Knee Arthroplasty Recovery With Transcranial Direct Current Stimulation

Official title

Knee Arthroplasty Recovery With Transcranial Direct Current Stimulation: A Randomized Controlled Pilot Trial

Overview

Total knee arthroplasty (TKA) is widely performed to reduce pain from advanced osteoarthritis, yet many patients experience severe postoperative pain and up to 25-44% develop chronic postsurgical pain (CPSP). Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has shown promise in reducing pain and opioid use in early studies but has not been evaluated using comprehensive perioperative, home-based protocols. This study will test whether a home-based tDCS intervention delivered before and after TKA can improve acute pain management and reduce the development of CPSP.

Detailed description

Participants will self-administer 15 tDCS sessions using a home-based device during the perioperative period. Feasibility and acceptability will be assessed through device-recorded adherence data, participant diaries completed during the intervention period, and follow-up diary entries on postoperative days 14, 30, and 90. Findings will be used to refine the protocol and inform the design of a future large-scale trial evaluating the efficacy of home-based tDCS for postoperative pain management following TKA.

Interventions

• Device Active tDCS Stimulation
  Participants will have electrodes positioned on their scalp at C3, C4 (primary motor cortices) and Oz (occipital cortex) according to the international 10-20 EEG system. They will receive active transcranial direct current stimulation (tDCS) to the primary motor cortex (M1) opposite the surgical site, with the Oz electrode serving as the return. Stimulation will be delivered at 2 mA for 20 minutes, including a 15-second ramp-up at the start and a 15-second ramp-down at the end. The PlatoWork 2.0
• Device Sham tDCS Stimulation
  Participants will receive sham (inactive) transcranial direct current stimulation (tDCS) using the PlatoWork 2.0 tDCS Neurostimulator headset at home. The headset is identical to the active device but does not deliver electrical stimulation. This allows for blinding of participants to the intervention condition while maintaining the same study procedures and device usage as the active tDCS group.

Primary outcome measures

• Feasibility outcomes [Time frame: Pre-op Days -5 to +90 days]

Secondary outcome measures (1)

• Treatment Acceptability [Time frame: Post-op 14 days]

Eligibility criteria

Inclusion criteria

• 18 years of age or older.
• American Society of Anesthesiologists (ASA) Physical Classification Status I-III.
• Scheduled to undergo unilateral elective primary total knee arthroplasty for advanced osteoarthritis of the knee.
• Access to a device running iOS Version 10.0 or above, or Android Version 5.0 or above that can connect to the internet.

Exclusion criteria

• History of brain surgery, central nervous system tumors, seizures (including epilepsy), stroke or intracranial implants (e.g plates, screws, deep brain stimulators)
• Have vascular, traumatic, infectious, or metabolic lesions or diseases of the brain
• Active diagnosis of a sleep disorder, defined as a documented diagnosis of any of the following conditions within the past 12 months, based on patient history or medical record review:

• Insomnia disorder (e.g., difficulty initiating or maintaining sleep, early morning awakening)
• Obstructive sleep apnea (OSA)
• Central sleep apnea
• Narcolepsy
• Restless legs syndrome
• REM sleep behavior disorder
• Circadian rhythm sleep-wake disorders
• Parasomnias (e.g., sleepwalking, night terrors)
• Active diagnosis of alcohol use disorder, defined as meeting DSM-5 criteria or documented in the patient's medical record within the past 12 months.
• Patients taking opioid medications with a daily Oral Morphine Equivalent (OME) of ≥ 80 mg
• Current use of medications or substances known to alter cortical excitability or possess psychoactive properties (e.g., antiepileptics, benzodiazepines, antidepressants, antipsychotics, hallucinogens, dissociatives), as determined by review of the patient's medication list, chart review, and patient history. This includes prescribed medications and illicit substances used within the past 30 days.
• Have metallic implants or objects in or on the head, including mouth (e.g. electrodes, stents, clips, pins, braces, shrapnel, jewellery (unremovable)
• Use passive or active implanted medical devices (e.g., pacemakers, defibrillators, cochlear implants, natural implants or active body-worn medical devices (e.g., neural stimulation or medication infusion devices)
• Have defects in the neurocranium (e.g., post-skull trepanation)
• Have large vessel occlusions (e.g., complete blockage of the internal carotid artery or other conditions affecting brain perfusion
• Have skin diseases of the scalp
• Are using other brain stimulation devices concurrently
• Are pregnant
• Are unable to provide informed consent
• Are unable to wear or tolerate the study device
• Unable to speak or read English, or understand device operation instructions

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

Quadruple blind

Primary purpose

Treatment

Study locations

Canada · 1 center

• Toronto Western Hospital (UHN) — Toronto

Identifiers

NCT: NCT07351578 · CTO 5609

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗