The clinical and cost-effectiveness of elective primary total knee replacement with PAtellar Resurfacing compared to selective patellar resurfacing. A pragmatic multicentre randomised controlled Trial with blinding (PART)
Status: In set up
Sponsor: North Bristol NHS Trust
Controlling pain and improving mobility in the long-term after knee replacement surgery has been highlighted as a research priority by patients. There are two ways to carry out this surgery:
- the kneecap (patella) is unaltered during the operation.
- the surgeon attaches a separate artificial implant to the back of the kneecap, which may help reduce further wear or pain. This is known as resurfacing the kneecap.
Resurfacing is an extra step in the operation which takes time and sometimes causes problems later.
Not resurfacing can cause long-term knee pain, and further surgery may be needed, resulting in risks for patients and expense to the NHS.
Recent national guidelines compared resurfacing the kneecap in all patients with never resurfacing the kneecap. They concluded that in the long-term always resurfacing was better than never resurfacing.
However, many surgeons make an individual choice about whether to resurface the kneecap, based on factors such as pain and the condition of the kneecap. We call this selective resurfacing. The National Institute for Health and Care Excellence (NICE) highlighted a need for research about whether selective resurfacing is better than always resurfacing during knee replacement.
Our study will compare patients undergoing knee replacement who all have the kneecap resurfaced with those who have it selectively resurfaced.
We would like to find out which strategy gives better outcomes for patients, and whether one is better value for money for the NHS.
Over 4 years we will recruit 530 patients having knee replacement at 15 or more hospitals in England. They will be put into two equal groups. This will be done randomly to allow a fair comparison. All the patients in one group will have their kneecap resurfaced. In the other group the surgeon will decide during the operation whether to resurface the kneecap or not.
All other aspects of care will be the same for all participants. We will follow up with participants for 1 year to monitor knee pain, mobility, quality of life, complications, further surgery and costs to the NHS and patients.
This study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (HTA NIHR131850). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Chief investigator: Professor Ashley Blom and Mr Gulraj Matharu
Trial Coordinator:Adam Boon
Looking for PPI members: No