Evaluation of Trinity Evolution in Patients Undergoing Foot and Ankle Fusion (TAF)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00988338
Recruitment Status : Completed
First Posted : October 2, 2009
Last Update Posted : April 8, 2014
Information provided by (Responsible Party):
Orthofix Inc.

Brief Summary:
The purpose of this study is to utilize Trinity Evolution as a graft source in foot/ankle fusions and to follow the subjects to measure the clinical outcomes and fusion rate. The hypothesis of the study is that Trinity Evolution will result in fusion rates and clinical outcomes similar to those obtained from autograft and other routinely used allograft materials; these include: fusion, improvement in pain, improvement in function, and absence of adverse events related to the use of the graft source.

Condition or disease Intervention/treatment Phase
Tibiotalar Arthrodesis Subtalar Arthrodesis Calcaneocuboid Arthrodesis Talonavicular Arthrodesis Double Arthrodesis (i.e. Calcaneocuboid and Talonavicular) Triple Arthrodesis (i.e. Subtalar, Calcaneocuboid, and Talonavicular) Biological: Trinity Evolution Not Applicable

Detailed Description:

Symptomatic arthritic conditions of the foot and ankle including osteoarthritis, post-traumatic arthritis, inflammatory arthropathies and others can be painful and disabling conditions that lead to a reduced quality of life. Major symptoms include pain, stiffness, swelling, and difficulty walking. Many patients may be initially treatable with non-invasive measures such as analgesics, ankle-foot orthosis, physical therapy and medications such as steroids; however, over time, surgery becomes necessary to improve quality of life and maintain function. Arthrodesis is a well-known procedure that can reduce pain and result in a foot/ankle that can withstand an active lifestyle.

Bone graft is used to stimulate new bone formation at the operative site by providing osteogenic cells with osteoinductive factors with an osteoconductive matrix. Although autologous bone is often used as the structural graft material for fusion procedures, donor site morbidity (e.g., pain, infection, and fracture), limited supply, and inconsistent osteogenic activity continue to be associated problems. The quality of an autograft is dependent upon the age and medical condition of the patient, as well as the number of viable mesenchymal and osteoprogenitor stem cells that are present in the specimen. This tissue is harvested during the surgical procedure; the process can prolong morbidity at the harvest site. The ideal bone graft would offer osteogenic cells, osteoinductive factors, and an osteoconductive matrix with a consistent supply of viable mesenchymal stem cells (MSCs) and osteoprogenitor cells (OPCs)—but without the morbidity of autograft.

Due to the limitations associated with autograft, researchers are pursuing the use of bone-graft substitutes to promote arthrodesis. Bone-graft substitutes now being used by surgeons include ceramic synthetics, bone morphogenic proteins (BMPs), demineralized bone matrices (DBMs) and other allografts; these may be used alone or in combination. Allografts available as substitutes for autograft offer some of the benefits of autograft without its limitations—but do not contain viable MSCs and OPCs.

Trinity Evolution is an allogeneic cancellous bone matrix containing demineralized cortical bone (DCB) as well as viable osteoprogenitor and mesenchymal stem cells. Adult mesenchymal stem cells and osteoprogenitor cells, such as those in Trinity Evolution, are the precursor cells that differentiate into osteoblasts—the cells responsible for bone growth and repair.

Trinity Evolution provides the required osteoconduction, osteogenesis, and osteoinductivity necessary for successful bone grafting. It offers viable osteoprogenitor and mesenchymal stem cells and demineralized cortical bone—all in a single product. Data from preclinical studies with Trinity Evolution have demonstrated in-vitro and in-vivo safety and effectiveness. Trinity Evolution is a "minimally manipulated" tissue that is considered an allograft, and as such, is labeled for bone repair for all orthopedic and podiatric indications where autograft is used. In this study, Trinity Evolution will be used as a substitute for autograft and/or standard allograft in the following arthrodesis procedures: tibiotalar, subtalar, calcaneocuboid, talonavicular, double fusions (i.e. calcaneocuboid and talonavicular), and triple fusions (i.e. subtalar, calcaneocuboid, and talonavicular).

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 106 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Radiographic and Clinical Study Evaluating a Novel Allogeneic, Cancellous, Bone Matrix Containing Viable Stem Cells (Trinity Evolution Matrix) in Subjects Undergoing Foot and Ankle Fusion
Study Start Date : September 2009
Actual Primary Completion Date : January 2013
Actual Study Completion Date : January 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Foot Health

Arm Intervention/treatment
Trinity Evolution Biological: Trinity Evolution
Novel Allogeneic, Cancellous, Bone Matrix Containing Viable Stem and Osteoprogenitor Cells
Other Names:
  • Allograft
  • Mesenchymal Stem Cells

Primary Outcome Measures :
  1. Fusion Success [ Time Frame: 12 months ]

Secondary Outcome Measures :
  1. Improvement in scores: Ankle-Hindfoot Scale (AHS), Visual Analog Scale (VAS), and Health Survey (SF-36v2). [ Time Frame: 12 months ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Foot and/or ankle pathology requiring fusion using open surgical technique with supplemental bone graft/substitute requiring one of the following procedures:

    • Ankle joint fusion
    • Subtalar fusion
    • Calcaneocuboid fusion
    • Talonavicular fusion
    • Double fusions (talonavicular and calcaneocuboid joints)
    • Triple fusions (subtalar, talonavicular, and calcaneocuboid joints)
  • At least 18 years of age
  • Willing and able to comply with the requirements of the protocol including follow-up requirements
  • Willing and able to sign a study-specific informed consent.

Exclusion Criteria:

  • Use of any other bone graft or bone graft substitute in addition to or in place of Trinity Evolution at the time of surgery
  • Use of adjunctive post-operative stimulation
  • Active local or systemic infection
  • Currently pregnant or considering becoming pregnant during the follow-up period
  • Active malignancy or having been on chemotherapy of any kind for a malignancy in the past 1 year
  • Immunosuppressive therapy of any kind within the past 1 year
  • Has a known history of hypersensitivity or anaphylactic reaction to dimethyl sulfoxide (DMSO).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00988338

United States, Florida
Orthopaedic Associates of South Broward, PA
Hollywood, Florida, United States, 33021
United States, Maryland
Sinai Hospital of Baltimore / Rubin Institute for Advanced Orthopedics
Baltimore, Maryland, United States, 21215
United States, New Mexico
New Mexico Orthopedics
Albuquerque, New Mexico, United States, 87106
United States, North Carolina
OrthoCarolina Research Institute
Charlotte, North Carolina, United States, 28203
Duke University Medical Center
Durham, North Carolina, United States, 27710
United States, Ohio
Ohio Orthopedic Center of Excellence
Upper Arlington, Ohio, United States, 43220
United States, Pennsylvania
The Western Pennsylvania Hospital
Pittsburgh, Pennsylvania, United States, 15224
University Orthopedics Center
State College, Pennsylvania, United States, 16801
United States, Tennessee
Central Tennessee Foot and Ankle Center
Sparta, Tennessee, United States, 38583
United States, Washington
Franciscan Foot and Ankle Specialists
Burien, Washington, United States, 98166
Sponsors and Collaborators
Orthofix Inc.
Study Director: Raymond J Linovitz, MD Orthofix Inc.

Responsible Party: Orthofix Inc. Identifier: NCT00988338     History of Changes
Other Study ID Numbers: TY01AF
First Posted: October 2, 2009    Key Record Dates
Last Update Posted: April 8, 2014
Last Verified: April 2014

Keywords provided by Orthofix Inc.:
Trinity Evolution
Foot Fusion
Ankle Fusion