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Personalised HTO Versus Generic HTO Virtual Clinical Trial

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ClinicalTrials.gov Identifier: NCT03419598
Recruitment Status : Completed
First Posted : February 5, 2018
Results First Posted : December 7, 2020
Last Update Posted : December 7, 2020
Sponsor:
Collaborator:
Royal Devon and Exeter NHS Foundation Trust
Information provided by (Responsible Party):
Richie Gill, University of Bath

Tracking Information
First Submitted Date January 26, 2018
First Posted Date February 5, 2018
Results First Submitted Date October 5, 2019
Results First Posted Date December 7, 2020
Last Update Posted Date December 7, 2020
Actual Study Start Date January 3, 2017
Actual Primary Completion Date June 28, 2019   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures
 (submitted: November 11, 2020)
Mechanical Stress in Plate During Gait [ Time Frame: 6 weeks simulated post-operation ]
Mechanical stress (Von Mises) calculated for functional loading using finite element analysis
Original Primary Outcome Measures
 (submitted: January 26, 2018)
Mechanical stress in plate [ Time Frame: 6 weeks simulated post-operation ]
Mechanical strain calculated for functional loading using finite element analysis
Change History
Current Secondary Outcome Measures
 (submitted: November 11, 2020)
Mechanical Strain in Bone Around Screws During Gait [ Time Frame: 6 weeks simulated post-operation ]
Mechanical strain calculated for functional loading using finite element analysis, note strain is dimensionless and hence has no units
Original Secondary Outcome Measures
 (submitted: January 26, 2018)
Mechanical strain in bone around screws [ Time Frame: 6 weeks simulated post-operation ]
Mechanical strain calculated for functional loading using finite element analysis
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title Personalised HTO Versus Generic HTO Virtual Clinical Trial
Official Title Personalised Subject Specific HTO Versus Generic HTO Virtual Clinical Trial
Brief Summary

High Tibial Osteotomy (HTO) is an alternative to knee replacement in suitable patients with early knee osteoarthritis (OA), it is particularly suited to patients with single compart disease who otherwise would be suitable for unicompartmental knee replacement (UKR). OA of the knee is very common and increasing driven by the ageing of the population. The current limitations of HTO are related to the difficulty of achieving the desired correction due to a challenging surgical technique and soft tissue irritation due to the use of generic stabilisation plates. This study will examine the safety equivalence of a new patient specific HTO process which has patient specific 3D printed plates, i.e. personalised HTO plates, with the existing most commonly used HTO procedure using the Tomofix generic HTO plate. Importantly this study will be undertaken as a Virtual Trial, existing anonymised 3D imaging data will be used to create the virtual patient cohort. This cohort will receive both procedures, which for this type of procedure is only possible in a virtual scenario.

The main question to be addressed is: "Is the personalised HTO procedure as safe as the most commonly used existing generic HTO procedure?". In this context safety concerns the mechanical loads placed upon the tibia and the support plate.

The interventions will all be made on computer models, the 3D imaging data will be used to create the intact (un-operated) models of the subject tibias. Each model will then be virtually operated upon, with both the personalised and generic HTO procedures. The models will then be loaded with physiological loads experienced during function and the mechanical states compared.

Detailed Description

Ethical approval was obtained to use CT scans of 30 patients with moderate to severe knee arthritis (REC reference: 17/HRA/0033, Royal Devon & Exeter National Health Service [NHS], UK).

The CT data will be used to generate the 3D geometry of each patient's proximal tibia. The osteotomy correction angle required for each patient such that the altered mechanical axis will pass through a point 62.5% of the distance from medial to lateral tibial plateau. Virtual HTO surgery will be performed on each patient to alter the mechanical axis of the knee by creating an opening wedge osteotomy.

After the virtual surgeries are performed, each virtual patient will be duplicated. One copy will have the osteotomy stabilised using a Generic plate and the other using a Personalised plate, thus forming the two arms of the trial.

For each participant in each arm finite element (FE) models will be created, and loads applied simulating walking, sit to stand and squatting. Four healings stages will be considered, stage 1 being immediately post-operation (this will not be modelled), stage 2 representing 2 weeks post-operation, stage 3 representing 6 weeks and stage 4 representing 12 weeks. The mechanical loads in the plates, and around the screw locations in the bone, will be established by solving these finite element models.

Study Type Observational
Study Design Observational Model: Case-Control
Time Perspective: Prospective
Target Follow-Up Duration Not Provided
Biospecimen Not Provided
Sampling Method Non-Probability Sample
Study Population Population was recruited from waiting list of patients with knee OA
Condition Osteoarthritis, Knee
Intervention
  • Procedure: Opening wedge high tibial osteotomy
    Realignment of knee by creating an opening wedge osteotomy in the upper part of the tibia. Since this is a virtual trial, the virtual patients were duplicated and enrolled into both arms
    Other Name: HTO
  • Device: Personalised subject specific custom HTO plate
    Subject specific custom plate for stabilizing an open wedge HTO
    Other Name: Personalised plate
  • Device: Generic HTO plate
    Generic plate for stabilizing an open wedge HTO
    Other Name: Generic plate
Study Groups/Cohorts All study participants
All virtual participants who received a virtual opening wedge high tibial osteotomy. The baseline information was the individual CT-based geometry of tibia.
Interventions:
  • Procedure: Opening wedge high tibial osteotomy
  • Device: Personalised subject specific custom HTO plate
  • Device: Generic HTO plate
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Completed
Actual Enrollment
 (submitted: November 11, 2020)
30
Original Estimated Enrollment
 (submitted: January 26, 2018)
20
Actual Study Completion Date June 28, 2019
Actual Primary Completion Date June 28, 2019   (Final data collection date for primary outcome measure)
Eligibility Criteria

Inclusion Criteria:

  • Appropriate existing CT data of lower limb.
  • Male or Female, aged 18 years or above.
  • Diagnosed with moderate to severe OA of the knee.

Exclusion Criteria:

  • Abnormal anatomy of tibia or presence of pathology other than OA, e.g. bone tumour.
  • Previous knee or osteotomy surgery.
  • Presence of metal-work
Sex/Gender
Sexes Eligible for Study: All
Ages 18 Years to 65 Years   (Adult, Older Adult)
Accepts Healthy Volunteers No
Contacts Contact information is only displayed when the study is recruiting subjects
Listed Location Countries United Kingdom
Removed Location Countries  
 
Administrative Information
NCT Number NCT03419598
Other Study ID Numbers RG433_TVT003
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement
Plan to Share IPD: No
Plan Description: Virtual cohort may be re-used for further studies, all virtual patients are anonymized
Current Responsible Party Richie Gill, University of Bath
Original Responsible Party Same as current
Current Study Sponsor University of Bath
Original Study Sponsor Same as current
Collaborators Royal Devon and Exeter NHS Foundation Trust
Investigators
Principal Investigator: Richie Gill, DPhil University of Bath
Principal Investigator: Andrew Toms, MD Royal Devon & Exeter NHS Trust
PRS Account University of Bath
Verification Date November 2020