Early tibial loosening of the cemented ATTUNE knee arthroplasty – Just a question of design?

Jaeger, Sebastian; Eissler, Marvin; Schwarze, Martin; Schonhoff, Mareike; Kretzer, Jan Philippe; Bitsch, Rudi G.

doi:10.1016/j.knee.2021.01.003

Cited by 14 publications

(9 citation statements)

References 8 publications

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“…The Attune component showed a 2 mm radial press fit with maximum incomplete seating of 1.8 mm for the cement mantle instrumentation. The radial press fit effect as reported by Jaeger et al 38 could be enhanced in sclerotic bone. Evaluation of the postoperative radiographs showed no significant differences in the cement penetration area for the AP or the lateral radiographs between both investigated groups.…”

Section: Discussionsupporting

confidence: 60%

“…The ligament tension force during cement hardening and the impaction force must exceed the radial press fit. Jaeger et al 38 found an increased radial press fit around the tibial stem and keel, with growing radii of the rounded tibial edges and with decreasing cement mantle space around the implants. The Attune component showed a 2 mm radial press fit with maximum incomplete seating of 1.8 mm for the cement mantle instrumentation.…”

Section: Discussionmentioning

confidence: 98%

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Does tibial design modification improve implant stability for total knee arthroplasty? An experimental cadaver study

Jaeger

Eissler

Schwarze

et al. 2022

Bone & Joint Research

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Aims One of the main causes of tibial revision surgery for total knee arthroplasty is aseptic loosening. Therefore, stable fixation between the tibial component and the cement, and between the tibial component and the bone, is essential. A factor that could influence the implant stability is the implant design, with its different variations. In an existing implant system, the tibial component was modified by adding cement pockets. The aim of this experimental in vitro study was to investigate whether additional cement pockets on the underside of the tibial component could improve implant stability. The relative motion between implant and bone, the maximum pull-out force, the tibial cement mantle, and a possible path from the bone marrow to the metal-cement interface were determined. Methods A tibial component with (group S: Attune S+) and without (group A: Attune) additional cement pockets was implanted in 15 fresh-frozen human leg pairs. The relative motion was determined under dynamic loading (extension-flexion 20° to 50°, load-level 1,200 to 2,100 N) with subsequent determination of the maximum pull-out force. In addition, the cement mantle was analyzed radiologically for possible defects, the tibia base cement adhesion, and preoperative bone mineral density (BMD). Results The BMD showed no statistically significant difference between both groups. Group A showed for all load levels significantly higher maximum relative motion compared to group S for 20° and 50° flexion. Group S improved the maximum failure load significantly compared to group A without additional cement pockets. Group S showed a significantly increased cement adhesion compared to group A. The cement penetration and cement mantle defect analysis showed no significant differences between both groups. Conclusion From a biomechanical point of view, the additional cement pockets of the component have improved the fixation performance of the implant. Cite this article: Bone Joint Res 2022;11(4):229–238.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 98%

Does tibial design modification improve implant stability for total knee arthroplasty? An experimental cadaver study

Jaeger

Eissler

Schwarze

et al. 2022

Bone & Joint Research

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“…A recent report showed that excessive press fit may lead to incomplete seating or tilting of the tibial component, especially in hard and uneven sclerotic bone. 52 Another factor attributed to tibial loosening is stress shielding. The ATTUNE system uses a thick CoCr tibial baseplate, and there has been a report of an increased rate of medial tibial bone resorption with the ATTUNE TKA, presenting in various locations and severities around the baseplate.…”

Section: Discussionmentioning

confidence: 99%

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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“…Regarding the latter, per manufacturer literature, the surface roughness of the tibial component is decreased compared to the femoral component (60 grit blasts vs. 220 grit blasts). Compared to the femoral component, the decreasing grit blast combined with the increased rotational forces and reduced surface area of the tibial baseplate may lead to the failures seen at the tibial implant-bone cement interface [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Early Aseptic Failure of the Tibial Component-Cement Interface in ATTUNE® Total Knee Arthroplasty: A Report of Three Cases

Murphy¹,

Braunlich²,

IV³

et al. 2021

Cureus

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Total knee arthroplasty (TKA) systems are designed to maximize the longevity of the implant. However, an unusually high rate of aseptic tibial tray loosening was observed in the DePuy ATTUNE ® total knee arthroplasty system (DePuy Synthes, Warsaw, USA). Affected patients noted symptoms of instability and reproducible pain at the bone-implant interface. However, there was no radiographic evidence of lucency or implant failure. Intra-operatively, the tibial component was grossly loose and lacked adhered cement. We hypothesize that the loosening is due to the smooth architecture of the undersurface of the tibial component, lacking either grit blasting or porous coating.

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Early tibial loosening of the cemented ATTUNE knee arthroplasty – Just a question of design?

Cited by 14 publications

References 8 publications

Does tibial design modification improve implant stability for total knee arthroplasty? An experimental cadaver study

Does tibial design modification improve implant stability for total knee arthroplasty? An experimental cadaver study

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

Early Aseptic Failure of the Tibial Component-Cement Interface in ATTUNE® Total Knee Arthroplasty: A Report of Three Cases

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