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CTRI Number  CTRI/2025/02/081105 [Registered on: 21/02/2025] Trial Registered Prospectively
Last Modified On: 19/02/2025
Post Graduate Thesis  No 
Type of Trial  Interventional 
Type of Study   Diagnostic 
Study Design  Randomized, Parallel Group Trial 
Public Title of Study   Observing how knee joint arthritis progresses using range of joint movements and MRI data: A Longterm comparative study  
Scientific Title of Study   Assessing the progression of Knee Joint Osteoarthritis using Arthro-kinematic and Finite Element Analysis: A Prospective Cohort study 
Trial Acronym  NIL 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Dr Sundip Charmode 
Designation  Associate Professor 
Affiliation  All-India Institute of Medical Sciences Rajkot 
Address  Department of Anatomy, Academic block, AIIMS Rajkot, KHANDHERI, RAJKOT-360110
Flat number 804, 8th floor, Fortune serenity tower, E-tower, Ghanteshwar, Behind Ganga-jamuna building, Jamnagar Road. Rajkot
Rajkot
GUJARAT
360110
India 
Phone  09633239685  
Fax    
Email  sundip.charmode@yahoo.com  
 
Details of Contact Person
Scientific Query
 
Name  Dr Sundip Charmode 
Designation  Associate Professor 
Affiliation  All-India Institute of Medical Sciences Rajkot 
Address  Department of Anatomy, Academic block, AIIMS Rajkot, KHANDHERI, RAJKOT-360110
Flat number 804, 8th floor, Fortune serenity tower, E-tower, Ghanteshwar, Behind Ganga-jamuna building, Jamnagar Road. Rajkot
Rajkot
GUJARAT
360110
India 
Phone  09633239685  
Fax    
Email  sundip.charmode@yahoo.com  
 
Details of Contact Person
Public Query
 
Name  Dr Sundip Charmode 
Designation  Associate Professor 
Affiliation  All-India Institute of Medical Sciences Rajkot 
Address  Department of Anatomy, Academic block, AIIMS Rajkot, KHANDHERI, RAJKOT-360110
Flat number 804, 8th floor, Fortune serenity tower, E-tower, Ghanteshwar, Behind Ganga-jamuna building, Jamnagar Road. Rajkot
Rajkot
GUJARAT
360110
India 
Phone  09633239685  
Fax    
Email  sundip.charmode@yahoo.com  
 
Source of Monetary or Material Support  
All India Institute of Medical Sciences (AIIMS) Rajkot, Gujarat-360110  
 
Primary Sponsor  
Name  All India Institute of Medical Sciences AIIMS Rajkot 
Address  Department of Anatomy, Academic block, AIIMS Rajkot, KHANDHERI, RAJKOT-360110 
Type of Sponsor  Government medical college 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Sundip Charmode  All India Institute of Medical Sciences (AIIMS) Rajkot  Department of Anatomy, Academic block, AIIMS Rajkot, KHANDHERI, RAJKOT-360110
Rajkot
GUJARAT 
09633239685

sundip.charmode@yahoo.com 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Institutional Ethical committee, AIIMS Rajkot  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: M179||Osteoarthritis of knee, unspecified,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Comparator Agent  Anthropometric, biomechanical and finite element analysis of knee joint  The patients using eligibility criteria will be divided into two groups: the Intervention group, and the control/comparator group. The control group will be receiving conventional management (e.g., physiotherapy, knee belt). The intervention in this project is not the treatment offered to the patients, but the Anthropometric, biomechanical and finite element analysis of knee joint. The control group will be followed at 3-month intervals for Anthropometric, biomechanical and Finite element analysis. MRI will be performed at the baseline and will be done at 9 and 18 months, whereas anthropometric and biomechanical analysis shall be done at 3, 6, 9, 12, 15 and 18 months. Soft copies of all the MRI scans shall be collected after prior approval from the competent authority and analyzed using RadiANT DICOM software for anthropometric measurements of distal end of femur and proximal end of tibia. Further the MRI data will be shared with the Department of Physics, Saurashtra university for Finite element analysis. Arthro-kinematic assessment (the anthropometry and biomechanical data) of all the patients shall be correlated with the MRI findings taking into consideration the various age groups and gender. 
Intervention  Anthropometric, biomechanical and finite element analysis of knee joint   The patients will be selected using eligibility criteria and will be divided into two groups: the intervention/study group, receiving customized orthotics after correction of the knee joint mechanical axis, and the control/comparator group. This study group shall be followed at 3-month intervals for Anthropometric, biomechanical and Finite element analysis. The intervention in this project is not the treatment offered to the patients, but the Anthropometric, biomechanical and finite element analysis of knee joint. MRI will be performed at the baseline and will be done at 9 and 18 months, whereas anthropometric and biomechanical analysis shall be done at 3, 6, 9, 12, 15 and 18 months. Soft copies of all the MRI scans shall be collected after prior approval from the competent authority and analyzed using RadiANT DICOM software for anthropometric measurements of distal end of femur and proximal end of tibia. Further the MRI data will be shared with the Department of Physics, Saurashtra university for Finite element analysis. Arthro-kinematic assessment (the anthropometry and biomechanical data) of all the patients shall be correlated with the MRI findings taking into consideration the various age groups and gender.  
 
Inclusion Criteria  
Age From  35.00 Year(s)
Age To  75.00 Year(s)
Gender  Both 
Details  1. Age 35 years and above.
2. Patient with degenerative changes in knee with any deviation from the normal mechanical axis.
 
 
ExclusionCriteria 
Details  1. Patients under 35 years.
2. Patients with any contraindication for MRI like electronic device, metallic implants, etc.
3. Patients with claustrophobia.
4. Neurological disorders, systemic disorders, muscular dystrophy, metabolic bone diseases affecting bone metabolism.
5. Soft tissue, or bone swelling causing knee misalignment.
6. Axial skeleton deformities.
7. Conditions requiring surgery.
8. Already operated cases for knee joint osteoarthritis.
9. Gross deformity in proximal (hip) and distal (ankle joint and foot) segments.
10. BMI above morbid obesity.
 
 
Method of Generating Random Sequence   Stratified randomization 
Method of Concealment   Case Record Numbers 
Blinding/Masking   Participant and Investigator Blinded 
Primary Outcome  
Outcome  TimePoints 
The patients will be selected using eligibility criteria and provide written consent. Demographics and medical history will be recorded via a patient information sheet. They will be divided into two groups: the study group, receiving customized orthotics after correction of the knee joint mechanical axis, and the control group, receiving conventional management (e.g., physiotherapy, knee belt). Both groups will be followed up at 3-month intervals.
At baselines:
A.MRI will be done of the knee joint affected side.

B. Anthropometric analysis of knee joint variables will be conducted as follows using ‘RadiANT DICOM Viewer’ software:

C. Knee joint biomechanical findings (Range of motion)
1. Flexion at knee joint (Active/passive)
2. Extension at knee joint (Active/passive)
3. Internal rotation (active/passive)
4. External rotation (active/passive)

 
Both groups will be followed up at 3-month intervals. MRI will be performed at the baseline and will be done at 9 and 18 months, whereas arthro-kinematic analysis shall be done at 3, 6, 9, 12, 15 and 18 months.

 
 
Secondary Outcome  
Outcome  TimePoints 
Finite element analysis of the knee joint (side) will be done using the sift copies of the MRI scans using the following parameters:
1 Contact area (mm3)
2 Contact pressure (MPa) Mean/Peak
3 Pore pressure (MPa) Mean/Peak
4 Tensile stress% (Mean/Peak)
5 Tensile strain% (Mean/Peak)
6 Translation of medial femoral condyle(mm)
7 Translation of lateral femoral condyle (mm)
8 Mechanical axis of hip joint
9 Femoro-tibial (Knee joint) mechanical axis
10 Medial collateral ligaments
11 Lateral collateral ligaments
 
Both groups will be followed up at 3-month intervals. MRI will be performed at the baseline and will be done at 9 and 18 months, whereas arthro-kinematic analysis shall be done at 3, 6, 9, 12, 15 and 18 months. Finite element analysis will be done at baseline, 9 months and 18 months stage in the follow up.



 
 
Target Sample Size   Total Sample Size="55"
Sample Size from India="55" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   N/A 
Date of First Enrollment (India)   15/03/2025 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="2"
Months="0"
Days="0" 
Recruitment Status of Trial (Global)   Not Applicable 
Recruitment Status of Trial (India)  Open to Recruitment 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - YES
  1. What data in particular will be shared?
    Response - Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures, and appendices).

  2. What additional supporting information will be shared?
    Response -  Study Protocol
    Response -  Statistical Analysis Plan
    Response - Informed Consent Form
    Response - Clinical Study Report
    Response -  Analytic Code

  3. Who will be able to view these files?
    Response - Researchers whose proposed use of the data has been approved by an independent review committee identified for this purpose.

  4. For what types of analyses will this data be available?
    Response - To achieve aims in the approved proposal.

  5. By what mechanism will data be made available?
    Response - Proposals should be directed to [sundip.charmode@yahoo.com].

  6. For how long will this data be available start date provided 01-01-2028 and end date provided 31-12-2029?
    Response - Immediately following publication. No end date.

  7. Any URL or additional information regarding plan/policy for sharing IPD? 
    Additional Information - NIL
Brief Summary  

Knee joint osteoarthritis is the second most common rheumatologic problem in Indian with a prevalence of 28.7 percent. There is no effective treatment to reverse the degenerative process, so the patient chooses to undergo surgical intervention as a management approach, which has its own disadvantages. Advancements in digital medicine and computing have enhanced finite element analysis (FEA), enabling non-invasive, cost-effective simulations of tissue mechanics through which stress and strains, deformations at tissue level can be observed in various structures of the body. In recent years, many researchers across the world have used FEA to visualize the tissue level and biomechanical changes occurring in osteoarthritic knee joints. In India, only couple of studies exist who have use FEA to study the underlying patho-physiology. The present prospective study aims to used FEA to prepare subject-specific 3D joint models of osteoarthritic knee joints before and after correction of its mechanical axis. Thus, FEA and modelling shall be used in facilitating the orthotics management, and shall observe the tissue level and biomechanical changes, along with contact pressures analyzing how the correcting the mechanical axis impacts the degenerative process in the osteoarthritic knee joints in Indian population despite their variable sitting postures.

This prospective study will be conducted in collaboration with the Department of Physics of Saurashtra university. The patients with knee osteoarthritis will be selected using the eligibility criteria and the radiological data (like MRI and X ray) will be collected after taking informed consent. Patient   demographics will be collected using a case record form. In case of any additional radiological investigations is required for the study purpose, it shall be conducted, and the soft copies of the data will be processed in RadiANT DICOM software and the measurements of knee condyles, cartilage, meniscus and joint spaces conducted. The entire data shall be provided to the department of physics for processing into Mimics (or equivalent software) for data segmentation and conversion into 3D models. Later, finite element software’s namely Abacus, ANSYS or any other equivalent software will be used to assign material properties and to calculate the stress, strain, density distribution and various other physical parameters when it is subjected to static load using the software. The FEA results will be shared to AIIMS Rajkot and based on them orthotic management will be provided to the patient. The patients will be followed up prospectively at regular periods and the FEA and joint modelling will be done to observe the tissue level and biomechanical changes along with contact pressures in the said joint, thereby observing the progression of the degenerative process in osteoarthritic knee joints.


 
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