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No difference in radiolucent lines after TKA: a matched-pair analysis of the classic implant and its evolutional design

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Total knee arthroplasty (TKA) designs evolve continuously to improve patient outcomes. However, incidences of radiolucent lines (RLL) in the latest TKA system have recently been reported, raising concerns. The purpose of the current study was to compare radiographic outcomes of this new TKA implant to its predecessor design.

Methods

A group of 100 patients undergoing TKA using the newer design (Attune) was matched by age and gender to 191 patients with the classic design (LCS). All patients underwent computer-navigated primary TKA by the same surgeon using the same technique. Radiographs were taken before discharge, and 2 and 12 months postoperatively. Radiographic analysis was performed independently by three assessors, using the Modern Knee Society Radiographic Evaluation System and Methodology (MKSRES).

Results

At 12 months postoperatively, the incidence of RLL did not statistically differ between the two implants (14%, n = 14 Attune vs. 8% n = 17 LCS, n.s.). The posterior femoral flange was most commonly affected (12%; n = 12 Attune vs. 7.9%; n = 15 LCS, n.s.) followed by the anterior flange (1%; n = 1 Attune vs. 3.1%; n = 6 LCS, n.s.). The tibial baseplate was only affected in 1% (n = 1) of the Attune and 2.6% (n = 5) of the LCS (n.s.).

Conclusion

At 12 months follow-up we found no significant difference in RLL between the two implants. Both Attune and LCS TKA systems showed RLL predominantly at the posterior femoral flange. The reasons for the RLL remain a matter of speculation; however, shortcomings in surgical and cementing techniques seem to be more important than implant-related factors.

Level of evidence

III

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Abbreviations

AP:

Anterior–posterior

CR:

Cruciate retaining

Fz:

Femoral zone

ICC:

Interclass-correlation coefficient

MKSRESM:

Modern Knee Society Radiographic Evaluation System and Methodology

RLL:

Radiolucent lines

RP:

Rotating platform

SD:

Standard deviation

TKA:

Total knee arthroplasty

Tz:

Tibial zone

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Funding

No external funding was used.

Author information

Author notes

  1. Henrik Behrend and Bettina Hochreiter contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Henrik Behrend, Bettina Hochreiter, Primoz Potocnik, Vilijam Zdravkovic & Thiago Tomazi

  2. Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Yassir El Baz

Authors
  1. Henrik Behrend
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  2. Bettina Hochreiter
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  3. Primoz Potocnik
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  4. Yassir El Baz
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  5. Vilijam Zdravkovic
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  6. Thiago Tomazi
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Correspondence to Henrik Behrend.

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Approval was obtained from the local ethics committee (Ethikkommission Ostschweiz, Project ID 2019-00927).

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Behrend, H., Hochreiter, B., Potocnik, P. et al. No difference in radiolucent lines after TKA: a matched-pair analysis of the classic implant and its evolutional design. Knee Surg Sports Traumatol Arthrosc 28, 3962–3968 (2020). https://doi.org/10.1007/s00167-020-05894-w

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  • DOI: https://doi.org/10.1007/s00167-020-05894-w

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