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Turgeon TR, Vasarhelyi E, Howard J, Teeter M, Righolt CH, Gascoyne T, Bohm E. Randomized controlled trial comparing traditional versus enhanced-fixation designs of a novel cemented total knee arthroplasty tibial component. Bone Jt Open 2024; 5:20-27. [PMID: 38229582 DOI: 10.1302/2633-1462.51.bjo-2023-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Aims A novel enhanced cement fixation (EF) tibial implant with deeper cement pockets and a more roughened bonding surface was released to market for an existing total knee arthroplasty (TKA) system.This randomized controlled trial assessed fixation of the both the EF (ATTUNE S+) and standard (Std; ATTUNE S) using radiostereometric analysis. Methods Overall, 50 subjects were randomized (21 EF-TKA and 23 Std-TKA in the final analysis), and had follow-up visits at six weeks, and six, 12, and 24 months to assess migration of the tibial component. Low viscosity bone cement with tobramycin was used in a standardized fashion for all subjects. Patient-reported outcome measure data was captured at preoperative and all postoperative visits. Results The patient cohort mean age was 66 years (SD seven years), 59% were female, and the mean BMI was 32 kg/m2 (SD 6 kg/m2). Mean two-year subsidence of the EF-TKA was 0.056 mm (95% confidence interval (CI) 0.025 to 0.086) versus 0.006 mm (95% CI -0.029 to 0.040) for the Std-TKA, and the two-year maximum total point motion (MTPM) was 0.285 mm (95% upper confidence limit (UCL) ≤ 0.363) versus 0.346 mm (95% UCL ≤ 0.432), respectively, for a mean difference of -0.061 mm (95% CI -0.196 to 0.074). Inducible displacement also did not differ between groups. The MTPMs between 12 and 24 months for each group was below the published threshold of 0.2 mm for predicting early aseptic loosening (p < 0.001 and p = 0.001, respectively). Conclusion Both the enhanced fixation and the standard tibial implant design showed fixation with a predicted low risk of long-term aseptic loosening.
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Affiliation(s)
- Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada
| | | | - James Howard
- London Health Sciences Centre, London, Ontario, Canada
| | - Matthew Teeter
- London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Christiaan H Righolt
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada
| | | | - Eric Bohm
- Concordia Joint Replacement Group, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada
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Yüksel Y, Koster LA, Kaptein BL, Nelissen RGHH, den Hollander P. No difference in component migration at five years between the cemented cruciate-retaining ATTUNE and PFC-Sigma knee prosthesis: an update of a randomized clinical radiostereometry trial. Bone Joint J 2023; 105-B:1168-1176. [PMID: 37907075 DOI: 10.1302/0301-620x.105b11.bjj-2022-0839.r4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes. Methods A total of 74 primary TKAs were included in this single-blind RCT. RSA examinations were performed, and PROMs and clinical outcomes were collected immediate postoperatively, and at three, six, 12, 24, and 60 months' follow-up. Radiolucent lines (RLLs) were measured in standard anteroposterior radiographs at six weeks, and 12 and 60 months postoperatively. Results At five-year follow-up, RSA data from 61 patients were available and the mean maximum total point motion (MTPM) of the femoral components were: ATTUNE: 0.96 mm (95% confidence interval (CI) 0.79 to 1.14) and PFC-Sigma 1.37 mm (95% CI 1.18 to 1.59) (p < 0.001). The PFC-Sigma femoral component migrated more in the first postoperative year, but stabilized thereafter. MPTM of the tibial components were comparable at five-year follow-up: ATTUNE 1.12 mm (95% CI 0.95 to 1.31) and PFC-Sigma 1.25 mm (95% CI 1.07 to 1.44) (p = 0.438). RLL at the medial tibial implant-cement interface remained more prevalent for the ATTUNE at five-year follow-up compared to the PFC-Sigma (20% vs 3%). RLL did not progress over time, and varied between patients at different timepoints for both TKA systems. Clinical outcomes and PROMs improved compared with preoperative scores, and were not different between groups. Conclusion MTPM migration at five-year follow-up of the femoral and tibial component of the ATTUNE were similar and as low as that of the PFC-Sigma. MTPM migration of both knee implants did not significantly change from one year post-surgery, indicating stable fixation. Long-term ATTUNE performance may be expected to be comparable to the clinically well-performing PFC-Sigma. We have not found evidence of increased tibial component migration as measured by RSA to support concerns about cement debonding and a higher risk of aseptic loosening with the ATTUNE TKA.
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Affiliation(s)
- Yasin Yüksel
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
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O'Donovan P, McAleese T, Harty J. Does lucency equate to revision? A five-year retrospective review of Attune and Triathlon total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:4773-4781. [PMID: 37516985 PMCID: PMC10598109 DOI: 10.1007/s00167-023-07509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The Attune® total knee arthroplasty system was introduced in 2013 to address lingering issues of patient dissatisfaction. However, recent literature reports concerns of early tibial tray debonding. The aim of this study was to compare the incidence of radiolucent lines, survivorship and patient reported outcome-measures between the Attune® system and the well-established Triathlon® system. METHODS This retrospective database review was conducted at a single institution in Cork, Ireland. All primary Attune® (N = 445) and Triathlon® (N = 285) systems implanted between 2015 and 2016 were reviewed. Radiolucent lines were assessed for those with a minimum two-year radiological follow-up (Attune® = 338; Triathlon® = 231). X-rays were taken post op, at 6 months, 2 years and 5 years. Radiolucent lines were documented using the Modern Knee Society Radiographic System. Five-year survival was assessed using Kaplan-Meier analysis with the Log Rank method to determine statistical significance. The Oxford Knee Score and EQ-5D-5L, were collected pre-op, at 6 months, 2 years and 5 years post-operatively and compared using the Kruskal-Wallis Test. RESULTS The Attune® had a higher proportion of radiolucent lines at the tibial tray [87.1% (54/62) vs 61.4% (27/44); p = 0.001] and at the implant-cement interface [62.9% (39/62) vs 43.2% (19/44); p = 0.02]. Conversely, the Triathlon® had a higher proportion AT the femur [38.6% (17/44) vs 12.9% (8/62); p = 0.001] and at the cement-bone interface [56.8% (25/44) vs 37.1% (23/62); p = 0.02]. The overall frequency of radiolucent lines was similar in both the Attune® and Triathlon® groups [17.8%, (60/338) vs 17.7%, (41/231); p = 0.49]. There was no difference in revision-free survival analysis at 5 years (Attune® 97.8% vs Triathlon® 95.8%; p = 0.129). The Attune® performed better at 5 years in the Oxford Knee Score [Attune® = 42.6 (SD 5.2) vs Triathlon® = 41 (SD 6.4); p = 0.001] and in the EQ-5D [Attune® = 0.773 (SD 0.187) vs Triathlon® = 0.729 (SD 0.218); p = 0.013]. There was no difference at 5 years in the EQ-VAS [Attune® = 80.4 (SD 13.7) vs Triathlon® = 78.5 (SD 15.3); p = 0.25]. CONCLUSION The Attune® system exhibited a higher incidence of radiolucent lines at the tibial tray. However, this did not lead to decreased survivorship at medium term follow-up compared to the Triathlon®. Furthermore, improvements in patient reported outcomes modestly favoured the Attune® system. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Paul O'Donovan
- School of Medicine, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland.
| | - Timothy McAleese
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
| | - James Harty
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
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Prodromidis AD, Chloros GD, Thivaios GC, Sutton PM, Pandit H, Giannoudis PV, Charalambous CP. High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty. Bone Joint J 2023; 105-B:610-621. [PMID: 37259548 DOI: 10.1302/0301-620x.105b6.bjj-2022-0675.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Loosening of components after total knee arthroplasty (TKA) can be associated with the development of radiolucent lines (RLLs). The aim of this study was to assess the rate of formation of RLLs in the cemented original design of the ATTUNE TKA and their relationship to loosening. Methods A systematic search was undertaken using the Cochrane methodology in three online databases: MEDLINE, Embase, and CINAHL. Studies were screened against predetermined criteria, and data were extracted. Available National Joint Registries in the Network of Orthopaedic Registries of Europe were also screened. A random effects model meta-analysis was undertaken. Results Of 263 studies, 12 were included with a total of 3,861 TKAs. Meta-analysis of ten studies showed high rates of overall tibial or femoral RLLs for the cemented original design of the ATTUNE TKA. The overall rate was 21.4% (95% confidence interval (CI) 12.7% to 33.7%) for all types of design but was higher for certain subgroups: 27.4% (95% CI 13.4% to 47.9%) for the cruciate-retaining type, and 29.9% (95% CI 15.6% to 49.6%) for the fixed-bearing type. Meta-analysis of five studies comparing the ATTUNE TKA with other implants showed a significantly higher risk of overall tibial or femoral RLLs (odds ratio (OR) 2.841 (95% CI 1.219 to 6.623); p = 0.016) for the ATTUNE. The rates of loosening or revision for loosening were lower, at 1.2% and 0.9% respectively, but the rates varied from 0% to 16.3%. The registry data did not report specifically on the original ATTUNE TKA or on revision due to loosening, but 'all-cause' five-year revision rates for the cemented ATTUNE varied from 2.6% to 5.9%. Conclusion The original cemented ATTUNE TKA has high rates of RLLs, but their clinical significance is uncertain given the overall low associated rates of loosening and revision. However, in view of the high rates of RLLs and the variation in the rates of loosening and revision between studies and registries, close surveillance of patients who have undergone TKA with the original ATTUNE system is recommended.
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Affiliation(s)
- Apostolos D Prodromidis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - George D Chloros
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | | | - Paul M Sutton
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hemant Pandit
- Department of Orthopaedics, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
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Does design change in total knee arthroplasty implants affect patient-reported outcomes? BMC Surg 2023; 23:49. [PMID: 36882774 PMCID: PMC9993584 DOI: 10.1186/s12893-023-01948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE The purpose of this study is to compare the early results of patient-reported outcomes between two generations of a total knee system. METHODS Between June 2018 and April 2020, 121 first-generation, cemented TKAs (89 patients) and 123 s-generation, cemented TKAs (98 patients) were performed by a single surgeon. Demographic and surgical data were collected from all patients. Starting at the 6-month follow-up, patient-reported outcome measures Knee Injury and Osteoarthritis Outcome Score, Joint Reconstruction (KOOS-JR) and Knee Society (KS) clinical and radiographic scores were prospectively recorded. This study represents a retrospective review of these prospectively collected data. RESULTS There were no statistically significant differences between the two groups in terms of demographic variables such as age, body mass index, gender and race. KOOS-JR and Knee Society (KS) scores improved significantly (p < 0.001) from their preoperative values in both device generations. There were no differences, pre-operatively, between the two groups in terms of KOOS-JR, KS functional, KS objective, patient satisfaction, and expectation scores; however, there were statistically significant (p < 0.001) lower values of KOOS-JR and KS functional scores for first versus second generation at 6 months (81 vs. 89 and 69 vs. 74, respectively). CONCLUSION While significant improvement in KS objective, subjective, and patient satisfaction scores were noted with both knee systems, KOOS-JR and KS function scores were significantly higher at the early (6-month) follow-up in the second-generation group. Patients responded acutely to the design change as evidenced by significantly improved patient-reported outcome scores for the second generation.
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Ruckenstuhl P, Revelant F, Hauer G, Bernhardt GA, Leitner L, Gruber G, Leithner A, Sadoghi P. No difference in clinical outcome, pain, and range of motion between fixed and mobile bearing Attune total knee arthroplasty: a prospective single-center trial. BMC Musculoskelet Disord 2022; 23:413. [PMID: 35501786 PMCID: PMC9063062 DOI: 10.1186/s12891-022-05382-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/25/2022] [Indexed: 12/11/2022] Open
Abstract
Background Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits. Methods The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up. Results The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups (p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° (p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings (p = 0.012). Conclusion According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05382-x.
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Affiliation(s)
- Paul Ruckenstuhl
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Fabio Revelant
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Georg Hauer
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Gerald Gruber
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
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Panchani SK, Divecha HM, Lafferty R, Pavlou G, Oakley J, Shaw D, Chitre A, Wynn Jones H, Raut V, Smith R, Gambhir A, Board T. Early Functional Outcomes After Evolutionary Total Knee Arthroplasty: A Randomized Controlled Trial. Is New Always Better? JB JS Open Access 2021; 6:JBJSOA-D-21-00016. [PMID: 34337284 PMCID: PMC8318648 DOI: 10.2106/jbjs.oa.21.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Total knee replacement (TKR) designs continue to evolve with the aim of improving patient outcomes; however, there remains a significant patient dissatisfaction rate. We report the early functional outcomes of an evolutionary knee design in the context of a single-blinded, noninferiority, randomized controlled trial.
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Affiliation(s)
| | | | | | | | - Jez Oakley
- Wrightington Hospital, Wigan, United Kingdom
| | - Debbie Shaw
- Wrightington Hospital, Wigan, United Kingdom
| | - Amol Chitre
- Wrightington Hospital, Wigan, United Kingdom
| | | | - Videsh Raut
- Wrightington Hospital, Wigan, United Kingdom
| | | | | | - Tim Board
- Wrightington Hospital, Wigan, United Kingdom
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Shetty G, Khairkar S. Loading on Attune® fixed-bearing cruciate-substituting total knee implant in knee malalignment during activities of daily living: A finite element analysis. J Orthop 2021; 26:36-41. [PMID: 34290486 DOI: 10.1016/j.jor.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose To compare contact stresses between Attune® and PFC Sigma® total knee arthroplasty (TKA) implants in the presence of knee malalignment. Methods Maximum contact stress after finite element analysis were compared during standing, walking, and stair climbing in 0°, 2.5° and 5°varus/valgus knee alignments. Results The percentage increase in contact stress was highest during walking with PFC Sigma® in 5° varus (238.5%), standing with Attune® in 5° valgus (127.2%), and standing with Attune® in 2.5° valgus (107.8%). Conclusion The newer Attune® design may be associated with higher maximum contact stresses and increased risk of wear and implant failure.
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Affiliation(s)
- Gautam Shetty
- Knee & Orthopaedic Clinic, Mumbai, India.,AIMD Research, Mumbai, India
| | - Shruti Khairkar
- Department of Mechanical Engineering, IIT Bombay, Mumbai, India
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