A Prospective Study to Evaluate Robot Assisted Total Knee Replacement Outcomes

Study Overview
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Brief Summary
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This study aims to see if outcomes for patients that receive the traditional total knee replacement surgical technique are different than the outcomes for patients that receive robot-assisted total knee replacement. The outcomes we will be tracking include: Patients' self-reported awareness of their artificial joints during activities of daily living; Patient's self-reported pain, other symptoms, function in daily living, function in sport and recreation, and knee-related quality of life; Patients' self-reported general health perceptions, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy-fatigue, social functioning and mental health; The accuracy of implant placement and limb alignment

Official Title
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A Prospective Study to Examine Patient Satisfaction, Function, and Limb Alignment Outcomes for Mako Versus Non-Mako Total Knee Replacements

Conditions
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Primary Osteoarthritis of Knee Nos

Intervention / Treatment
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* Procedure: Robot Assisted Total Knee Replacement
* Procedure: Traditional Total Knee Replacement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 or older Diagnosed with primary osteoarthritis and cleared to undergo total knee arthroplasty at the Virtua JRI Willing to provide informed consent, participate in study, and comply with study protocol Exclusion Criteria: Pregnant or contemplating pregnancy prior to surgery; Worker's compensation or personal injury related to knee (clinical outcomes have been shown to be less predictable and often poorer in this patient group; there may also exist potential issues with reimbursement) Post-traumatic arthropathy (clinical outcomes have been shown to be less predictable; pre-operative deformity and risk factors are greater and difficult to propensity-match between groups) Self-pay patients or patients whose insurance are known to typically decline reimbursement for preoperative CT scans

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Robot Assisted Total Knee Replacement<br>In addition to expert judgment and hand-eye coordination, the surgeon also relies on a robot in making cuts within the pre-determined diseased areas of the joints and placing the implants. This is made possible by uploading 3-dimensional (3D) images of the knee joints into the robot prior to surgery. The robot uses these 3D images to guide the surgeon during the procedure. The 3D images are obtained from a computerized tomography (CT) scan that combines a series of X-ray images taken from different angles to create cross-sectional images of the bones. | Procedure: Robot Assisted Total Knee Replacement<br>* A robotic-assisted surgical procedure to treat a condition in which the patient's knee joints become diseased or injured due to a loss of cartilage that acts as a protective cushion between the knee joints<br>|
| Active Comparator: Traditional Total Knee Replacement<br>The traditional method where the surgeon employs mechanical guides, expert judgment, and natural hand-eye coordination in making the necessary cuts to prepare the bone for the implant as well as in placing the implant. | Procedure: Traditional Total Knee Replacement<br>* A surgical procedure using mechanical guides to treat a condition in which the patient's knee joints become diseased or injured due to a loss of cartilage that acts as a protective cushion between the knee joints<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient reported Forgotten Joint Score (FJS) | The FJS is a self-completed 12-item questionnaire used to assess patients' awareness of their artificial joint during activities of daily living on an awareness scale of 0 (never) to 4 (mostly) | Up to 5 years postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient reported Knee injury and Osteoarthritis Outcome Score (KOOS) | The KOOS is a knee-specific instrument used to evaluate short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis. It consists of 42 questions in 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL) | Up to 5 years postoperatively | 
| Patient reported Veterans Rand 12-item Health Survey Score (VR-12) | The VR-12 is a 12-item questionnaire corresponding to eight principal physical and mental health domains including general health perceptions, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy-fatigue, social functioning and mental health. | Up to 5 years postoperatively | 
| The mechanical alignment of the post-operative limb | The mechanical alignment of the entire post-operative limb will be measured at 6 weeks by long-limb radiograph cassettes and compared to the pre-operative plan for accuracy and deviation less than or greater than 3 degrees from the intended target. From each treatment group, the percentage of patients with radiographic outliers (deviation greater that 3 degrees from the expected implant placement) will be compared. | 6 weeks postoperatively |