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This study is designed to investigate whether iovera° treatment prior to TKA decreases cumulative participant opioid use over the course of 6 weeks following TKA while maintaining similar levels of pain relief. The study will also investigate whether there is a relationship between participants treated with iovera° and participant reported pain and function as measured by knee injury and osteoarthritis outcomes score (KOOS JR), numeric rating scale (NRS) for pain; use of hospital services post-TKA and improved physical rehabilitation as measured by range of motion.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| iovera° Device Treatment Group | Experimental | Iovera° device presurgical cryoneurolysis treatment, 5 (+/- 2) days prior to TKA. Additionally, all participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
|
| Standard of Care Treatment Group | No Intervention | All participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| iovera° | Device | The iovera° device applies cold to a target nerve to cause a temporary peripheral nerve block based on a process called Wallerian degeneration (2nd degree axonotmesis) without disrupting connective nerve tissue. |
| Measure | Description | Time Frame |
|---|---|---|
| Cumulative Opioid Consumption | The cumulative consumption of opioids was determined from the time of Total Knee Arthroplasty (TKA) surgery to 6 weeks post-TKA surgery. Opioid consumption was converted to morphine milligram equivalents (MME) and participant consumption was verified by pill count at follow-up visits. The cumulative morphine equivalent was divided by the number of days to provide the total daily morphine equivalent (TME) for the participant, | From the time of TKA surgery to 6 weeks post-TKA surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Area Under the Curve (AUC)/Time for Change From Baseline in Knee Injury and Osteoarthritis Outcomes Score (KOOS JR.) Overall Score Through 6 Weeks Post-TKA | The KOOS JR. was a participant completed questionnaire that consists of 7 questions from 3 subscales: stiffness (1 question), pain (4 questions), and function in daily living (2 questions). Standardized answer options are given (5 Likert boxes) and each question was assigned a score from none (0) to extreme (4). A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) was calculated. A positive change from baseline indicates improvement. AUC/time based on Changes from Baseline in KOOS JR. scores through 6 weeks post-TKA, is the AUC of Change in KOOS JR. scores from the Baseline visit through the 6-week visit divided by the number of days from TKA until the 6-week visit. AUC was calculated using the trapezoidal rule and the changes in the KOOS JR. score at the following time points: Baseline (change=0), 72 hours, 2 weeks, and 6 weeks post-TKA. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| William Mihalko, MD, PhD | UTHSC - COM - Orthopaedic Surgery & Biomedical Engineering | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Campbell Clinic | Germantown | Tennessee | 38138 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33279353 | Derived | Mihalko WM, Kerkhof AL, Ford MC, Crockarell JR Jr, Harkess JW, Guyton JL. Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial. J Arthroplasty. 2021 May;36(5):1590-1598. doi: 10.1016/j.arth.2020.11.013. Epub 2020 Nov 14. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Iovera° Device Treatment Group | Iovera° device presurgical cryoneurolysis treatment, 5 (+/- 2) days prior to total knee arthroplasty (TKA). Additionally, all participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
| FG001 | Standard of Care Treatment Group | All participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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Intent-to-Treat (ITT) population included all participants who were randomized into the study.
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| ID | Title | Description |
|---|---|---|
| BG000 | Iovera° Device Treatment Group | Iovera° device presurgical cryoneurolysis treatment, 5 (+/- 2) days prior to TKA. Additionally, all participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
| BG001 | Standard of Care Treatment Group |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Cumulative Opioid Consumption | The cumulative consumption of opioids was determined from the time of Total Knee Arthroplasty (TKA) surgery to 6 weeks post-TKA surgery. Opioid consumption was converted to morphine milligram equivalents (MME) and participant consumption was verified by pill count at follow-up visits. The cumulative morphine equivalent was divided by the number of days to provide the total daily morphine equivalent (TME) for the participant, | Intent-to-treat (ITT) population included all participants who were randomized into the study. Overall number analyzed is the number of participants with data available for analysis. | Posted | Mean | Standard Error | TME | From the time of TKA surgery to 6 weeks post-TKA surgery |
|
From first treatment up to the end of the study (Up to approximately 12 weeks)
All-cause Mortality: ITT population included all randomized participants. Serious Adverse Events and Adverse Events: Safety population included all participants who received study treatment.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Iovera° Device Treatment Group | Iovera° device presurgical cryoneurolysis treatment, 5 (+/- 2) days prior to TKA. Additionally, all participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Bilateral Pulmonary Emboli | Vascular disorders | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| R/O Deep vein thrombosis | Vascular disorders | Systematic Assessment | R/O=Rule Out |
This study was acquired from another sponsor. Results for the Primary Outcome Measure, Cumulative Opioid Consumption, are reported for the Time Frame (From the time of TKA surgery to 6 weeks post-TKA surgery) because the results for the Time Frame (From the time of hospital discharge to 6 weeks post-TKA surgery) are not available.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Kent Jones/ Sr. Director, Quality and Medical Affairs | Pacira CryoTech, Inc. | 510-933-1513 | kent.jones@pacira.com |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Sep 14, 2017 | Apr 13, 2021 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Mar 19, 2019 | Apr 13, 2021 | SAP_001.pdf |
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The active group will receive the iovera° treatment prior to a TKA. The control group will receive a TKA and no iovera° treatment.
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| Baseline to 6 weeks post-TKA surgery |
| AUC/Time for Change From Baseline in Numeric Rating Scale (NRS) for Pain Through 6 Weeks Post-TKA | NRS was an 11-point scale for self-reporting of pain intensity by participants. Scores range from 0 to 10, where 0 points equals "no pain" and 10 points equals the "worst pain imaginable". A positive change represented improvement (or reduction) in pain intensity. AUC/time based on Changes from Baseline in NRS Pain score through 6 weeks post-TKA, is the AUC of Change in NRS for Pain score from the Baseline visit through the 6-week visit divided by the number of days from TKA until the 6-week visit. AUC was calculated using the trapezoidal rule and the changes in the NRS for Pain score at the following time points: Baseline (change=0), 72 hours, 2 weeks, and 6 weeks post-TKA. | Baseline to 6 weeks post-TKA surgery |
| AUC/Time for Change From Baseline in Timed Get Up and Go (TUG) Tests Through 6 Weeks Post-TKA | The time required by the participants to raise from sitting, walk 10 feet, turn around, walk back and sit back down was measured in seconds. A positive change from baseline indicates improvement. AUC/time based on Changes from Baseline in the TUG test through 6 weeks post-TKA, is the AUC of Change in TUG test from the Baseline visit through the 6-week visit divided by the number of days from TKA until the 6-week visit. AUC was calculated using the trapezoidal rule and the changes in the TUG test at the following time points: Baseline (change=0), 72 hours, 2 weeks, and 6 weeks post-TKA. | Baseline to 6 weeks post-TKA surgery |
| Missed Visit 6 (Week 6 Visit) |
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| Fungal infection |
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| Discharged to Rehabilitation |
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| Missing |
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All participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Participants may have identified as more than one Race. | Number | participants |
|
| OG001 | Standard of Care Treatment Group | All participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. |
|
|
|
| Secondary | Area Under the Curve (AUC)/Time for Change From Baseline in Knee Injury and Osteoarthritis Outcomes Score (KOOS JR.) Overall Score Through 6 Weeks Post-TKA | The KOOS JR. was a participant completed questionnaire that consists of 7 questions from 3 subscales: stiffness (1 question), pain (4 questions), and function in daily living (2 questions). Standardized answer options are given (5 Likert boxes) and each question was assigned a score from none (0) to extreme (4). A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) was calculated. A positive change from baseline indicates improvement. AUC/time based on Changes from Baseline in KOOS JR. scores through 6 weeks post-TKA, is the AUC of Change in KOOS JR. scores from the Baseline visit through the 6-week visit divided by the number of days from TKA until the 6-week visit. AUC was calculated using the trapezoidal rule and the changes in the KOOS JR. score at the following time points: Baseline (change=0), 72 hours, 2 weeks, and 6 weeks post-TKA. | ITT population included all participants who were randomized into the study. | Posted | Mean | Standard Error | score on a scale/days | Baseline to 6 weeks post-TKA surgery |
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| Secondary | AUC/Time for Change From Baseline in Numeric Rating Scale (NRS) for Pain Through 6 Weeks Post-TKA | NRS was an 11-point scale for self-reporting of pain intensity by participants. Scores range from 0 to 10, where 0 points equals "no pain" and 10 points equals the "worst pain imaginable". A positive change represented improvement (or reduction) in pain intensity. AUC/time based on Changes from Baseline in NRS Pain score through 6 weeks post-TKA, is the AUC of Change in NRS for Pain score from the Baseline visit through the 6-week visit divided by the number of days from TKA until the 6-week visit. AUC was calculated using the trapezoidal rule and the changes in the NRS for Pain score at the following time points: Baseline (change=0), 72 hours, 2 weeks, and 6 weeks post-TKA. | ITT population included all participants who were randomized into the study. Overall number analyzed is the number of participants with data available for analysis at the given timepoint. | Posted | Mean | Standard Deviation | score on a scale/days | Baseline to 6 weeks post-TKA surgery |
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|
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| Secondary | AUC/Time for Change From Baseline in Timed Get Up and Go (TUG) Tests Through 6 Weeks Post-TKA | The time required by the participants to raise from sitting, walk 10 feet, turn around, walk back and sit back down was measured in seconds. A positive change from baseline indicates improvement. AUC/time based on Changes from Baseline in the TUG test through 6 weeks post-TKA, is the AUC of Change in TUG test from the Baseline visit through the 6-week visit divided by the number of days from TKA until the 6-week visit. AUC was calculated using the trapezoidal rule and the changes in the TUG test at the following time points: Baseline (change=0), 72 hours, 2 weeks, and 6 weeks post-TKA. | ITT population included all participants who were randomized into the study. Overall number analyzed is the number of participants with data available for analysis. | Posted | Mean | Standard Deviation | seconds/days | Baseline to 6 weeks post-TKA surgery |
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|
|
| 0 |
| 62 |
| 2 |
| 59 |
| 4 |
| 59 |
| EG001 | Standard of Care Treatment Group | All participants received treatment as per all the standard pre-, peri-, and post-operative surgical protocols. | 0 | 62 | 2 | 60 | 3 | 60 |
| R/O Popliteal Arterial Aneurysm | Vascular disorders | Systematic Assessment |
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| Neuropsychotic/seizures | Psychiatric disorders | Systematic Assessment |
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| Anaphylaxis | Skin and subcutaneous tissue disorders | Systematic Assessment |
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| t-test, 1 sided |
| 0.2204 |
p-value was calculated from a one-sided, two-sample t-test, |
| Difference in Means |
| 0.4 |
| 2-Sided |
| 95 |
| -0.6 |
| 1.3 |
| Superiority |
Pain Right Now - Testing the null hypothesis that the iovera° mean was less than or equal to the Standard of Care mean versus the alternative hypothesis that the iovera° mean was greater than the Standard of Care mean. |