Structured Treatment of Osteoarthritis of the Knee With or Without Total Knee Replacement - Full Text View

Purpose

The purpose of this study is to test whether surgical insertion of total knee replacement provides further improvement in quality of life, pain and function in addition to an algorithm for systematic non-surgical treatment consisting of corrective insoles, neuromuscular training, weight loss, patient education and pharmacological treatment with paracetamol, NSAIDs and Pantoprazol in patients with knee OA, collectively called the MEDIC-treatment(Medicine Exercise Diet Insoles Cognitive).

The H1-hypothesis is that surgery with insertion of TKR in addition to the MEDIC-treatment results in a greater increase in quality of life and functional capacity and greater reduction in pain than the MEDIC- treatment alone at the primary endpoint, which is follow-up 12months after the start of the treatment.

Condition	Intervention
Osteoarthritis of the Knee	Other: Neuromuscular training (NEMEX-TJR) Drug: Paracetamol Drug: Burana Drug: Pantoprazol Behavioral: Dietary counseling Behavioral: Patient education Procedure: TKR Other: Insoles

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Structured Treatment of Osteoarthritis of the Knee With or Without Total Knee Replacement. A Randomized Controlled Trial of Pain, Physical Function and Quality of Life With 12months Follow-up

Resource links provided by NLM:

MedlinePlus related topics: Knee Replacement Osteoarthritis

Drug Information available for: Acetaminophen Pyrantel Pyrantel pamoate

U.S. FDA Resources

Further study details as provided by Northern Orthopaedic Division, Denmark:

Primary Outcome Measures:

KOOS4 (Knee injury and Osteoarthritis Outcome Score) [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months. ] [ Designated as safety issue: No ]
The average score for four of the five KOOS subscales, covering pain, symptoms, difficulty in sports and recreational activities, and quality of life (KOOS4), with scores ranging from 0 (worst) to 100 (best).

Secondary Outcome Measures:

EQ-5D [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
Visual Analog Scale (VAS) [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
Timed Up & Go (TUG) [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
20-meter walk [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
Isometric Muscle Strength [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
Knee extension and knee flexion measured in sitting position using a handheld dynamometer.
Pain [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
Pain measured at 4 sites in relation to the knee, and 1 control site at m. tibialis anterior using a handheld pressure algometer.
Self-efficacy [ Time Frame: Primary: 12months. Other: 3, 6 and 24 months ] [ Designated as safety issue: No ]
Self-efficacy on a 100mm VAS in relation to pain, function and quality of life

Estimated Enrollment:	100
Study Start Date:	September 2011
Estimated Study Completion Date:	March 2015
Estimated Primary Completion Date:	December 2014 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: MEDIC Medicine, Exercise, Diet, Insole and Cognitive/patient education (MEDIC) for three months.	Other: Neuromuscular training (NEMEX-TJR) 60min. of neuromuscular training two times a week for 3 months (12 weeks) using the neuromuscular training program called NEMEX-TJR. Other Name: no other names Drug: Paracetamol 1 g x 4/day Other Name: no other names Drug: Burana 400 mg x 3/day for three weeks Other Name: NSAIDs are chosen in collaboration with the participant. Drug: Pantoprazol 20mg x 1/day for three weeks Other Name: no other names Behavioral: Dietary counseling For participants with a BMI equal to or >25. The dietitian initiates a 3-month intervention that provides instruction and guidance in relation to diet and plans the number of visits according to the individual participant needs. Other Name: no other names Behavioral: Patient education The aim is to strengthen the participant's involvement in the treatment, so the participant will be in a position to handle, master and act reasonable in relation to their knee OA. This aspect of the intervention is based on principles from The Chronic Disease Self-Management Program, "Lær at leve med kronisk sygdom (Learn to live with chronic illness)" by The National Board of Health, Denmark and "Artrosskolan Spenshult" in Sweden. Other Name: no other names Other: Insoles The position of the knee is assessed using Single Leg Mini Squat. On the basis of this test it is decided which of two types of insoles (Formthotics System) the participant should have (neutral with a lateral wedge or neutral). The participants will be advised to use the insoles in all shoes. Other Name: no other names
Active Comparator: MEDIC + TKR Medicine, Exercise, Diet, Insole and Cognitive/patient education (MEDIC) for three months after a total knee replacement.	Other: Neuromuscular training (NEMEX-TJR) 60min. of neuromuscular training two times a week for 3 months (12 weeks) using the neuromuscular training program called NEMEX-TJR. Other Name: no other names Drug: Paracetamol 1 g x 4/day Other Name: no other names Drug: Burana 400 mg x 3/day for three weeks Other Name: NSAIDs are chosen in collaboration with the participant. Drug: Pantoprazol 20mg x 1/day for three weeks Other Name: no other names Behavioral: Dietary counseling For participants with a BMI equal to or >25. The dietitian initiates a 3-month intervention that provides instruction and guidance in relation to diet and plans the number of visits according to the individual participant needs. Other Name: no other names Behavioral: Patient education The aim is to strengthen the participant's involvement in the treatment, so the participant will be in a position to handle, master and act reasonable in relation to their knee OA. This aspect of the intervention is based on principles from The Chronic Disease Self-Management Program, "Lær at leve med kronisk sygdom (Learn to live with chronic illness)" by The National Board of Health, Denmark and "Artrosskolan Spenshult" in Sweden. Other Name: no other names Procedure: TKR Surgical treatment with insertion of total knee replacement following standard procedures. Other Names: Total Knee Replacement Knee arthroplasty Other: Insoles The position of the knee is assessed using Single Leg Mini Squat. On the basis of this test it is decided which of two types of insoles (Formthotics System) the participant should have (neutral with a lateral wedge or neutral). The participants will be advised to use the insoles in all shoes. Other Name: no other names
Active Comparator: Observational Cohort If the patient can be included, but doesn't want to participate in the randomization, the patient is offered to enter into a prospective observational cohort with the same endpoints and the same follow-up as in the randomized study. The participant can then, in consultation with his/her physician, choose whether they would like MEDIC-treatment or TKR in combination with MEDIC-treatment.	Other: Neuromuscular training (NEMEX-TJR) 60min. of neuromuscular training two times a week for 3 months (12 weeks) using the neuromuscular training program called NEMEX-TJR. Other Name: no other names Drug: Paracetamol 1 g x 4/day Other Name: no other names Drug: Burana 400 mg x 3/day for three weeks Other Name: NSAIDs are chosen in collaboration with the participant. Drug: Pantoprazol 20mg x 1/day for three weeks Other Name: no other names Behavioral: Dietary counseling For participants with a BMI equal to or >25. The dietitian initiates a 3-month intervention that provides instruction and guidance in relation to diet and plans the number of visits according to the individual participant needs. Other Name: no other names Behavioral: Patient education The aim is to strengthen the participant's involvement in the treatment, so the participant will be in a position to handle, master and act reasonable in relation to their knee OA. This aspect of the intervention is based on principles from The Chronic Disease Self-Management Program, "Lær at leve med kronisk sygdom (Learn to live with chronic illness)" by The National Board of Health, Denmark and "Artrosskolan Spenshult" in Sweden. Other Name: no other names Procedure: TKR Surgical treatment with insertion of total knee replacement following standard procedures. Other Names: Total Knee Replacement Knee arthroplasty Other: Insoles The position of the knee is assessed using Single Leg Mini Squat. On the basis of this test it is decided which of two types of insoles (Formthotics System) the participant should have (neutral with a lateral wedge or neutral). The participants will be advised to use the insoles in all shoes. Other Name: no other names

Detailed Description:

Knee osteoarthritis (OA) is the degenerative joint disease that most often requires treatment and at the same time the one associated with the greatest social costs. In addition, the disease has many personal costs and is greatly contributing to reduced functionality and autonomy of older adults.

It is recommended both nationally and internationally that the treatment of knee OA should include multiple treatment modalities. Clinical guidelines recommend that exercise, weight loss and patient education is the first step in treatment and that insoles and pharmacological treatment can be included as a supplement. If this non-surgical treatment is ineffective surgical treatment, especially surgery with insertion of total knee replacement (TKR), may be indicated. There are effects of both non-surgical treatment and TKR, but no studies exist, which examine the effect of surgery with insertion of TKR in addition to the recommended non-surgical treatment of knee OA.

Eligibility

Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Knee-OA detected by x-ray (Kellgren & Lawrence grade 2 or greater)
Considered a candidate for TKR by the orthopedic surgeon.
The participant is > 18 years of age.
The participant can provide relevant and adequate, informed consent.

Exclusion Criteria:

Mean VAS > 6
Investigator considers that the mental condition of the participant does not allow participation.
The participant is considered to be unable to follow the intervention.
Not present in the region during the study.
The participant must not be pregnant or plan pregnancy during the study.
Cannot read or understand Danish*. * Due to the cost of interpreters the participant must be able to read and understand Danish.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01410409

Contacts

Contact: Søren T Skou, PhD-student	+45 23708640	sots@rn.dk
Contact: Sten Rasmussen, MD	+45 99322367	sten.rasmussen@rn.dk

Locations

Denmark
Department of Occupational and Physiotherapy, Aalborg Hospital-Aarhus University Hospital	Recruiting
Aalborg, Denmark, 9000
Contact: Søren T Skou, PhD-student +45 23708640 sots@rn.dk
Farsoe Hospital	Recruiting
Farsø, Denmark, 9640
Contact: Søren T Skou, PhD-student +45 23708640 sots@rn.dk
Vendsyssel Hospital, Frederikshavn	Recruiting
Frederikshavn, Denmark, 9900
Contact: Søren T Skou, PhD-student +45 23708640 sots@rn.dk

Sponsors and Collaborators

Northern Orthopaedic Division, Denmark

The Danish Rheumatism Association

Obel Family Foundation

Spar Nord Foundation

The Bevica Foundation

Aalborg University

The Association of Danish Physiotherapists Research Fund

Formthotics

Medical Specialist Heinrich Kopp's Grant

The Danish Medical Association Research Fund.

Investigators

Principal Investigator:	Søren T Skou, PhD-student	Orthopaedic Research Unit, Aalborg University Hospital, Denmark
Study Chair:	Ewa M Roos, PhD	Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
Study Chair:	Lars Arendt-Nielsen, Dr.Sci.Med.	Center for Sensory-Motor Interaction (SMI), Department of Health Sciences and Technology, Aalborg University
Study Chair:	Mogens B Laursen, PhD	Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Study Chair:	Sten Rasmussen, MD	Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Study Chair:	Michael S Rathleff, PhD-student	Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark
Study Chair:	Ole H Simonsen, Dr.Med.	Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark

More Information

Publications:

Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001 Feb;60(2):91-7. Review.

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008 Feb;16(2):137-62. Review.

Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M; Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003 Dec;62(12):1145-55. Review.

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007 Sep;15(9):981-1000. Epub 2007 Aug 27. Review.

Walker-Bone K, Javaid K, Arden N, Cooper C. Regular review: medical management of osteoarthritis. BMJ. 2000 Oct 14;321(7266):936-40. Review. No abstract available.

Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006 Mar 18;332(7542):639-42. Review. No abstract available.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen OH, Rasmussen S. Total knee replacement plus physical and medical therapy or treatment with physical and medical therapy alone: a randomised controlled trial in patients with knee osteoarthritis (the MEDIC-study). BMC Musculoskelet Disord. 2012 May 9;13:67. doi: 10.1186/1471-2474-13-67.

Responsible Party:	Søren Thorgaard Skou, MSc, ph.d. student, Northern Orthopaedic Division, Denmark
ClinicalTrials.gov Identifier:	NCT01410409 History of Changes
Other Study ID Numbers:	N-20110024
Study First Received:	August 2, 2011
Last Updated:	April 30, 2013
Health Authority:	Denmark: The Danish National Committee on Biomedical Research Ethics Denmark: Danish Dataprotection Agency

Keywords provided by Northern Orthopaedic Division, Denmark:

Osteoarthritis, Knee
Treatment Outcome
Time Factors
Arthroplasty, Replacement
Rehabilitation
Combined Modality Therapy
Middle Aged

Aged
Aged, 80 and over
Male
Female
Humans
Analysis of Variance

Additional relevant MeSH terms:

Osteoarthritis
Osteoarthritis, Knee
Arthritis
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Acetaminophen
Antipyretics

Physiological Effects of Drugs
Pharmacologic Actions
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Central Nervous System Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on June 13, 2013

Structured Treatment of Osteoarthritis of the Knee With or Without Total Knee Replacement (MEDIC)