safety and effectiveness of cartiva implant in the treatment of first cmc joint osteoarthritis compared to lrti (grip 2)

Conditions: Osteoarthritis

Summary: this study will evaluate whether cartiva is an effective treatment for individuals with osteoarthritis of the first cmc joint in the hand compared to lrti.

this is a prospective, multicenter study with one treatment arm. comparisons will be made to a performance target defined by subtracting a non-inferiority margin of 0.05 from an expected standard of care success rate of 0.55. the active treatment arm will receive a cartiva® sci for cmc. a total of 74 subjects will be enrolled into the pivotal study. follow up visits will occur at the following time points after the surgical procedure: 2 week, 6 week, 3 month, 6 month, 1 year, 2 year, 3 year, 4 year and 5 year.

Eligibility criteria:
inclusion criteria: * ≥ 22 years of age * refractory to conservative non-operative standard of care treatment for first cmc oa lasting for at least 6 months that requires surgical intervention * eaton classification stage ii or iii oa of the first cmc joint based on x-rays taken within 6 months of the operative date and evidence of first cmc joint oa based on subjective review of associated clinical symptoms * preoperative vas pain score of ≥ 40 in the treated hand * preoperative 11 question quickdash score of ≥ 20 * presence of good bone stock - i.e., no need for bone graft * capable of completing self-administered questionnaires * be willing and able to return for all study-related follow up procedures * have been informed of the nature of the study, agreeing to its requirements, and have signed the informed consent approved by the irb/reb/ethics committee exclusion criteria: * active systemic infection * active infection at the site of surgery * previous cmc implant, trapeziectomy, or lrti to the affected joint to be treated * inflammatory arthropathy and/or diagnosis of grout * history of or current diagnosis of rheumatoid arthritis * any significant bone loss, avascular necrosis, or cyst \> 8mm of the supporting bone structure * eaton classification stage iv advanced oa of the first cmc joint based on x-rays taken within 6 months of the operative date * physical conditions that would tend to eliminate adequate implant support (e.g., inadequate cortical bone stock of at least 2mm circumferentially insufficient quality or quantity of bone resulting from cancer, congenital dislocation, or osteoporosis), systemic and metabolic disorders leading to progressive deterioration of bone (e.g., cortisone therapies or immunosuppressive therapies), and/or tumors and/or cysts of the supporting bone structures * oa of the scaphotrapeziotrapezoidal (stt) joint based on radiographic assessment in the hand to be treated * any disease, including uncontrolled diabetes mellitus, which is clinically known to impact wound healing ability * known or suspected allergic reaction to polyvinyl alcohol * patient is on chronic anticoagulation due to a bleeding disorder or has taken anticoagulants within 3 days prior to surgery * diagnosed with cancer in the last two years and received treatment with chemotherapy or received radiation to the upper extremity to be treated with cartiva * any medical condition that makes the subject unsuitable for inclusion in the study, including, but not limited to, patients with a diagnosis of concomitant injury that may interfere with healing; patients with clinically significant renal, hepatic, cardiac, endocrine, hematologic, autoimmune or any systemic disease or systemic infection which may make interpretation of the results difficult; patients who have undergone systemic administration within 30 days prior to implantation of any type of corticosteroid in the thumb, antineoplastic, immunostimulating or immunosuppressive agents * have participated in any other investigational or invasive clinical trial within the last three months, and will not participate in any other investigational or invasive clinical trial during this study * co-morbidity that reduces life expectancy to less than 12 months * if female, be pregnant, planning to become pregnant during the course of the study, breast-feeding, or if childbearing age, is not using contraception * current or recent history of substance abuse (e.g., recreational drugs, narcotics, or alcohol) requiring intervention * is a prisoner or ward of the state * is unable to meet the treatment and follow up protocol requirements * is being compensated under workers' compensation or are currently involved in litigation that is related to the musculoskeletal system

Keywords: cmc joint osteoarthritis cartilage replacement first cmc joint osteoarthritis damaged articular surface lrti ligament reconstruction tendon interposition