Knee Fix or Replace Trial (KFORT): A randomized controlled feasibility study

Hull, Peter D., Chou, Daud T. S., Lewis, Sophie, Carrothers, Andrew D., Queally, Joseph M., Allison, Annabel, Barton, Gary and Costa, Matthew L. (2019) Knee Fix or Replace Trial (KFORT): A randomized controlled feasibility study. Bone & Joint Journal, 101-B (11). pp. 1408-1415. ISSN 2049-4394

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AIMS: The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients. PATIENTS AND METHODS: Seven centres recruited patients into the study. Patients were eligible if they were greater than 65 years of age with a distal femoral fracture, and if the surgeon felt that they were suitable for either form of treatment. Outcome measures included the patients' willingness to participate, clinicians' willingness to recruit, rates of loss to follow-up, the ability to capture data, estimates of standard deviation to inform the sample size calculation, and the main determinants of cost. The primary clinical outcome measure was the EuroQol five-dimensional index (EQ-5D) at six months following injury. RESULTS: Of 36 patients who met the inclusion criteria, five declined to participate and eight were not recruited, leaving 23 patients to be randomized. One patient withdrew before surgery. Of the remaining patients, five (23%) withdrew during the follow-up period and six (26%) died. A 100% response rate was achieved for the EQ-5D at each follow-up point, excluding one missing datapoint at baseline. In the DFR group, the mean cost of the implant outweighed the mean cost of many other items, including theatre time, length of stay, and readmissions. For a powered RCT, a total sample size of 1400 would be required with 234 centres recruiting over three years. At six months, the EQ-5D utility index was lower in the DFR group. CONCLUSION: This study found that running a full-scale trial in this country would not be feasible. However, it may be feasible to undertake an international multicentre trial, and our findings provide some guidance about the power of such a study, the numbers required, and some challenges that should be anticipated and addressed. Cite this article: Bone Joint J 2019;101-B:1408-1415.

Item Type: Article
Uncontrolled Keywords: distal femoral fracture,distal femoral replacement,internal fracture fixation,older patient,surgery,orthopedics and sports medicine ,/dk/atira/pure/subjectarea/asjc/2700/2746
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Faculty of Medicine and Health Sciences > Research Groups > Health Economics
Faculty of Medicine and Health Sciences > Research Centres > Population Health
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Depositing User: LivePure Connector
Date Deposited: 18 Nov 2019 15:31
Last Modified: 19 Oct 2023 02:35
DOI: 10.1302/0301-620X.101B11.BJJ-2019-0370.R2

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