Electrical stimulation to reduce pain and improve function after knee replacement

DESCRIPTION provided by applicant The goal of this project is to evaluate the feasibility Phase I and demonstrate the safety and effectiveness Phase II of a novel peripheral nerve stimulation therapy to treat pain and enable early rehabilitation after total knee arthroplasty i replacement resulting in improved function independence and quality of life Total knee arthroplasty is a surgical procedure to treat disabling knee conditions and approximately half of all patients experience moderate to severe pain during the first four weeks after surgery that can interfere with rehabilitation Opioids carry risks of debilitating side effects that interfere with rehabilitation Nerve blocks are not suited for extended use at home due to risks of infection local anesthetic toxicity and falls from motor block A non opioid therapy that enables patients to engage fully in physical rehabilitation during the first weeks after surgery is needed for pai after total knee arthroplasty Patients who are unable to engage fully in rehabilitation during thi period risk substantial delays in returning to normal function In Phase I the feasibility of providing immediate pain relief and improvements in function will be evaluated during in a case series study of individuals suffering from postoperative pain and reduced knee range of motion following total knee arthroplasty Electrical stimulation will be delivered to the nerve innervating the region of pain with the goal of evoking comfortable sensations without unwanted motor activation The aims are to determine if stimulation generates immediate reductions in pain increases knee range of motion and improves mobility If all aims are successful Phase II of the research will be conducted In Phase II our approach to relieve pain and improve function during the critical four weeks following total knee arthroplasty will be evaluated in a randomized placebo controlled trial enrolling individuals scheduled to undergo surgery A percutaneous lead will be placed preoperatively in each subject and active stimulation Treatment Group or sham placebo stimulation Control Group will be delivered for four weeks after surgery The Phase II aims are to determine if the Treatment Group compared to the Control Group has significantly greater reductions in pain while walking significantly improved knee function independence and quality of life and significantly improved endurance and mobility If Phase II is successful then these data will support FDA k clearance for this assistive technology to improve function independence and quality of life of patients following total knee arthroplasty The commercialization of our novel peripheral nerve stimulation therapy will substantially impact clinical practice by providing surgeons and their patients with a non opioid minimally invasive simple safe and effective treatment option resulting in pain relief and improved physical function that extends into the post discharge home rehabilitation period enabling full participation in rehabilitation and achievement of greater mobility and independence PUBLIC HEALTH RELEVANCE Approximately half of all patients experience moderate to severe pain during the first month after total knee arthroplasty i e replacement surgery that can interfere with rehabilitation leading to reduced mobility independence and quality of life Our proposed therapy is designed to avoid the systemic side effects infection risk and muscle weakness associated with current treatments If the proposed clinical studies are successful a safe and effective pain therapy that enables rehabilitation will be commercialized improving the physical function of patients undergoing total knee arthroplasty allowing patients to meet hospital discharge goals and motivating the million Americans who qualify for total knee arthroplasty to move forward with the procedure