Robotic-assisted Total Knee Arthroplasty vs. Conventional One

Study Overview
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Brief Summary
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This study compares and evaluates differences in movement analysis, patient-reported outcome and radiological assesment between patients undergoing robotic-assisted total knee arthroplasty and conventional one.

Detailed Description
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Osteoarthritis causes the joints to become painful and stiff. Osteoarthritis of the knee is a common condition that is expected to be a lot more frequent in the next two decades. As a consequence, an increase of total knee replacement surgery is predicted. Total knee replacement surgery is offered when knee pain and stiffness caused by osteoarthritis can no longer be managed and these symptoms significantly impact on an individual's normal activities of daily living. Most total knee replacements are successful but up to 34% of all patients have poor functional outcomes following surgery. This leaves affected people at a greater risk of reduced physical activity and thus impacts longer-term general health. Poor outcomes are therefore of importance to patients and have a considerable financial and service-provision impact on National Health Service (NHS) care. While patient-related characteristics and their relationship to patient outcomes have been identified, few studies have been undertaken to determine how kinematic outcomes (how the prosthetic knee moves) are related to functional outcome and patient satisfaction. The kinematic outcome of a total knee replacement is hypothesised to relate to both the structural design (shape) of the implant and the surgical procedure itself. In recent years, there has been development of high technology tools to help surgeon restoring proper joint biomechanics. Nowadays on the market there are several robots designed to fulfill this function. To date, no studies have investigated the kinematic outcomes of robotic-assisted total knee arthroplasty in comparison to conventional surgery. Whilst it is known that long term success of total knee replacement depends largely upon correct alignment of the prosthesis components during surgery, no studies have looked at the anatomical alignments of the osteoarthritic knee prior to undergoing surgery (using Computerised Tomography (CT) scanning). The aim of the study is to examine relationships between movement analysis (kinematic and functional outcomes), patient reported outcome measures (PROMS) with use of the combination of either Oxford score or KOOS score with addition of WOMAC and Lysholm scores and CT measurement, both pre- and post-operatively, between robotic-assisted total knee arthroplasty and conventional surgery.

Official Title
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Does Robotic-assisted Total Knee Arthroplasty Improves Functional Outcome and Gait Pattern in Comparison to Conventional Total Knee Arthroplasty With Use of Bicruciate-stabilized (BS) Implant? Randmized-controlled Trial

Conditions
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Osteo Arthritis Knee, Knee Arthritis, Knee Pain Chronic

Intervention / Treatment
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* Procedure: Total knee arthroplasty
* Diagnostic Test: Computer tomography scan
* Diagnostic Test: biomechanical assesment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Listed for a primary total knee replacement (TKR) Indication for the TKR is primary osteoarthritis of the knee joint involving one or more compartments Aged 18 or over Patient willing to provide full informed consent to the trial Exclusion Criteria: Listed for a single-stage one-sided TKR procedure Severe symptoms in the contralateral knee so as to require staged bilateral knee replacements within 6 months of the primary procedure Fixed flexion deformity of 15 degrees or greater who will require excessive resection of the distal femur Clinically assessed uncorrectable varus/valgus deformity of 15 degrees or greater Any co-morbidity which, in the opinion of the investigator, is severe enough to present an unacceptable risk to the patient's safety Inflammatory arthritis Previous septic arthritis in the affected knee joint Previous surgery to the collateral ligaments of the affected knee A contralateral total knee replacement that has been implanted less than one year from the date of consultation A contralateral total knee replacement that is severely painful Patients on warfarin or novel oral anticoagulants (NOACs) Will not be resident in the catchment area for at least 6 months post-surgery Undertaking the surgery as a private patient Patients who, in the opinion of the clinical staff, do not have capacity to consent Patients who are pregnant Unable to understand written and spoken Polish

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Robotic-assisted total knee arthroplasty<br>Patients undergoing robotic-assisted total knee arthroplasty with use of Journey II BCS implants | Procedure: Total knee arthroplasty<br>* Participant will undergo robotic-assisted or conventional total knee arthroplasty<br>Diagnostic Test: Computer tomography scan<br>* CT scans of the affected knee joint before and after the surgical procedure<br>Diagnostic Test: biomechanical assesment<br>* Participants will be asked to perform biomechanical assesment before and following surgery at baseline, 6-8 weeks and 6-months postoperatively<br>|
| Active Comparator: Conventional total knee arthroplasty<br>Patients undergoing conventional total knee arthroplasty with use of Journey II BCS implants | Procedure: Total knee arthroplasty<br>* Participant will undergo robotic-assisted or conventional total knee arthroplasty<br>Diagnostic Test: Computer tomography scan<br>* CT scans of the affected knee joint before and after the surgical procedure<br>Diagnostic Test: biomechanical assesment<br>* Participants will be asked to perform biomechanical assesment before and following surgery at baseline, 6-8 weeks and 6-months postoperatively<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in patients reported outcome measures - Oxford Knee Score (OKS) | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 48, with higher scores corresponding to better outcomes. | At baseline (preoperatively), 6-8 weeks and 12 months postoperatively. | 
| Changes in patients reported outcome measures - Knee injury and Osteoarthritis Outcome Score (KOOS) | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 100, with higher scores corresponding to better outcomes. | At baseline, 6-8 weeks post-operatively and 12 months post-operatively. | 
| Changes in patients reported outcome measures - Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 96, with lower scores corresponding to better outcomes. | At baseline, 6-8 weeks post-operatively and 12 months post-operatively. | 
| Changes in patients reported outcome measures - Lysholm knee scoring scale | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 100, with higher scores corresponding to better outcomes. | At baseline, 6-8 weeks post-operatively and 12 months post-operatively. | 
| Changes in patients range of motion (ROM) | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 100, with higher scores corresponding to better outcomes. | At baseline, 6-8 weeks post-operatively and 12 months post-operatively. | 
| *We take into consideration the possible use of other PROM questionnaires and analysis of different adverse events depending on the unpredictable circumstances. | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 100, with higher scores corresponding to better outcomes. | At baseline, 6-8 weeks post-operatively and 12 months post-operatively. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in patients reported outcome measures - Oxford Knee Score (OKS) | To explore differences between outcome in patients treated with RATKA and conventional total knee arthroplasty. Results range from 0 to 48, with higher scores corresponding to better outcomes. | [Time Frame: 1 week and 6-8 weeks post-operatively] | 
| Changes in patients reported outcomes - Oxford Knee Score Activity & Participation Questionnaire (OKS_APQ) | To explore differences in higher levels of activity and social participation | Time Frame: 1 week, 6-8 weeks and 6 months post- operatively | 
| Changes in patients reported outcomes - Forgotten Joint Score (FJS) | To explore differences in patient's ability to forget about a joint as a result of successful treatment. Results range from 0 to 100, with higher scores corresponding to better outcomes. | Time Frame: 6-8 weeks and 6 months post-operatively | 
| Changes in patients reported outcomes - UCLA (University of California) score | To explore differences in patient's physical activity. Results range from 0 to 10, with higher scores corresponding to better outcomes. | Time Frame: 6-8 weeks and 12 months post-operatively | 
| Changes in knee range of motion | To explore differences in range of motion (flexion and extension) | Time Frame: preoperatively, 6-8 weeks and 12 months post-operatively | 
| Changes in pain medication | To asses evolution of post-operative knee pain | Time Frame: 1 week, 6-8 weeks and 3-6 months post-operatively | 
| arthroplasty related complications | To count and asses all complications that may occur during surgery and in postoperative period | Time Frame: 1 week post- operatively, 6-8 weeks post-operatively and 6-12 months post-operatively | 
| arthroplasty revision surgeries | To count and asses the reason of all revision surgeries that may occur during postoperative period | Time Frame: 1 week, 6-8 weeks and 12 months post-operatively | 
| walking abilities | To asses up and go time | Time Frame: 6-8 weeks and 12 months post-operatively | 
| Length of hospital stay | To measure number of days counting from surgery to the discharge | Time Frame: from baseline to discharge from hospital ranging averagely from 1 up to 7 days postoperatively | 
| Biomechanical 3D motion and emg walking outcomes | Overground walking is measured using 3D Motion analysis and electromyography (EMG) | Time Frame: at baseline, 6-8 weeks and 12 months post-operatively | 
| Radiological outcome on CT scans | Rotational alignment of the total knee component is assessed by measuring the femoral antetorsion, Alignment of the total knee component is assessed by measuring the tibial tubercle-trochlear groove distance (TT-TG) | Time Frame: at baseline preoperatively and 6 weeks post- operatively | 
| 6- minute walking abilities | to asses pace and model of 6-minute walk | Time Frame: 6-8 weeks and 12 months post-operatively | 
| Biomechanical stair climbing outcomes | Stair climbing and descending is measured using 3D Motion analysis and EMG | Time Frame: at baseline, 6-8 weeks and 12 months post-operatively | 
| Biomechanical static balance outcomes | Static balance is measured using a force plate | Time Frame: at baseline, 6-8 weeks and 12 months post-operatively | 
| Biomechanical dynamic balance outcomes | Dynamic balance is measured using a force plate and the modified Star Excursion Balance Test (mSEBT) | Time Frame: at baseline, 6-8 weeks and 12 months post-operatively | 
| Leg muscle strength outcomes | Leg muscle strength measured using maximal voluntary isometric contraction (MVIC) test of the hamstring and quadriceps muscles on both limbs. | Time Frame: at baseline, 6-8 weeks and 12 months post-operatively |