Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis?

Abstract

Introduction and Aim: Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. Methods: A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. Results: At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). Conclusion: This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune’s predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.

Comparison of revision rates and epidemiological data of a single total knee arthroplasty system of different designs (cruciate retaining, posterior stabilized, mobile bearing, and fixed bearing): a meta-analysis and systematic review of clinical trials and national arthroplasty registries

“…Twelve papers were found and reviewed for their eligibility to be included into the study in Cochrane. One article met the inclusion criteria and could be included into final analysis [ 25 ].…”

“…Three publications [ 18 – 20 ] published sufficient epidemiological data in the period from 2020 to 2022 included 205 patients who received primary TKA with the Attune TKA. Cochran's trail [ 25 ] included 64 patients who received primary Attune TKA in 2020. The two arthroplasty registries ((1) Germany–EPRD and (2) England, Wales, Northern Ireland, the Isle of Man, States of Guernsey–NJR) collectively included 45 101 Attune TKAs at of follow-up in 2020.…”

“…Pooled data of three clinical studies [ 18 – 20 ], the Cochrane trial [ 25 ] and the two knee registries (EPRD and NJR) showed an average age of 67.8 years (Range 64–70.5y) and a gender distribution of 60% female and 40% male at implantation (range men 22–44.6%; women 52.4–76%). The three clinical studies and the Cochrane trail showed a pooled average BMI of 29.4 kg/m 2 .…”