Patient case: 68-year-old male with melanoma; genetic feature: PTEN loss of function

Clinical trial: Study of the HemiCAP™ Unicondylar Femoral Resurfacing Prosthesis."

Summary: Patients with large unstable Grade IV articular surface defects, with significant subchondral bone exposure and who will likely receive a joint replacement will receive the HemiCAP™ Femoral Resurfacing Prosthesis. The Subject Device intends to offer a surgical alternative to these patients who might otherwise endure years of pain and loss of function while awaiting a more appropriate age for joint replacement surgery.

Detailed description: The objective of the proposed clinical investigation is to determine safety and effectiveness of the investigational device in the management of pain and restoration of joint function as part of an interim clinical treatment strategy.
  This is a pivotal, prospective, non-randomized, non-comparative, open label clinical study, to evaluate the safety and effectiveness of the HemiCAP™ Femoral Resurfacing Prosthesis.
  The study will involve up to 15 qualified investigational sites.
  Patients who meet the inclusion/exclusion criteria will be consented by the coordinator for the study at the centre and receive a baseline evaluation and knee exam. Standard radiographs will be taken and the subject will fill out quality of life questionnaires. The surgical procedure will take place within 1 month of the baseline evaluation.
  Follow-up evaluations will occur at 2 weeks, 6 weeks and 3 months following the surgery. At these evaluations, radiographs will be taken and the patient will fill out a post-op progress and satisfaction assessment forms. Any concomitant medications and adverse events will be documented. In addition at 6, 12 and 24 months following the surgery, the patients will fill out the quality of life questionnaires.

Eligibility: Inclusion Criteria:
  - We can only include Canadians in our study
  -  Pre-operative Inclusion Criteria: Patients must meet all of the following criteria to be eligible to be enrolled into the study:
  -  Patient age greater than or equal to 40 years.
  -  Articular surface defect located on the medial or lateral femoral condyle.
  -  Articular surface defect that penetrates or exposes subchondral bone.
  -  Clinical symptoms meet criteria established in the Cincinnati Knee Rating System, Symptom Rating Form for Patient Grade less than or equal to 5 (on 1-10 scale) or, Pain associated with function is less than or equal to 5 (on 1-10 scale) or symptoms of weight bearing pain significantly limit the patients quality of life.
  -  Patient must have failed conservative care and a) undergone recognized arthroscopic surgical interventions, such as previous marrow stimulation cartilage repairs (drilling, micro-fracture or abrasions); or not be an appropriate candidate for these surgical interventions or b) have not undergone a recognized arthroscopic intervention for the treatment of defect, including patients suffering from Avascular Necrosis (AVN).
  -  Patient exhibits overall well being, has signed the informed consent form, and is willing to follow instructions and comply with activity restrictions.
  -  Patient understands and is willing to comply with the follow-up requirements of the study.Intra-Operative Inclusion CriteriaPatients must meet all of the following intra-operative criteria to be included in the study:
  -  Articular surface defect can be largely circumscribed by a 15mm or 20mm diameter circular sizing guide.
  -  Articular surface defect is located relatively central to the femoral condyle so that resurfacing implant does not extend beyond the limit of the condyle. -
  Exclusion Criteria:
  1. Patient is obese, defined as BMI > 30kg/m2, at screening.
  2. Patient is known to be infected with HIV or has acquired AIDS.
  3. Patient is known to have a history of substance abuse.
  4. Patient displays varus joint mal-alignment, in the affected limb only, of greater than 2º anatomic or 7º mechanical.
  5. Patient presents evidence of metabolic disorders, which may impair the formation or healing of bone.
  6. Patient presents evidence of infections at remote sites, which may spread to the implant site.
  7. Patient presents evidence of rheumatoid arthritis, gross joint destruction, infectious/crystal arthropathies or bone resorption visible on roentgenogram.
  8. Patient presents evidence of chronic instability or deficient soft tissues, support structures, vascular or muscular insufficiency.
  9. Patient has a known sensitivity to materials typically used in orthopedic implants.
  10. Patient has irresolvable joint pain or loss of function with an undeterminable cause.
  11. Patient who suspects or is confirmed to be pregnant. -

Relevance to patient case: not relevant