Total Knee AnthroplastyPhase 1/2COSTINCT06809998
COntralateral CorticoSTeroid Injection in Total Knee Arthroplasty
A Phase 1/2 study testing Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL). and Band-Aid in people with Total Knee Anthroplasty and Osteoarthritis(Primary), run by Unity Health Toronto at 1 site in Canada.
Trial summary
Through a triple-blinded randomized control trial, the primary purpose of this pilot study is to assess the efficacy of administering peri-operative contralateral corticosteroid injection in patients undergoing TKA. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Total Knee Anthroplasty, Osteoarthritis(Primary), Osteoarthritis (OA) of the Knee
- What is being tested?
- Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL). and Band-Aid
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 60 participants
- Where
- 1 siteCanada
- Study dates
- 24 Jan 2025to 30 Aug 2027
- Phase
- Phase 1/2
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients 18 years of age and older
- Primary osteoarthritis diagnosis with indication for primary elective unilateral TKA
- No previous contralateral knee injections (steroids/biologics) within one year of study
- Not scheduled for bilateral TKA or a subsequent staged contralateral TKA within the next six months
- No previous or active infection or trauma (osseous/ligamentous/extensor mechanism) on the contralateral knee
- Contralateral knee pain \& symptoms - defined as a VAS of >4/10 at initial pre-op visit
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- Contralateral knee OA quantified as: Kellgren and Lawrence grade >2-4
- Assessed by PI (AK) who will not be contributing any patients to the study through examination of blinded knee radiographs (3 views: AP/lateral/Sunrise)
- Patient is able to read and understand English and provide informed consent to participation in the study
Who cannot join
- Other aetiologies of OA that warrants TKA (inflammatory or post traumatic arthritis)
- Cognitive impairment (dementia, Alzheimer's, uncontrolled delirium) which will prevent patients from completing primary outcome measure or comply with follow-up requirements
- Previous TKA or ORIF or nailing on either knee
- Previous or active knee infection or extensor mechanism disruption
- Previous arthroscopy on either knee
- Medical contraindication to elective TKA surgery
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Cassandra Tardif-Theriault, BKin contact
Canada1 site, 1 recruiting
- Recruiting
St. Michael's Hospital
Toronto, Ontario, M5B 1W8
Amir Khoshbin, MD, FRCS (C), 416-864-5265, amir.khoshbin@unityhealth.to
Cassandra Tardif-Theriault, BKin, 416-864-6060 ext. 77117, cassandra.tardif-theriault@unityhealth.to
About this study
Official title: COSTI: COntralateral CorticoSTeroid Injection in Total Knee Arthroplasty - A Triple Blinded, Randomized Controlled Trial Pilot Study
Through a triple-blinded randomized control trial, the primary purpose of this pilot study is to assess the efficacy of administering peri-operative contralateral corticosteroid injection in patients undergoing TKA. The secondary outcome was to assess the effect of contralateral corticosteroid injection on pain and functional outcomes of patients undergoing TKA.
Read the detailed description
Total knee arthroplasty (TKA) is a common and successful procedure used to improve the quality of life and function for patients experiencing debilitating pain from degenerative knee osteoarthritis (OA).
Some patients with knee OA have bilateral involvement and surgery may be needed in both knees. Having bilateral knee OA is a known risk factor for dissatisfaction, as there can be an overuse of the less affected, contralateral knee, in order to avoid symptoms from the more severely affected knee. Moreover, one of the principal determinants of patient-reported functional outcome after a unilateral TKA is residual pain and limited function in the contralateral, un-replaced knee.
One option to improve range of motion, pain, functional scores and reduce postoperative stiffness on both knees is a bilateral TKA; however, it has been previously reported to have a higher risk of serious cardiac complications, pulmonary complications, and mortality when compared with a unilateral TKA. A less invasive and widely available treatment option is intra-articular corticosteroids applied pre-/peri-operatively in the contralateral (un-replaced) knee to improve post-operative rehabilitation.
Intra-articular corticosteroids are extensively used to reduce inflammation and pain in inflamed arthritic joints. They are associated with a moderate improvement in pain and a small improvement in physical function usually up to 3 months after injection. The use of intra-articular corticosteroids in patients with symptomatic knee OA has been shown to improve Visual Analog Scale (VAS) scores at up to 3 months, as well as the WOMAC scores up to 6 months, compared with baseline scores. There is limited data on contralateral steroid injections and its impact on surgical site infection or PROMs.
It is estimated that from 6.5% to 20% of patients report early dissatisfaction after knee replacement surgery. Furthermore, having bilateral OA is a known risk factor for dissatisfaction among patients who undergo TKA. Residual pain, limited function and limited range of motion are primary factors in patient satisfaction after undergoing TKA. Therefore, improved pain control in the contralateral knee is hypothesized to play a role in improving patient satisfaction after a TKA on the opposite side, in addition to helping with the post-operative rehabilitation process.
Understanding whether contralateral steroid injections confer superior functional and/or patient reported outcome measures after a TKA is critical to enhance patient care and improve patient functional outcomes in OA patients. There is currently a lack of high-quality prospective trials investigating the use of contralateral corticosteroid injections for TKA outcomes.
The COSTI trial (Contralateral Steroid Injection in Total Knee Arthroplasty) was developed to fill this knowledge gap. We propose a prospective, triple-blinded (patient, surgeon and outcome assessor), randomized controlled trial comparing contralateral corticosteroid knee injections versus placing a band-aid (control) in patients with bilateral osteoarthritis undergoing a TKA for osteoarthritis.
- Conditions
- Total Knee Anthroplasty, Osteoarthritis(Primary), Osteoarthritis (OA) of the Knee, Bilateral Knee Osteoarthritis
- Being tested
- Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL)., Band-Aid
- Keywords
- COSTI, Total Knee Arthroplasty, Corticosteroid Injection
- Medical subject headings
- Osteoarthritis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).Drug
Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
Band-AidOther
Band-Aid
| Study group | Role | What they receive |
|---|---|---|
| Group A - Corticosteroid Injection | Experimental | Corticosteroid injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL).
The patient will be brought to the regional room where a fully licensed anaesthesiologist will perform standard of care anaesthesia followed by an ultrasound guided intra-articular knee injection with steroid AFTER the spinal neuraxial blockage has already been administered. Receives: Drug: Corticosteroid Injection - 80mg methylprednisolone (total volume 2ml) with 6 mL of 1% Bupivacaine without epinephrine (Total Volume 8 mL). |
| Group B - Band-Aid Placement | Sham comparator | The patient will be brought to the regional room where a fellowship trained interventional pain/regional anaesthesiologist will perform standard of care anaesthesia followed by the application of a band-aid. Receives: Other: Band-Aid |
What is being measured
The primary outcome is the main question the study is designed to answer.
Oxford Knee Score (OKS)
Repeated mean score of a short questionnaire consisting of 12 questions ranging from 0 to 48 points, designed to assess function and pain after knee replacement surgery. Higher values represent a better outcome.
Measured: 4-, 8-, 12-weeks and 1-year post-surgery
Secondary outcomes (5)
Visual Analogue Scale (VAS) Pain Score
Assess pain from a visual scale that ranges from 0 to 10. Straight line with the endpoints defining extreme limits such as 'no pain at all' (zero) and 'pain as bad as it could be' (ten). Assess both the operative and injected knees.
Measured: 4-, 8-, 12-weeks and 1-year post-surgery
EuroQol five-dimensional descriptive system (EQ-5D-5L)
The European Quality of Life 5 Dimensions (EQ5D) is a patient reported outcome where patients self rate their level of severity of health status and health related quality of life. Consists of 5 dimensions (mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) and each one of them has 5 levels (no problems, slight problems, moderate problems, severe problems, and extreme problems) where patients will indicate how they feel regarding their health status and quality of life.
Measured: 4-, 8-, 12-weeks and 1-year post-surgery
Knee range of motion (ROM)
The therapist/assessor uses a goniometer (instrument that measures an angle of a joint) to measure the degree of knee flexion and extension of a patient. Knee ROM of both the operated and injected knees will be taken.
Knee Flexion - the measurable degree in which the leg (and knee joint) is bent. Knee Extension - The measurable degree in which the knee is extended (making the joint angle larger, or straightening the knee.
Measured: 4-, 8-, 12-weeks and 1-year post-surgery
Timed Up Go Test (TUG)
TUG is a simple test used to assess a person's mobility (in seconds) and requires both static and dynamic balance. A line is placed on the floor 3 meters away from a chair where patient will be sitting.
When instructed to "GO" patient will stand, walk to a line on the floor at his/her regular pace, turn around and walk back to the chair and sit down. The longer it takes for subject to complete the test, higher is the risk of fall and lower is the its functional mobility.
Reference values are:
60-69 years old = 8.1 seconds; 70-79 years old = 9.2 seconds; 80-99 years old = 11.3 seconds. Over 14 seconds is associate with high risk of fall
Measured: 4-, 8-, 12-weeks and 1-year post-surgery
Forgotten Joint Score (FJS)
A patient-reported outcome measure (PROM) that assesses how well a patient can forget about an affected knee after surgery. 12-question survey that asks patients to rate their awareness of their knee during daily activities.
Patients answer each question on a scale of 0-4, with 0 being "never aware" and 4 being "mostly aware". The final score ranges from 0-100, with higher scores indicating less awareness of the knee.
Measured: 12-weeks and 1-year post-surgery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Feb 2025
- Study start24 Jan 2025
- Primary completion30 Aug 2026 (estimated)
- Study completion30 Aug 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (16)Papers the sponsor has linked to this study.
- Other trials for Total Knee AnthroplastyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Triple-blind randomized controlled superiority trial
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Outcomes assessor
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Unity Health Toronto
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Amir Khoshbin, MD, FRCS (C), Principal investigator, Unity Health Toronto
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06809998
- Sponsor's protocol ID
- 24-158
- Acronym
- COSTI
- Status last verified
- Apr 2026
- First submitted
- 20 Jan 2025
- Last updated
- 30 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Following completion of the trial, de-identified participant data that support the findings of the study will be made available upon reasonable request to the corresponding author, subject to institutional approvals, applicable privacy regulations, and data sharing agreements.
Publications
Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg. 2017 Oct;25(10):703-714. doi: 10.5435/JAAOS-D-16-00541.
PubMed 28953085da Costa BR, Hari R, Juni P. Intra-articular Corticosteroids for Osteoarthritis of the Knee. JAMA. 2016 Dec 27;316(24):2671-2672. doi: 10.1001/jama.2016.17565.
PubMed 28027351Tian K, Cheng H, Zhang J, Chen K. Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Apr;97(15):e0240. doi: 10.1097/MD.0000000000010240.
PubMed 29642145Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty. 2013 Aug;28(7):1141-7. doi: 10.1016/j.arth.2012.09.023. Epub 2013 Mar 19.
PubMed 23518424Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007 Jun;89(6):1220-6. doi: 10.2106/JBJS.F.01353.
PubMed 17545424Sheth DS, Cafri G, Paxton EW, Namba RS. Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality. J Arthroplasty. 2016 Sep;31(9 Suppl):212-6. doi: 10.1016/j.arth.2016.03.018. Epub 2016 Mar 17.
PubMed 27430183Bagsby D, Pierson JL. Functional outcomes of simultaneous bilateral versus unilateral total knee arthroplasty. Orthopedics. 2015 Jan;38(1):e43-7. doi: 10.3928/01477447-20150105-59.
PubMed 25611419Meehan JP, Monazzam S, Miles T, Danielsen B, White RH. Postoperative Stiffness Requiring Manipulation Under Anesthesia Is Significantly Reduced After Simultaneous Versus Staged Bilateral Total Knee Arthroplasty. J Bone Joint Surg Am. 2017 Dec 20;99(24):2085-2093. doi: 10.2106/JBJS.17.00130.
PubMed 29257014Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty. 2017 Dec;32(12):3854-3860. doi: 10.1016/j.arth.2017.07.021. Epub 2017 Jul 21.
PubMed 28844632Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. The rate and predictors of patient satisfaction after total knee arthroplasty are influenced by the focus of the question: a standard satisfaction question is required. Bone Joint J. 2018 Jun 1;100-B(6):740-748. doi: 10.1302/0301-620X.100B6.BJJ-2017-1292.R1.
PubMed 29855236Huang S, Li X, Tang Y, Stiphan S, Yan B, He P, Xu D. Different patient satisfaction levels between the first and second knee in the early stage after simultaneous bilateral total knee arthroplasty (TKA): a comparison between subjective and objective outcome assessments. J Orthop Surg Res. 2017 Jul 26;12(1):121. doi: 10.1186/s13018-017-0605-0.
PubMed 28747231Walmsley P, Murray A, Brenkel IJ. The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade. Data from the Scottish Arthroplasty Project. Knee. 2006 Mar;13(2):102-5. doi: 10.1016/j.knee.2006.01.003. Epub 2006 Feb 14.
PubMed 16481171Marmon AR, Zeni JA Jr, Snyder-Mackler L. Perception and presentation of function in patients with unilateral versus bilateral knee osteoarthritis. Arthritis Care Res (Hoboken). 2013 Mar;65(3):406-13. doi: 10.1002/acr.21825.
PubMed 22933450Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006 Nov;452:35-43. doi: 10.1097/01.blo.0000238825.63648.1e.
PubMed 16967035Lim JB, Chou AC, Chong HC, Lo NN, Chia SL, Tay KJ, Yeo SJ. Are patients more satisfied and have better functional outcome after bilateral total knee arthroplasty as compared to total hip arthroplasty and unilateral total knee arthroplasty surgery? A two-year follow-up study. Acta Orthop Belg. 2015 Dec;81(4):682-9.
PubMed 26790791