Attune total knee arthroplasty: is there evidence of early tibial component de-bonding? A prospective cohort study with a minimum two year follow-up

Robinson, Thomas E.; King, Samuel W.; Pilling, R W D; Aderinto, Joseph; Veysi, Veysi; Wall, Owen; Lamb, Jonathan; Pandit, Hemant

doi:10.1016/j.jajs.2021.03.007

Cited by 5 publications

(15 citation statements)

References 30 publications

(31 reference statements)

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“…The results are summarized in Table III. Five studies with a control group showed higher rates of RLLs, predominantly tibial or overall, for the ATTUNE groups, 20,23,24,29,27 with two demonstrating a significant difference. 24,29 Two studies reported no RLLs for the ATTUNE group in either the tibia or femur at a mean follow-up of about two years.…”

Section: Resultsmentioning

confidence: 98%

“…26,31 Three studies reported on the progression of RLLs, 23,24,27 with two showing no progression. 23,27 One reported that medial tibial RLLs were progressive, with the rate increasing from 17% for the ATTUNE group at two weeks’ to 42% at two years’ follow-up. 24 One study compared patients in the ATTUNE group with RLLs with those without RLLs.…”

Section: Resultsmentioning

confidence: 99%

“…20,23,31 Meta-analysis of ten studies including 1,558 TKAs showed an overall rate of 21.4%% (95% CI 12.7% to 33.7%) for any RLL (tibial or femoral) overall. 20-27,29,31…”

Section: Resultsmentioning

confidence: 99%

“…Analysis of six studies compared the rate of RLLs in the ATTUNE TKAs with a variety of other systems (PFC Sigma, Vanguard, PERSONA, LCS). 20,23,24,27,29,26 One study including 200 TKAs reported no RLLs in either group. 26 Meta-analysis of studies with zero events are discarded, hence this study was excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis of six studies showed an overall rate of loosening of 1.2% (95% CI 0.2% to 6.3%) (heterogeneity: tau 2 = 6.092, I 2 = 93.273, Q = 29.731; p < 0.001). 21,23,25,27,29,30 Meta-analysis of three studies reporting on rates of loosening of TKAs with fixed-bearing components showed an overall rate of 2.4% (95% CI 0.2% to 25.5%) (heterogeneity: tau 2 = 4.605, I 2 = 91.283, Q = 22.942; p < 0.001). 21,25,27 Analysis of three studies reporting rates of loosening of TKAs with PS components showed a rate of 1.5% (95% CI 0.1% to 22.6%) (heterogeneity: tau 2 = 3.936, I 2 = 93.702, Q = 79.394; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

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High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty

et al. 2023

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AimsLoosening 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.MethodsA 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.ResultsOf 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%.ConclusionThe 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.Cite this article: Bone Joint J 2023;105-B(6):610–621.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

“…20,23,31 Meta-analysis of ten studies including 1,558 TKAs showed an overall rate of 21.4%% (95% CI 12.7% to 33.7%) for any RLL (tibial or femoral) overall. 20-27,29,31…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty

et al. 2023

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Does lucency equate to revision? A five‐year retrospective review of Attune and Triathlon total knee arthroplasty

O’Donovan

McAleese

Harty

2023

Knee surg. sports traumatol. arthrosc.

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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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Medial tibial bone resorption following total knee arthroplasty comparing a traditional with a kinematic design

Saini,

Reddy,

Reddy

et al. 2023

Arch Orthop Trauma Surg

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Attune total knee arthroplasty: is there evidence of early tibial component de-bonding? A prospective cohort study with a minimum two year follow-up

Abstract: This is a repository copy of Attune total knee arthroplasty: is there evidence of early tibial component de-bonding? A prospective cohort study with a minimum two year follow-up.

Cited by 5 publications

References 30 publications

High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty

High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty

Does lucency equate to revision? A five‐year retrospective review of Attune and Triathlon total knee arthroplasty

Medial tibial bone resorption following total knee arthroplasty comparing a traditional with a kinematic design

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