Short term patient outcomes after total knee arthroplasty: Does the implant matter?

Molloy, Ilda B.; Keeney, Benjamin J.; Sparks, Michael; Paddock, Nicholas G.; Koenig, Karl; Moschetti, Wayne E.; Jevsevar, David S.

doi:10.1016/j.knee.2019.01.018

Cited by 16 publications

(19 citation statements)

References 46 publications

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“…There was no relation between these radiolucencies and any of the migration profiles (translations, rotations, MTPM). Similar to other studies, 13 , 27 - 29 differences in the secondary outcome parameters such as clinical outcome and PROMS were not found, but the study was not powered for these parameters.…”

Section: Discussionsupporting

confidence: 72%

A randomized controlled trial comparing tibial migration of the ATTUNE cemented cruciate-retaining knee prosthesis with the PFC-sigma design

Kaptein

Hollander

Thomassen

et al. 2020

The Bone & Joint Journal

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Aims The primary objective of this study was to compare migration of the cemented ATTUNE fixed bearing cruciate retaining tibial component with the cemented Press-Fit Condylar (PFC)-sigma fixed bearing cruciate retaining tibial component. The secondary objectives included comparing clinical and radiological outcomes and Patient Reported Outcome Measures (PROMs). Methods A single blinded randomized, non-inferiority study was conducted including 74 patients. Radiostereometry examinations were made after weight bearing, but before hospital discharge, and at three, six, 12, and 24 months postoperatively. PROMS were collected preoperatively and at three, six, 12, and 24 months postoperatively. Radiographs for measuring radiolucencies were collected at two weeks and two years postoperatively. Results The overall migration (mean maximum total point motion (MPTM)) at two years was comparable: mean 1.13 mm (95% confidence interval (CI), 0.97 to 1.30) for the ATTUNE and 1.16 mm (95% CI, 0.99 to 1.35) for the PFC-sigma. At two years, the mean backward tilting was -0.43° (95% CI, -0.65 to -0.21) for the ATTUNE and 0.08° (95% CI -0.16 to 0.31), for the PFC-sigma. Overall migration between the first and second postoperative year was negligible for both components. The clinical outcomes and PROMs improved compared with preoperative scores and were not different between groups. Radiolucencies at the implant-cement interface were mainly seen below the medial baseplate: 17% in the ATTUNE and 3% in the PFC-sigma at two weeks, and at two years 42% and 9% respectively (p = 0.001). Conclusion In the first two postoperative years the initial version of the ATTUNE tibial component was not inferior with respect to overall migration, although it showed relatively more backwards tilting and radiolucent lines at the implant-cement interface than the PFC-sigma. The version of the ATTUNE tibial component examined in this study has subsequently undergone modification by the manufacturer. Level of Evidence: 1 (randomized controlled clinical trial) Cite this article: Bone Joint J 2020;102-B(9):1158–1166.

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Section: Discussionsupporting

confidence: 72%

A randomized controlled trial comparing tibial migration of the ATTUNE cemented cruciate-retaining knee prosthesis with the PFC-sigma design

Kaptein

Hollander

Thomassen

et al. 2020

The Bone & Joint Journal

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“…This is in accordance with the current studies with the largest cohort of patients; Molloy, Martin, and Ranawatt analysed respectively 2116, 1983, and 200 patients who undergone these two types of TKAs and failed to find any significant difference at functional scores [20][21][22][23]. Only a significant reduction of patellar crepitus and length of stay in hospital were seen in patients who underwent Attune TKA [20,22]. Discordant with these results are some minor studies with limited cohort of patients, which showed a little superiority of Attune TKA at functional scores [24,25].…”

Section: Discussionsupporting

confidence: 92%

No reduced patellar loading with latest-generation cruciate-retaining total knee arthroplasty—a comparative study of Attune and Press-Fit Condylar®

Schiapparelli

Ahmadi

Amsler

et al. 2020

International Orthopaedics (SICOT)

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Purpose To investigate if the latest-generation cruciate-retaining total knee arthroplasty (CR-TKA) systems through more patella-friendly femoral trochlea reduce the patellar bone loading. Methods Twenty patients who underwent Attune CR-TKA were matched with twenty-one patients who underwent Press-Fit Condylar® (PFC) CR-TKA. The patella was always preserved. The in vivo patellar loading was measured twice by two blinded observers and localised on an 8-quadrant grid on 1-year post-operatively SPECT/CT images. The position of the TKA components, patella height, thickness, tilt, and tibial tuberosity-trochlear groove index were measured in 3D CT. Knee function was assessed pre-operatively, at 12 and 24 months post-operatively with the knee society score (KSS). All data were compared between groups with the Mann-Whitney U test and within groups with Spearman's correlation. Results A significantly higher bone tracer uptake (BTU) was seen in the Attune group in the lateral non-articular patellar quadrants. No other significant differences of the BTU were seen. The post-operative KSS did not differ significantly. Spearman's correlation showed no correlations between the significantly higher BTU of the lateral non-articular patellar quadrants and the position of the TKA and patellar measurements. All patellar measurements did not correlate with bone stress in SPECT/CT. Conclusion No significant improvement in terms of in vivo patellar bone stress was seen with the latest-generation CR-TKA system. The increased bone stress at the non-articular lateral patellar quadrants of the Attune could be due to higher stabilising quadriceps forces.

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“…These authors even question the legitimacy of using a newer and costlier design in the absence of clear benefits. Another retrospective analysis by Molloy et al [8] demonstrated that Attune implants do not appear to improve ROM and physical function outcomes relative to PFC. The primary goal of the modification of a well-established implant should be an improvement of functional outcome and a decrease of unsatisfied patients.…”

Section: Discussionmentioning

confidence: 99%

Mid-term results show no significant difference in postoperative clinical outcome, pain and range of motion between a well-established total knee arthroplasty design and its successor: a prospective, randomized, controlled trial

Hauer

Hörlesberger

Klim

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to compare the clinical and functional outcome scores following total knee arthroplasty (TKA) with two different systems. The hypothesis was that there is a difference between patients receiving the newer design than those receiving the predecessor. Methods Two hundred patients who underwent TKA were randomized into two groups: patients received either Attune TKA or PFC Sigma (both DePuy Synthes, Warsaw, IN). Clinically, the Knee Society Knee and Function Scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Range of Motion (ROM) and Visual Analogue Scale (VAS) were evaluated and compared between the groups 2 years after surgery. 158 patients (80 in the Attune group and 78 in the PFC Sigma group) were available for follow-up. Results Through bivariate analysis using parametric and non-parametric statistical tests, no significant differences in postoperative KS, FS, WOMAC, ROM or VAS between the two groups were detected. Both groups significantly improved regarding all evaluated endpoints 2 years after surgery. Conclusions In the current study population, no difference in clinical outcome between the two systems was found. The expected benefits of design modifications could not be observed in clinical outcome scores 2 years postoperatively. Both designs are effective options for improving pain and function in end-stage osteoarthritis. Level of evidence I.

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Short term patient outcomes after total knee arthroplasty: Does the implant matter?

Cited by 16 publications

References 46 publications

A randomized controlled trial comparing tibial migration of the ATTUNE cemented cruciate-retaining knee prosthesis with the PFC-sigma design

A randomized controlled trial comparing tibial migration of the ATTUNE cemented cruciate-retaining knee prosthesis with the PFC-sigma design

No reduced patellar loading with latest-generation cruciate-retaining total knee arthroplasty—a comparative study of Attune and Press-Fit Condylar®

Mid-term results show no significant difference in postoperative clinical outcome, pain and range of motion between a well-established total knee arthroplasty design and its successor: a prospective, randomized, controlled trial

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