Analysis of the Attune tibial tray backside

Cerquiglini, Arianna; Henckel, Johann; Hothi, Harry; Allen, Paul; Lewis, J. L.; Eskelinen, Antti; Skinner, JA; Hirschmann, Michael T.; Hart, Alister

doi:10.1302/2046-3758.83.bjj-2018-0102.r2

Cited by 39 publications

(36 citation statements)

References 22 publications

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“…From a biomechanical point of view, the similar fixation behavior of the CoCrMo and the ZrN multilayer-coated tibial trays is reasonable, because of their equivalent F22 corundium blast surface texture and roughness (Rz 25-35; Ra 3.5-4.5), whereas the PFC Sigma FB has a visible and measureable smoother surface (Rz 5-7; Ra 0.5-1). These results on the PFC Sigma FB tray fit very well into the corridor of roughness values (Ra 0.3-0.74), measured for PFC Sigma FB tibial implants (n ¼ 12 Ti6Al4V; n ¼ 8 CoCrMo) in a comparative retrieval study by Cerquiglini et al [43].…”

Section: Discussionsupporting

confidence: 82%

Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements

Grupp

Schilling²,

Schwiesau

et al. 2020

The Journal of Arthroplasty

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Background: The objectives of this study are to (1) evaluate if there is a potential difference in cemented implant fixation strength between tibial components made out of cobalt-chromium (CrCoMo) and of a ceramic zirconium nitride (ZrN) multilayer coating and to (2) test their behavior with 5 different bone cements in a standardized in vitro model for testing of the implant-cement-bone interface conditions. We also analyzed (3) whether initial fixation strength is a function of timing of the cement apposition and component implantation by an early, mid-term, and late usage within the cement-specific processing window. Methods: An in vitro study using a synthetic polyurethane foam model was performed to investigate the implant fixation strength after cementation of tibial components by a push-out test. A total of 20 groups (n ¼ 5 each) was used: Vega PS CrCoMo tibia and Vega PS ZrN tibia with the bone cements BonOs R, SmartSet HV, Cobalt HV, Palacos R, and Surgical Simplex P, respectively, using mid-term cement apposition. Three different cement apposition timesdearly, mid-term, and late usagedwere tested with a total of 12 groups (n ¼ 5 each) with the bone cements BonOs R and SmartSet HV. Results: There was no significant difference in implant-cement-bone fixation strength between CrCoMo and ZrN multilayer-coated Vega tibial trays tested with 5 different commonly used bone cements. Conclusion: Apposition of bone cements and tibial tray implantation in the early to mid of the cementspecific processing window is beneficial in regard to interface fixation in TKA.

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Section: Discussionsupporting

confidence: 82%

Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements

Grupp

Schilling²,

Schwiesau

et al. 2020

The Journal of Arthroplasty

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“…One paper reported more revisions supposedly related to cement implant debonding for the ATTUNE, 15 however this was a case series without reporting the size of the series in which the findings were made, making it of limited scientific value. 35 , 36 Potential problems with cement adherence to the undersurface of the tibial plateau have also been presented by others, 37 , 38 and for other modern tibial components of TKA implants. 39 Although the undersurface of the ATTUNE tibial plateau has increased roughness compared to the PFC-sigma, it is not equipped with a cement pocket area with an undercut.…”

Section: Discussionmentioning

confidence: 77%

“… 39 Although the undersurface of the ATTUNE tibial plateau has increased roughness compared to the PFC-sigma, it is not equipped with a cement pocket area with an undercut. 38 …”

Section: Discussionmentioning

confidence: 99%

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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“…The parameter, the proportion of bone resorption area, did not include the intensity of bone resorption but reflected whether each area was at risk of bone resorption or not, under the given conditions including the material composition, the design of implant, and thickness of tibial implant. The other possible reason is that the implant Ca used in our study is advanced version compared to the implant used in the previous studies PLOS ONE [27,28]. After the concerns of the implant Ca such as debonding were reported, the company made cement pocket under the tibial baseplate and increased roughness [27].…”

Section: Plos Onementioning

confidence: 98%

A three-dimensional finite element analysis on the effects of implant materials and designs on periprosthetic tibial bone resorption

et al. 2021

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Introduction Implant material is a more important factor for periprosthetic tibial bone resorption than implant design after total knee arthroplasty (TKA). The virtual perturbation study was planned to perform using single case of proximal tibia model. We determined whether the implant materials’ stiffness affects the degree of periprosthetic tibial bone resorption, and whether the effect of material change with the same implant design differed according to the proximal tibial plateau areas. Materials and methods This three-dimensional finite element analysis included two cobalt-chromium (CoCr) and two titanium (Ti) tibial implants with different designs. They were implanted into the proximal tibial model reconstructed using extracted images from computed tomography. The degree of bone resorption or formation was measured using the strain energy density after applying axial load. The same analysis was performed after exchanging the materials while maintaining the design of each implant. Results The degree of periprosthetic tibial bone resorption was not determined by the type of implant materials alone. When the implant materials were changed from Ti to CoCr, the bone resorption in the medial compartment increased and vice versa. The effect of material composition’s change on anterior and posterior areas varied accordingly. Conclusions Although the degree of bone resorption was associated with implant materials, it differed depending on the design of each implant. The effect on the degree of bone resorption according to the materials after TKA should be evaluated while concomitantly considering design.

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Analysis of the Attune tibial tray backside

Cited by 39 publications

References 22 publications

Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements

Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements

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

A three-dimensional finite element analysis on the effects of implant materials and designs on periprosthetic tibial bone resorption

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