A Study to Compare Different Ways of Steroid Administration After Total Knee Implantation

Phase 4

Recruiting

• Conditions: Total Knee Replacement
• Interventions: Drug: Dexamethasone Sodium Phosphate 4 mg/ml intravenous; Drug: Dexamethasone Sodium Phosphate 4 mg/ml intra-articular

• Registration Number: NCT04432012
• Lead Sponsor: Christian Candrian

Brief Summary

We are going to evaluate the difference between perioperative intravenous steroid supplementation, perioperative periarticular steroid supplementation, and standard anaesthesia protocols. We'll evaluate the outcome of patients with knee osteoarthritis who are undergoing Total Knee Arthroplasty to understand which of the three treatments give more benefits to the patient.

Detailed Description

A total of 159 patients will be needed (53 patients per arm, 3 arms in total). Dexamethasone (brand name: Mephameson) is the steroid drug that we perioperative administer in two different ways: intra-venous (IV) dexamethasone (9mg) in arm-A, intra-articular (IA) dexamethasone (9mg) in arm-B. No steroid supplementation will be provided in the control group (arm-C).

The primary objective of the study is to compare the effect on post-operative pain of I.V. and I.A. perioperative dexamethasone supplementation for total knee arthroplasty (TKA).

The secondary objectives of the studies will be the comparison between I.V. and I.A. peri-operative dexamethasone supplementation in terms of post-operative pain and function, opioids and analgesic drugs consumption, knee range of motion, systemic inflammatory response, time to mobilisation, length of stay, and patient satisfaction.

Moreover, both I.V. and I.A. steroid supplementation protocols will be compared to routine analgesia protocol (no steroid supplementation group) in order to document their advantages over the absence of steroid supplementation.

The safety of I.V. and I.A. peri-operative dexamethasone will be evaluated and compared recording all the steroid supplementation related complications. In particular, the risk of hyperglycaemia-related complications and post-operative infections will be documented. The safety of both I.V. and I.A. steroid supplementation protocols will be verified comparing them to the no-treatment group in terms of incidence of complications.

Overall study duration will be 12 years: 2 years to enroll all the patients and 10 years to complete the last follow-up. Primary data analysis is planned after the completion of the 1-year follow-up visits.

Study Timeline

• Study First Submitted: 2020-06-10
• Study First Submitted QC: 2020-06-12
• Study First Posted: 2020-06-16
• Study Start: 2020-07-01
• Status Verified: 2024-08
• Last Update Submitted: 2024-08-27
• Last Update Posted: 2024-08-28
• Primary Completion: 2025-04-30
• Study Completion: 2032-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 159

Inclusion Criteria

• Patients undergoing unilateral primary TKA at the Ospedale Regionale di Lugano.
• Patients with a BMI >18.5 and <35.
• Patients able to provide informed consent and follow all the study procedures as indicated by the protocol.
• Informed Consent as documented by signature (Appendix Informed Consent Form).

Exclusion Criteria

• Contraindications to steroids.
• Revision TKA.
• Active steroid therapy.
• Women who are pregnant or breast feeding.
• Presence of other clinically significant concomitant disease states (ASA IV).
• Uncontrolled diabetes mellitus
• Known or suspected non-compliance, drug or alcohol abuse.
• Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant.
• Participation in another study with investigational drug within the 30 days preceding and during the present study.
• Previous enrolment into the current study.
• Enrolment of the investigator, his/her family members, employees and other dependent persons.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
arm-A Intra-venous dexamethasone	Dexamethasone Sodium Phosphate 4 mg/ml intravenous	9 mg of Intra-venous dexamethasone
arm-B intra-articular dexamethasone	Dexamethasone Sodium Phosphate 4 mg/ml intra-articular	9 mg of intra-articular dexamethasone

Primary Outcome Measures

Name	Time	Method
Mean daily pain at rest during the first 3 days on a 0-10 numeric rating scale	3 days after surgery	Mean daily pain at rest during the first 3 days reported on a 0-10 numeric rating scale (NRS) by the patients.; The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating no pain and 10 reflecting the worst possible pain.

Secondary Outcome Measures

Name	Time	Method
Post-operative knee pain during the first 10 years after surgery	10 years	reported on 0-10 NRS at 3, 6, 12, 24, 60 and 120 months using a questionnaire. The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating no pain and 10 reflecting the worst possible pain.
Post-operative knee outcome on Western Ontario and McMaster Universities Arthritis Index (WOMAC)	10 years	Questionnaire at 2 and 6 weeks, and at 3, 6, 12, 24, 60 and 120 months. The WOMAC questionnaire is composed of 3 sub-scores that evaluate pain (5 questions, 0-20 points), stiffness (2 questions, 0-8 points), and function (17 questions, 0-68 points) and is a validated patient-reported outcome measure (PROM) to evaluate knee osteoarthritis.; Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Knee conditions on Knee society score (KSS)	10 years	Questionnaire at 2 and 6 weeks, and at 3, 6, 12, 24, 60 and 120 months. The original KSS has a "Knee Score" section (7 items) and a "Functional Score" section (3 items). Both sections are scored from 0 to 100 with lower scores being indicative of worse knee conditions and higher scores being indicative of better knee conditions.
Quality of pain on PainDETECT questionnaire	10 years	Questionnaire at 2 and 6 weeks, and at 3, 6, 12, 24, 60 and 120 months. PainDETECT consists of seven questions that address the quality of pain symptoms; it is completed by the patient and no physical examination is required. A score ≤12 indicates that pain is unlikely to have a neuropathic component (\< 15%), while a score of ≥19 suggests that pain is likely to have a neuropathic component (\> 90%). An intermediate score (≥13, ≤18) indicates a possible neuropathic component .
Post-operative nausea intensity	During Hospitalization, approximately 3 days	intensity (on a 0-10 NRS) of nausea will be evaluated in the first post-operative days.; The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating no nausea and 10 reflecting the maximum intensity of nausea.
Time needed for climbing stairs the first time	approximately 1 week
Post-operative knee pain during the first 6 weeks after surgery on a 0-10 numeric rating scale	6 weeks after surgery	Pain reported on 0-10 numeric rating scale (NRS) during the first 6 weeks and documented with a mobile application (developed at our Institution) that will ask the patients to report pain twice a day (once in the morning, once in the evening). Comparison will be performed in terms of mean daily pain during the first 6 weeks and mean daily pain during every single week.; The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating no pain and 10 reflecting the worst possible pain.
Patient satisfaction: numeric rating scale (NRS)	10 years	Patient satisfaction reported on 0-10 numeric rating scale (NRS) at 3, 6, 12, 24, 60 and 120 months using a questionnaire.; The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating that patient is not satisfied at all and 10 reflecting that patient is totally satisfied.
Post-operative function during the first 6 weeks after surgery	6 weeks	reported on 0-10 NRS 8see above) during the first 6 weeks, documented with a mobile application developed by our institution that will ask the patients to report pain twice a day (once in the morning, once in the evening). Comparison will be performed in terms of mean daily pain during the first 6 weeks and mean daily pain during every single week. Furthermore, pain trajectories will be created.; The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating the worst possible function and 10 reflecting the best possible function.
Post-operative knee function during the first 10 years after surgery	10 years	reported on 0-10 NRS at 3, 6, 12, 24, 60 and 120 months using a questionnaire. The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating the worst possible function and 10 reflecting the best possible function.
Post-operative opioids and analgesic drugs consumption	During Hospitalization, approximately 3 days	Medication Quantification Scale (MQS) score will be used to evaluate analgesic drug consumption.; Medication Quantification Scale (MQS) scor is calculated for each medication by taking a consensus-based detriment weight for a given pharmacologic class and multiplying it by a score for dosage. The calculated values for each medication are then summed for a total MQS score. The score can provide a useful point measure of medication usage for any pain medication regimen.
Post-operative C-Reactive Protein (CRP)	every days 3 days from surgery	Hematic C-Reactive Protein in mg/L will be evaluated as index of post-operative inflammatory response.
Time from surgery to first mobilization	During Hospitalization, approximately 1 days
Length of hospital stay	approximately 1 week
Post-operative nausea incidence	During Hospitalization, approximately 3 days	incidence (on a 0-10 NRS) of nausea will be evaluated in the first post-operative days.; The 0-10 NRS consists in a single 11-point numeric scale, with 0 indicating no nausea and 10 reflecting the maximum intensity of nausea.
Post-operative erythrocyte sedimentation rate (ESR)	every days 3 days from surgery	Erythrocyte sedimentation rate (mm/h) will be evaluated as index of post-operative inflammatory response.

Trial Locations

Locations (1)

Ospedale Regionale di Lugano Civico e Italiano; 🇨🇭 Lugano, Switzerland