COntralateral CorticoSTeroid Injection in Total Knee Arthroplasty
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL)., Band-Aid.
- Who it may be relevant to
- Registry conditions: Total Knee Anthroplasty, Osteoarthritis(Primary), Osteoarthritis (OA) of the Knee, Bilateral Knee Osteoarthritis. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Canada
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
COSTI: COntralateral CorticoSTeroid Injection in Total Knee Arthroplasty - A Triple Blinded, Randomized Controlled Trial Pilot Study
Overview
Through a triple-blinded randomized control trial, the primary purpose of this pilot study is to assess the efficacy of administering peri-operative contralateral corticosteroid injection in patients undergoing TKA. The secondary outcome was to assess the effect of contralateral corticosteroid injection on pain and functional outcomes of patients undergoing TKA.
Detailed description
Total knee arthroplasty (TKA) is a common and successful procedure used to improve the quality of life and function for patients experiencing debilitating pain from degenerative knee osteoarthritis (OA).
Some patients with knee OA have bilateral involvement and surgery may be needed in both knees. Having bilateral knee OA is a known risk factor for dissatisfaction, as there can be an overuse of the less affected, contralateral knee, in order to avoid symptoms from the more severely affected knee. Moreover, one of the principal determinants of patient-reported functional outcome after a unilateral TKA is residual pain and limited function in the contralateral, un-replaced knee.
One option to improve range of motion, pain, functional scores and reduce postoperative stiffness on both knees is a bilateral TKA; however, it has been previously reported to have a higher risk of serious cardiac complications, pulmonary complications, and mortality when compared with a unilateral TKA. A less invasive and widely available treatment option is intra-articular corticosteroids applied pre-/peri-operatively in the contralateral (un-replaced) knee to improve post-operative rehabilitation.
Intra-articular corticosteroids are extensively used to reduce inflammation and pain in inflamed arthritic joints. They are associated with a moderate improvement in pain and a small improvement in physical function usually up to 3 months after injection. The use of intra-articular corticosteroids in patients with symptomatic knee OA has been shown to improve Visual Analog Scale (VAS) scores at up to 3 months, as well as the WOMAC scores up to 6 months, compared with baseline scores. There is limited data on contralateral steroid injections and its impact on surgical site infection or PROMs.
It is estimated that from 6.5% to 20% of patients report early dissatisfaction after knee replacement surgery. Furthermore, having bilateral OA is a known risk factor for dissatisfaction among patients who undergo TKA. Residual pain, limited function and limited range of motion are primary factors in patient satisfaction after undergoing TKA. Therefore, improved pain control in the contralateral knee is hypothesized to play a role in improving patient satisfaction after a TKA on the opposite side, in addition to helping with the post-operative rehabilitation process.
Understanding whether contralateral steroid injections confer superior functional and/or patient reported outcome measures after a TKA is critical to enhance patient care and improve patient functional outcomes in OA patients. There is currently a lack of high-quality prospective trials investigating the use of contralateral corticosteroid injections for TKA outcomes.
The COSTI trial (Contralateral Steroid Injection in Total Knee Arthroplasty) was developed to fill this knowledge gap. We propose a prospective, triple-blinded (patient, surgeon and outcome assessor), randomized controlled trial comparing contralateral corticosteroid knee injections versus placing a band-aid (control) in patients with bilateral osteoarthritis undergoing a TKA for osteoarthritis.
Interventions
- Drug Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL). - Other Band-Aid
Band-Aid
Primary outcome measures
- Oxford Knee Score (OKS) [Time frame: 4-, 8-, 12-weeks and 1-year post-surgery]
Secondary outcome measures (5)
- Visual Analogue Scale (VAS) Pain Score [Time frame: 4-, 8-, 12-weeks and 1-year post-surgery]
- EuroQol five-dimensional descriptive system (EQ-5D-5L) [Time frame: 4-, 8-, 12-weeks and 1-year post-surgery]
- Knee range of motion (ROM) [Time frame: 4-, 8-, 12-weeks and 1-year post-surgery]
- Timed Up Go Test (TUG) [Time frame: 4-, 8-, 12-weeks and 1-year post-surgery]
- Forgotten Joint Score (FJS) [Time frame: 12-weeks and 1-year post-surgery]
Eligibility criteria
Inclusion criteria
- Patients 18 years of age and older
- Primary osteoarthritis diagnosis with indication for primary elective unilateral TKA
- No previous contralateral knee injections (steroids/biologics) within one year of study
- Not scheduled for bilateral TKA or a subsequent staged contralateral TKA within the next six months
- No previous or active infection or trauma (osseous/ligamentous/extensor mechanism) on the contralateral knee
- Contralateral knee pain \& symptoms - defined as a VAS of >4/10 at initial pre-op visit
- Contralateral knee OA quantified as: Kellgren and Lawrence grade >2-4
- Assessed by PI (AK) who will not be contributing any patients to the study through examination of blinded knee radiographs (3 views: AP/lateral/Sunrise)
- Patient is able to read and understand English and provide informed consent to participation in the study
Exclusion criteria
- Other aetiologies of OA that warrants TKA (inflammatory or post traumatic arthritis)
- Cognitive impairment (dementia, Alzheimer's, uncontrolled delirium) which will prevent patients from completing primary outcome measure or comply with follow-up requirements
- Previous TKA or ORIF or nailing on either knee
- Previous or active knee infection or extensor mechanism disruption
- Previous arthroscopy on either knee
- Medical contraindication to elective TKA surgery
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Triple blind
- Primary purpose
- Supportive care
Study locations
Canada · 1 center
- St. Michael's Hospital — Toronto
Publications
- Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg. 2017 Oct;25(10):703-714. doi: 10.5435/JAAOS-D-16-00541. PMID 28953085
- da Costa BR, Hari R, Juni P. Intra-articular Corticosteroids for Osteoarthritis of the Knee. JAMA. 2016 Dec 27;316(24):2671-2672. doi: 10.1001/jama.2016.17565. PMID 28027351
- Tian K, Cheng H, Zhang J, Chen K. Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Apr;97(15):e0240. doi: 10.1097/MD.0000000000010240. PMID 29642145
- Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty. 2013 Aug;28(7):1141-7. doi: 10.1016/j.arth.2012.09.023. Epub 2013 Mar 19. PMID 23518424
- Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007 Jun;89(6):1220-6. doi: 10.2106/JBJS.F.01353. PMID 17545424
- Sheth DS, Cafri G, Paxton EW, Namba RS. Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality. J Arthroplasty. 2016 Sep;31(9 Suppl):212-6. doi: 10.1016/j.arth.2016.03.018. Epub 2016 Mar 17. PMID 27430183
- Bagsby D, Pierson JL. Functional outcomes of simultaneous bilateral versus unilateral total knee arthroplasty. Orthopedics. 2015 Jan;38(1):e43-7. doi: 10.3928/01477447-20150105-59. PMID 25611419
- Meehan JP, Monazzam S, Miles T, Danielsen B, White RH. Postoperative Stiffness Requiring Manipulation Under Anesthesia Is Significantly Reduced After Simultaneous Versus Staged Bilateral Total Knee Arthroplasty. J Bone Joint Surg Am. 2017 Dec 20;99(24):2085-2093. doi: 10.2106/JBJS.17.00130. PMID 29257014
Identifiers
NCT: NCT06809998 · 24-158