.23
ZimmerChange in Walking Speed From Baseline to 52 Weeks Following Total Knee Replacement.Walking Speed Pre-Operative1.16 miles per hourStandard Deviation 0.28
ZimmerChange in Walking Speed From Baseline to 52 Weeks Following Total Knee Replacement.Walking Speed Post-Op 52 Weeks1.28 miles per hourStandard Deviation 0.23
p-value: 0.158ANOVA
p-value: <0.001ANOVA
p-value: 0.365ANOVA
Secondary

Walking Speed at 6 Weeks Following Total Knee Replacement.

Each subject will complete three walking trials at a self-selected comfortable walking speed along a 5 meter walkway in order to record walking speed at each time point.

Time frame: 6 weeks following total knee replacement

ArmMeasureValue (MEAN)Dispersion
StrykerWalking Speed at 6 Weeks Following Total Knee Replacement.1.21 miles per hourStandard Deviation 0.28
ZimmerWalking Speed at 6 Weeks Following Total Knee Replacement.1.19 miles per hourStandard Deviation 0.22
Other Pre-specified

Change in Forgotten Joint Score (FJS) From 6 Weeks to 52 Weeks Following Total Knee Replacement.

The FJS is a patient reported measure of how bothersome the total joint replacement is for them, how much it affects daily activity and how much they are aware of the implant. The FJS is a 12-question survey regarding functional outcome, pain, stability, daily living, activity and sport. Scoring is from 0 to 4 with 0 as the best outcome; a low score means high satisfaction. Not all questions must be answered to score, all responses are summed and the total is divided by number of completed items multiplied by 25, with the final result subtracted from 100. The score range is from 0 to 100 with the highest score of 100 indicating the best outcome (the joint is completely forgotten) and 0 indicating the worst outcome.

Time frame: 6 weeks and 52 weeks following total knee replacement

Population: Participants who completed the Forgotten Joint Score (FJS) at week 6 and week 52. Not all subjects completed the FJS.

ArmMeasureGroupValue (MEAN)Dispersion
StrykerChange in Forgotten Joint Score (FJS) From 6 Weeks to 52 Weeks Following Total Knee Replacement.FJS, at 6 weeks69.63 units on a scaleStandard Deviation 20.9
StrykerChange in Forgotten Joint Score (FJS) From 6 Weeks to 52 Weeks Following Total Knee Replacement.FJS, at 52 weeks37.7 units on a scaleStandard Deviation 21.4
ZimmerChange in Forgotten Joint Score (FJS) From 6 Weeks to 52 Weeks Following Total Knee Replacement.FJS, at 6 weeks76.59 units on a scaleStandard Deviation 20.39
ZimmerChange in Forgotten Joint Score (FJS) From 6 Weeks to 52 Weeks Following Total Knee Replacement.FJS, at 52 weeks30.8 units on a scaleStandard Deviation 29.6
p-value: 0.319t-test, 2 sided
Other Pre-specified

Change in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total From Baseline to 52 Weeks Following Total Knee Replacement.

The KOOS is a standardized and validated patient outcome score that assesses functional limitation in patient with knee problems. KOOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and knee related Quality of life (QOL). The previous week is the time period considered when answering the questions. Standardized answer options are given (5 Likert boxes) and each question is assigned a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

Time frame: Baseline (Pre-Operative) and 52 weeks following total knee replacement

Population: Subjects used in the final analysis were those subjects who completed the assessment at pre-op and 1 year post-op (20 subjects per arm).

ArmMeasureGroupValue (MEAN)Dispersion
StrykerChange in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total From Baseline to 52 Weeks Following Total Knee Replacement.KOOS Total, Baseline Pre-Operative45.60 units on a scaleStandard Deviation 12.32
StrykerChange in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total From Baseline to 52 Weeks Following Total Knee Replacement.KOOS Total, Post-Op 52 week67.32 units on a scaleStandard Deviation 35.62
ZimmerChange in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total From Baseline to 52 Weeks Following Total Knee Replacement.KOOS Total, Baseline Pre-Operative46.08 units on a scaleStandard Deviation 13.5
ZimmerChange in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total From Baseline to 52 Weeks Following Total Knee Replacement.KOOS Total, Post-Op 52 week64.24 units on a scaleStandard Deviation 38.79
p-value: 0.83ANOVA
p-value: <0.001ANOVA
p-value: 0.728ANOVA
Other Pre-specified

Change in University of California, Los Angeles (UCLA) Activity Score From Baseline to 52 Weeks Following Total Knee Replacement.

The UCLA activity score is a validated patient reported outcome of overall physical activity. Results on a scale of 1 to 10, 1 is Wholly Inactive, dependent on others, and can not leave residence and 10 is Regularly participates in impact sports.

Time frame: Baseline and 52 weeks following total knee replacement

Population: Subjects used in the final analysis were those subjects who completed the assessment at pre-op and 1 year post-op (20 subjects per arm).

ArmMeasureGroupValue (MEAN)Dispersion
StrykerChange in University of California, Los Angeles (UCLA) Activity Score From Baseline to 52 Weeks Following Total Knee Replacement.UCLA Activity Pre-Operative4.19 units on a scaleStandard Deviation 1.33
StrykerChange in University of California, Los Angeles (UCLA) Activity Score From Baseline to 52 Weeks Following Total Knee Replacement.UCLA Activity Post-Op 52 Weeks5.90 units on a scaleStandard Deviation 1.55
ZimmerChange in University of California, Los Angeles (UCLA) Activity Score From Baseline to 52 Weeks Following Total Knee Replacement.UCLA Activity Pre-Operative3.83 units on a scaleStandard Deviation 1.38
ZimmerChange in University of California, Los Angeles (UCLA) Activity Score From Baseline to 52 Weeks Following Total Knee Replacement.UCLA Activity Post-Op 52 Weeks5.61 units on a scaleStandard Deviation 1.91
p-value: 0.416ANOVA
p-value: <0.001ANOVA
p-value: 0.917ANOVA
Other Pre-specified

Knee Society Score (KSS)

The KSS is a patient reported measure of knee function that is specific to patients who are scheduled to receive or have previously had a total knee replacement. This outcome measures both patient reported pain and function changes from prior to surgery through recovery. The score range is from 0 to 100. The highest score of 100 points will be obtained by a well-aligned knee with no pain, 125 degrees of motion, and negligible anteroposterior and mediolateral instability.

Time frame: Baseline (Pre-Operative), 6 weeks and 52 weeks following total knee replacement

Population: Only 20 subjects in each arm completed the assessment at 1 year post-op.

ArmMeasureGroupValue (MEAN)Dispersion
StrykerKnee Society Score (KSS)KSS Satsifaction, 6 weeks28.9 units on a scaleStandard Deviation 7.3
StrykerKnee Society Score (KSS)KSS Functional Activity, 6 weeks60.8 units on a scaleStandard Deviation 18.1
StrykerKnee Society Score (KSS)KSS Functional Activity, Baseline44.3 units on a scaleStandard Deviation 11.2
StrykerKnee Society Score (KSS)KSS Functional Activity, 52 weeks Post-operative67.3 units on a scaleStandard Deviation 35.6
StrykerKnee Society Score (KSS)KSS Satisfaction, Baseline Pre-Operatively11.1 units on a scaleStandard Deviation 5.2
ZimmerKnee Society Score (KSS)KSS Functional Activity, 52 weeks Post-operative64.2 units on a scaleStandard Deviation 38.8
ZimmerKnee Society Score (KSS)KSS Satisfaction, Baseline Pre-Operatively13.6 units on a scaleStandard Deviation 8.8
ZimmerKnee Society Score (KSS)KSS Satsifaction, 6 weeks29.5 units on a scaleStandard Deviation 8.8
ZimmerKnee Society Score (KSS)KSS Functional Activity, Baseline47.0 units on a scaleStandard Deviation 13.7
ZimmerKnee Society Score (KSS)KSS Functional Activity, 6 weeks61.6 units on a scaleStandard Deviation 16.7
Other Pre-specified

Sit to Stand Time

The sit to stand test requires patients to stand up and sit down as many times as possible in 10 seconds from a standard arm chair.

Time frame: Baseline (Pre-Operative), 6 weeks and 52 weeks following total knee replacement

Population: The 6 week time point was not used in the final analysis based on the clinical decision that 6 weeks was too early in recovery to provide accurate information for clinical decision making. Subjects used in the final analysis were those subjects who completed the assessment at pre-op and 1 year post-op (20 subjects per arm).

ArmMeasureGroupValue (MEAN)Dispersion
StrykerSit to Stand TimeSit to stand Pre-Operative3.90 Number of timesStandard Deviation 0.95
StrykerSit to Stand TimeSit to stand Post-Op 6 weeks4.5 Number of timesStandard Deviation 1.7
StrykerSit to Stand TimeSit to stand Post-Op 52 weeks5.40 Number of timesStandard Deviation 1.45
ZimmerSit to Stand TimeSit to stand Pre-Operative4.34 Number of timesStandard Deviation 1.34
ZimmerSit to Stand TimeSit to stand Post-Op 6 weeks4.6 Number of timesStandard Deviation 1.1
ZimmerSit to Stand TimeSit to stand Post-Op 52 weeks5.47 Number of timesStandard Deviation 1.81
Other Pre-specified

Timed Get up and go

The timed up and go requires a patient to rise from a chair walk three meters around a piece of tape and return to the chair again as quickly as possible.

Time frame: Baseline (Pre-Operative), 6 weeks and 52 weeks following total knee replacement

Population: The 6 week time point was not used in the final analysis based on the clinical decision that 6 weeks was too early in recovery to provide accurate information for clinical decision making. Subjects used in the final analysis were those subjects who completed the assessment at pre-op and 1 year post-op (20 subjects per arm).

ArmMeasureGroupValue (MEAN)Dispersion
StrykerTimed Get up and goTimed up and go Pre-Operative9.55 SecondsStandard Deviation 3.86
StrykerTimed Get up and goTimed up and go Post-Op 6 weeks9.38 SecondsStandard Deviation 3.58
StrykerTimed Get up and goTimed up and go Post-Op 52 weeks6.99 SecondsStandard Deviation 1.8
ZimmerTimed Get up and goTimed up and go Pre-Operative9.07 SecondsStandard Deviation 2.48
ZimmerTimed Get up and goTimed up and go Post-Op 6 weeks8.89 SecondsStandard Deviation 1.89
ZimmerTimed Get up and goTimed up and go Post-Op 52 weeks7.17 SecondsStandard Deviation 1.39
Other Pre-specified

University of California, Los Angeles (UCLA) Activity Score at 6 Weeks Following Total Knee Replacement.

The UCLA activity score is a validated patient reported outcome of overall physical activity. Results on a scale of 1 to 10, 1 is Wholly Inactive, dependent on others, and can not leave residence and 10 is Regularly participates in impact sports.

Time frame: 6 weeks following total knee replacement

Population: Only subjects who were able to complete the UCLA at six weeks were included in the analysis.

ArmMeasureValue (MEAN)Dispersion
StrykerUniversity of California, Los Angeles (UCLA) Activity Score at 6 Weeks Following Total Knee Replacement.4.48 units on a scaleStandard Deviation 1.42
ZimmerUniversity of California, Los Angeles (UCLA) Activity Score at 6 Weeks Following Total Knee Replacement.4.73 units on a scaleStandard Deviation 1.52

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026