5-year migration and inducible displacement of the uncemented LCS and ATTUNE rotating platform knee systems: a secondary report of a randomized controlled RSA trial
DOI:
https://doi.org/10.2340/17453674.2024.42744Keywords:
Arthroplasty, Implants, Knee, OsteoarthrosisAbstract
Background and purpose: Early migration of the uncemented cruciate-sacrificing rotating platform ATTUNE and Low Contact Stress (LCS) tibial components was classified as at-risk for aseptic loosening rates exceeding 6.5% at 15 years based on recent fixation-specific migration thresholds. In this secondary report of a randomized controlled trial (RCT) we aimed to evaluate whether the 5-year migration, inducible displacement, and the clinical outcome of the ATTUNE components were comparable to those of the LCS.
Methods: Patients from the initial 2-year radiostereometric analysis (RSA) RCT were recruited for a 5-year follow-up. At 5 years, participants underwent 2 supine and 1 loaded RSA examination, clinical assessments, and questionnaires. Migration was analyzed using maximum total point motion (MTPM), translations, and rotations, focusing on 5-year migration, continuous migration (> 0.10 mm/year), and inducible displacement. Revisions, along with clinical and functional outcomes, were also evaluated.
Results: At 5 years, 24 ATTUNE and 24 LCS implants were analyzed. The mean MTPM was similar for tibial components (ATTUNE 1.13mm [confidence interval (CI) 0.94–1.33]; LCS 1.24 mm [CI 1.05–1.46]) but significantly lower for the ATTUNE femoral component (1.14 mm [CI 0.92–1.39]) than LCS 1.87 mm [CI 1.57–2.21]). 2-to-5-year migration rates were comparable, but 11 ATTUNE and 7 LCS exceeded 0.10 mm MTPM/year, indicating a higher risk of loosening. Inducible displacement was similar, although 1 patient with a tibial ATTUNE showed excessive displacement (3.34 mm MTPM) with focal osteolysis but no symptoms. 1 revision 10 days post-surgery was performed for an ATTUNE insert spinout, resolved with an isolated insert exchange. Clinical and functional outcomes were comparable.
Conclusion: At the 5-year follow-up, ATTUNE tibial components showed similar migration, while the femoral component migrated significantly less than the LCS, which mainly occurred during the first 2 years. 2-to-5-year migration rates, inducible displacement, and clinical and functional outcomes were comparable. These findings suggest a comparable long-term risk of aseptic loosening between the uncemented ATTUNE and LCS knee systems.
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Anand R, Graves S E, de Steiger R N, Davidson D C, Ryan P, Miller L N, et al. What is the benefit of introducing new hip and knee prostheses? J Bone Joint Surg Am 2011; 93(Suppl 3): 51-4. doi: 10.2106/JBJS.K.00867. DOI: https://doi.org/10.2106/JBJS.K.00867
Nelissen R G H H, Pijls B G, Kärrholm J, Malchau H, Nieuwenhuijse M J, Valstar E R. RSA and registries: the quest for phased introduction of new implants. J Bone Joint Surg Am 2011; 93(Suppl 3): 62-5. doi: 10.2106/JBJS.K.00907. DOI: https://doi.org/10.2106/JBJS.K.00907
Lewis P L, Graves S E, De Steiger R N, Campbell D G, Peng Y, Hatton A, et al. Does knee prosthesis survivorship improve when implant designs change? Findings from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478: 1156-72. doi: 10.1097/CORR.0000000000001229. DOI: https://doi.org/10.1097/CORR.0000000000001229
Staats K, Wannmacher T, Weihs V, Koller U, Kubista B, Windhager R. Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor. Knee Surg Sports Traumatol Arthrosc 2019; 27: 1148-55. doi: 10.1007/S00167-018-5130-0. DOI: https://doi.org/10.1007/s00167-018-5130-0
Torino D, Damsgaard C, Kolessar D J, Hayes D S, Foster B, Constantino J, et al. Tibial baseplate–cement interface debonding in the ATTUNE total knee arthroplasty system. Arthroplast Today 2022; 17: 165. doi: 10.1016/J.ARTD.2022.06.012. DOI: https://doi.org/10.1016/j.artd.2022.06.012
Jaeger S, Eissler M, Schwarze M, Schonhoff M, Kretzer J P, Bitsch R G. Early tibial loosening of the cemented ATTUNE knee arthroplasty: just a question of design? Knee 2021; 30: 170-5. doi: 10.1016/J.KNEE.2021.01.003. DOI: https://doi.org/10.1016/j.knee.2021.01.003
Kaptein B L, Pijls B G C W, Koster L, Kärrholm J, Hull M, Niesen A, et al. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95: 256. doi: 10.2340/17453674.2024.40709. DOI: https://doi.org/10.2340/17453674.2024.40709
Laende E K, Dunbar M J, Richardson C G. Predictive value of short-term migration in determining long-term stable fixation in cemented and cementless total knee arthroplasties. Bone Joint J 2019; 101: 55-60. doi: 10.1302/0301-620X.101B7.BJJ-2018-1493.R1. DOI: https://doi.org/10.1302/0301-620X.101B7.BJJ-2018-1493.R1
Puijk R, Puijk R H, Laende E K, Dunbar M J, Plevier J W M, Nolte P A, et al. 6-month migration sufficient for evaluation of total knee replacements: a systematic review and meta-analysis. Acta Orthop 2023; 94: 577-87. doi: 10.2340/17453674.2023.24579. DOI: https://doi.org/10.2340/17453674.2023.24579
Toksvig-Larsen S, Ryd L, Lindstrand A. Early inducible displacement of tibial components in total knee prostheses inserted with and without cement: a randomized study with roentgen stereophotogrammetric analysis. J Bone Joint Surg Am 1998; 80: 83-9. DOI: https://doi.org/10.2106/00004623-199801000-00014
Uvehammer J, Kärrholm J. Inducible displacements of cemented tibial components during weight-bearing and knee extension observations during dynamic radiostereometry related to joint positions and 2 years history of migration in 16 TKR. J Orthop Res 2001; 19: 1168-77. doi: 10.1016/S0736-0266(01)00046-8. DOI: https://doi.org/10.1016/S0736-0266(01)00046-8
Broberg J S, Koff M F, Howard J L, Lanting B A, Potter H G, Teeter M G. A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging. J Orthop Res 2024; 42: 100-8. doi: 10.1002/JOR.25662. DOI: https://doi.org/10.1002/jor.25662
Wilson D A J, Astephen J L, Hennigar A W, Dunbar M J. Inducible displacement of a trabecular metal tibial monoblock component. J Arthroplasty 2010; 25: 893-900. doi: 10.1016/J.ARTH.2009.06.015. DOI: https://doi.org/10.1016/j.arth.2009.06.015
Lam Tin Cheung K, Lanting B A, McCalden R W, Yuan X, MacDonald S J, Naudie D D, et al. Inducible displacement of cemented tibial components ten years after total knee arthroplasty. Bone Joint J 2018; 100B: 170-5. doi: 10.1302/0301-620X.100B2.BJJ-2017-0428.R2 DOI: https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0428.R2
Regnér L, Carlsson L, Kärrholm J, Herberts P. Tibial component fixation in porous- and hydroxyapatite-coated total knee arthroplasty: a radiostereometric evaluation of migration and inducible displacement after 5 years. J Arthroplasty 2000; 15: 681-. doi: 10.1054/arth.2000.8103. DOI: https://doi.org/10.1054/arth.2000.8103
Koster L A, Rassir R, Kaptein B L, Sierevelt I N, Schager M, Nelissen R G H H, et al. A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty. Bone Joint J 2023; 105-B: 148-57. doi: 10.1302/0301-620X.105B2.BJJ-2022-0414.R1. DOI: https://doi.org/10.1302/0301-620X.105B2.BJJ-2022-0414.R1
Puijk R, Singh J, Puijk R H, Laende E K, Plevier J W M, Nolte P A, et al. Evaluation and refinement of thresholds for early migration of total knee replacements as an estimator of late aseptic loosening: an updated systematic review of RSA and survival studies. Acta Orthop 2025; 96: 1-10. doi: 10.2340/17453674.2024.42574 DOI: https://doi.org/10.2340/17453674.2024.42574
Rassir R, Puijk R, Singh J, Sierevelt I N, Vergroesen D A, de Jong T, et al. Long-term clinical performance of an uncemented, mobile bearing, anterior stabilized knee system and the impact of previous knee surgery. J Arthroplasty 2022; 37: 2041-8. doi: 10.1016/j.arth.2022.04.039. DOI: https://doi.org/10.1016/j.arth.2022.04.039
McMahon S E, Doran E, O’Brien S, Cassidy R S, Boldt J G, Beverland D E. Seventeen to twenty years of follow-up of the low contact stress rotating-platform total knee arthroplasty with a cementless tibia in all cases. J Arthroplasty 2019; 34: 508-12. doi: 10.1016/J.ARTH.2018.11.024. DOI: https://doi.org/10.1016/j.arth.2018.11.024
Dutch Arthroplasty Registry (LROI). Annual report 2023 [Online]. Available from: https://www.lroi-report.nl.
Schulz K F, Altman D G, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152: 726-32. doi: 10.7326/0003-4819-152-11-201006010-00232. DOI: https://doi.org/10.7326/0003-4819-152-11-201006010-00232
Ryd L, Albrektsson B E, Carlsson L, Dansgård F, Herberts P, Lindstrand A, et al. Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg Br 1995; 77: 377-83. DOI: https://doi.org/10.1302/0301-620X.77B3.7744919
National Joint Registry (NJR): 20th Annual Report 2023 of England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey. [Online]. Available from: https://reports.njrcentre.org.uk/.
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR): Hip, Knee & Shoulder Arthroplasty: Annual Report 2023. Adelaide: AOANJRR; 2023.
Rassir R, Sierevelt I N, Schager M, Nolte P A, Rademakers M V, Vergroesen DA, et al. Design and rationale of the ATtune Knee Outcome Study (ATKOS): multicenter prospective evaluation of a novel uncemented rotating platform knee system. BMC Musculoskelet Disord 2021; 22. doi: 10.1186/S12891-021-04493-1. DOI: https://doi.org/10.1186/s12891-021-04493-1
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Copyright (c) 2025 Raymond Puijk, Lennard A Koster, Bart G C W Pijls, Jiwanjot Singh, Marjolein Schager, Bart L Kaptein, Peter A Nolte
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