Unexpected high rate of revision of a modern cemented fixed bearing modular posterior-stabilized knee arthroplasty

Author:

Lachiewicz Paul F.12,Steele John R.1,Wellman Samuel S.12

Affiliation:

1. Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA

2. Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA

Abstract

Aims To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. Methods This is a retrospective study of 166 (154 patients) consecutive cemented, fixed bearing, posterior-stabilized (PS) TKAs (ATTUNE) at one hospital performed by five surgeons. These were compared with a reference cohort of 511 knees (470 patients) of other designs (seven manufacturers) performed at the same hospital by the same surgeons. There were no significant differences in age, sex, BMI, or follow-up times between the two cohorts. The primary outcome was revision performed or pending. Results In total, 19 (11.5%) ATTUNE study TKAs have been revised at a mean 30.3 months (SD 15), and loosening of the tibial component was seen in 17 of these (90%). Revision is pending in 12 (7%) knees. There was no difference between the 31 knees revised or with revision pending and the remaining 135 study knees in terms of patient characteristics, type of bone cement (p = 0.988), or individual surgeon (p = 0.550). In the reference cohort, there were significantly fewer knees revised (n = 13, 2.6%) and with revision pending (n = 8, 1.5%) (both p < 0.001), and only two had loosening of the tibial component as the reason for revision. Conclusion This new TKA design had an unexpectedly high early rate of revision compared with our reference cohort of TKAs. Debonding of the tibial component was the most common reason for failure. Additional longer-term follow-up studies of this specific component and techniques for implantation are warranted. The version of the ATTUNE tibial component implanted in this study has undergone modifications by the manufacturer. Cite this article: Bone Joint J 2021;103-B(6 Supple A):137–144.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

Reference48 articles.

1. Ten-Year Follow-up of a Rotating-Platform, Posterior-Stabilized Total Knee Arthroplasty

2. Patient dissatisfaction following total knee replacement

3. No authors listed. The ATTUNE primary total knee replacement value dossier. 2013. Depuy Synthes Companies. https://static1.squarespace.com/static/56b145a91d07c07730995ec0/t/56d1f3ea86db43f4f76f3947/1456600050367/ATTUNE_Value_Dossier.pdf (date last accessed 8 January 2021).

4. No authors listed. 17th Annual Report 2020. National Joint Registry. https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2017th%20Annual%20Report%202020.pdf (date last accessed 12 March 2020).

5. No authors listed. Hip, Knee & Shoulder Arthroplasty: Annual Report 2020. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). 2020. https://aoanjrr.sahmri.com/annual-reports-2020 (date last accessed 8 January 2021).

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