Knee Arthropathy
Conditions
Keywords
bone mineral density
Brief summary
The purpose of this study is to examine femur bone mineral density (BMD) change before and after surgery in patients receiving cemented or cementless total knee arthroplasty (TKA). performed with manual or robotic methods. 100 participants will be enrolled and can expect to be on study for up to 26 months.
Detailed description
It has previously been reported that total knee arthroplasty (TKA) causes major femur bone loss (\ 18% within 1 year). Prior studies did not examine different surgical methods, such as the use of cement or robotics, in TKA. The investigators hypothesize that previously reported differences in distal femur BMD change following TKA exist between patients receiving cemented vs. cementless prostheses. Specific Aim 1: In the entire study cohort, our primary endpoint is to estimate percent BMD change 12 and 24 months after TKA at the distal femur 25% region of interest (ROI). Specific Aim 1a: To compare percent BMD change 12 and 24 months after TKA at the distal femur 25% ROI in cemented vs uncemented implants. Specific Aim 1b: To compare percent BMD change 12 and 24 months after TKA at the distal femur 25% ROI in those receiving robotic vs manual implants. Specific Aim 2: In the entire study cohort, our secondary endpoints are to estimate percent BMD change 12 and 24 months after TKA at a.) the distal femur 15% ROI and b.) a proximal tibial ROI Specific Aim 2a: To compare percent BMD change 12 and 24 months after TKA at the distal femur 15% ROI and proximal tibial ROI in cemented vs uncemented implants. Specific Aim 2b: To compare percent BMD change 12 and 24 months after TKA at the distal femur 15% ROI and proximal tibial ROI in in those receiving robotic vs manual implants. Exploratory Aim 1: Compare patient reported pain and function at 2 weeks, 3 months, 12 months, and 24 months; 1. in those receiving cemented and cementless implants. 2. in those receiving robotic vs manual implants. Exploratory Aim 2: Evaluate leg lean mass change as measured by DXA and BIS at 2 weeks, 3 months, 12 months, and 24 months over time. 1. In the entire cohort 2. in those receiving cemented and cementless implants. 3. in those receiving robotic vs manual implants.
Interventions
PROCEDURECement
The cemented approach includes inserting cement into the femur and tibia prior to setting the prosthetic.
OTHERCementless
The non-cement approach uses a different type of prosthetic that is placed tight against the bone and requires no other fixation material.
PROCEDUREManual Surgery
The manual approach is the surgeon determining prosthetic placement using techniques developed during training.
PROCEDURERobotic Surgery
The haptic robotic assisted approach uses a computer and robot to determine specific placement of the prosthetic.
Sponsors
University of Wisconsin, Madison
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients age greater than or equal to 55 years undergoing TKA with no prior total joint arthroplasty on the surgical side * Normal BMD or osteopenia with Fracture Risk Assessment Tool (FRAX) not meeting Bone Health and Osteoporosis Foundation (BHOF) treatment recommendations, i.e., 10-year major osteoporotic fracture risk greater then or equal to 20 percent or hip fracture risk greater than or equal to 3 percent.
Exclusion criteria
* Known clinical osteoporosis defined as any one of the following: * Hip or spine T-score less than or equal to -2.5 * History of low trauma fracture after age 50 * FRAX fracture risk calculation greater than or equal to 20 percent for major osteoporotic fracture or greater than or equal to 3 percent for hip fracture * Prior or current use of osteoporosis medications * Current use of systemic glucocorticoids or bone-active medications * Rheumatoid arthritis * Laboratory abnormalities that in the opinion of study investigators may impact bone mineral density; including calcium, creatinine, albumin and parathyroid hormone (PTH) * 25(OH)D less than 20 ng/mL * Not suitable for study participation due to other reasons at the investigator's discretion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change in Bone Mineral Density within 25 percent of the region of interest at 12 and 24 months post TKA: All Participants | 12 months, 24 months | Primary endpoint is to estimate percent BMD change 12 and 24 months after TKA at the distal femur, 25 percent region of interest, reported for all participants together. |
| Percent Change in Bone Mineral Density within 25 percent of the region of interest at 12 and 24 months post TKA: Cemented vs Uncemented | 12 months, 24 months | Compare percent BMD change 12 and 24 months after TKA at the distal femur, 25 percent region of interest between all cemented and uncemented implants. |
| Percent Change in Bone Mineral Density within 25 percent of the region of interest at 12 and 24 months post TKA: Robotic vs Manual | 12 months, 24 months | Compare percent BMD change 12 and 24 months after TKA at the distal femur, 25 percent region of interest between all robotic vs manual implants. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change in Bone Mineral Density within 15 percent of the region of interest at 12 and 24 months post TKA: All Participants | 12 months, 24 months | Secondary endpoint is to estimate percent BMD change 12 and 24 months after TKA at the distal femur and the proximal tibia, 15 percent region of interest, reported for all participants together. |
| Percent Change in Bone Mineral Density within 15 percent of the region of interest at 12 and 24 months post TKA: Cemented vs Uncemented | 12 months, 24 months | Compare percent BMD change 12 and 24 months after TKA at the distal femur and the proximal tibia, 15 percent region of interest, reported for cemented vs uncemented implants. |
| Percent Change in Bone Mineral Density within 15 percent of the region of interest at 12 and 24 months post TKA: Robotic vs Manual | 12 months, 24 months | Compare percent BMD change 12 and 24 months after TKA at the distal femur and the proximal tibia, 15 percent region of interest, reported for robotic vs manual implants. |
Countries
United States
Contacts
CONTACTOsteoporosis Clinical Research Program
PRINCIPAL_INVESTIGATORBrian Nickel, MD
UW School of Medicine and Public Health
Outcome results
None listed