No difference in joint awareness after TKA: a matched-pair analysis of a classic implant and its evolutional design

  • Henrik BehrendEmail author
  • Vilijam Zdravkovic
  • Marco Bösch
  • Bettina Hochreiter



Total knee arthroplasty (TKA) designs continuously evolve with the aim of improving patient outcomes. The purpose of the current study was to compare clinical and patient-reported outcome (PRO) results of a new TKA implant to its predecessor. The hypothesis of this study was that joint awareness and range of motion (ROM) of the newer design would be better than the classic design.


One hundred patients undergoing TKA using the newer design (Attune®) were matched by age and gender to 200 patients with the classic design (LCS®). All patients underwent computer-navigated (Vector Vision, Brain-Lab, Germany) primary TKA by the same surgeon using the same technique. Data (FJS-12, WOMAC and ROM) were collected preoperatively and at 12 months follow-up at our implant registry.


Compared to preoperative scores, FJS-12, WOMAC and ROM improved significantly at 12 months follow-up. In the Attune group, mean FJS-12 and WOMAC at follow-up were 67.6 (SD 27.8) and 14.8 (SD 14.9) respectively, compared to 70.8 (SD 33.8) and 15 (SD 17.9) in the LCS group. Mean postoperative ROM was similar in both groups (Attune 120°, range 90°–140°, SD 10.4 and LCS 120°, range 85°–140°, SD 10.3).


The newer TKA and the predecessor design achieved comparable joint awareness, WOMAC scores and ROM at 1-year follow-up. The benefits expected of the newer design could not be observed in early clinical and PROs. The clinical relevance of this study is that it questions the importance of implant design as the single most important factor for patient outcomes.

Level of evidence



Total knee arthroplasty TKA Attune LCS Forgotten Joint Score-12 (FJS-12) Matched-pair analysis Patient-reported outcomes (PROs) 



No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval was obtained from the local ethics committee (Ethikkommission Ostschweiz, Project ID 2018-00927).


  1. 1.
    Amis AA, Senavongse W, Bull AMJ (2006) Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res 24(12):2201–2211CrossRefGoogle Scholar
  2. 2.
    Anand R, Graves SE, de Steiger RN, Davidson DC, Ryan P et al (2011) What is the benefit of introducing new hip and knee prostheses? J Bone Jt Surg 3:51–54CrossRefGoogle Scholar
  3. 3.
    Baumann F, Ernstberger T, Loibl M, Zeman F, Nerlich M et al (2016) Validation of the German Forgotten Joint Score (G-FJS) according to the COSMIN checklist: does a reduction in joint awareness indicate clinical improvement after arthroplasty of the knee? Arch Orthop Trauma Surg 136(2):257–264CrossRefGoogle Scholar
  4. 4.
    Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 27(3):430–436CrossRefGoogle Scholar
  5. 5.
    Bellamy N, Buchanan WW (1986) A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 5(2):231–241CrossRefGoogle Scholar
  6. 6.
    Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R et al (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis Care Res 51:100–109CrossRefGoogle Scholar
  7. 7.
    Hamilton DF, Giesinger JM, MacDonald DJ, Simpson AHRW, Howie CR et al (2016) Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty. Bone Jt Res 5(3):87–91CrossRefGoogle Scholar
  8. 8.
    Hamilton DF, Loth FL, Giesinger JM, Giesinger K, MacDonald DJ et al (2017) Validation of the English language Forgotten Joint Score-12 as an outcome measure for total hip and knee arthroplasty in a British population. Bone Jt J 99(2):218–224CrossRefGoogle Scholar
  9. 9.
    Hossain FS, Konan S, Patel S, Rodriguez-Merchan EC, Haddad FS (2015) The assessment of outcome after total knee arthroplasty: are we there yet? Bone Jt J 97(1):3–9CrossRefGoogle Scholar
  10. 10.
    Indelli PF, Pipino G, Johnson P, Graceffa A, Marcucci M (2016) Posterior-stabilized total knee arthroplasty: a matched pair analysis of a classic and its evolutional design. Arthroplasty Today 2:193–198CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Kalson NS, Borthwick LA, Mann DA, Deehan DJ, Lewis P et al (2016) International consensus on the definition and classification of fibrosis of the knee joint. Bone Jt J 98(11):1479–1488CrossRefGoogle Scholar
  12. 12.
    Kim YH, Park JW, Kim JS (2012) High-flexion total knee arthroplasty: survivorship and prevalence of osteolysis: results after a minimum of ten years of follow-up. J Bone Jt Surg 94(15):1378–1384CrossRefGoogle Scholar
  13. 13.
    Ko YB, Jang EC, Park SM, Kim SH, Kwak YH et al (2015) No difference in clinical and radiologic outcomes after total knee arthroplasty with a new ultra-congruent mobile bearing system and rotating platform mobile bearing systems after minimum 5-year follow-up. J Arthroplasty 30:379–383CrossRefGoogle Scholar
  14. 14.
    Lampart M, Behrend H, Moser LB, Hirschmann MT (2018) Due to great variability fixed HKS angle for alignment of the distal cut leads to a significant error in coronal TKA orientation. Knee Surg Sports Traumatol Arthrosc. Google Scholar
  15. 15.
    Martin JR, Jennings JM, Watters TS, Levy DL, McNabb DC et al (2017) Femoral implant design modification decreases the incidence of patellar crepitus in Total knee arthroplasty. J Arthroplasty 32:1310–1313CrossRefGoogle Scholar
  16. 16.
    Matsumoto M, Baba T, Homma Y, Kobayashi H, Ochi H et al (2015) Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure. Eur J Orthop Surg Traumatol 25(7):1141–1145CrossRefGoogle Scholar
  17. 17.
    Peltola M, Malmivaara A, Paavola M (2012) Introducing a knee endoprosthesis model increases risk of early revision surgery. Clin Orthop Relat Res 470(6):1711–1717CrossRefGoogle Scholar
  18. 18.
    Ranawat CS, White PB, West S, Ranawat AS (2017) Clinical and radiographic results of attune and PFC sigma knee designs at 2-year follow-up: a prospective matched-pair analysis. J Arthroplasty 32(2):431–436CrossRefGoogle Scholar
  19. 19.
    Shadid MB, Vinken NS, Marting LN, Wolterbeek N (2016) The Dutch version of the Forgotten Joint Score: test-retesting reliability and validation. Acta Orthop Belg 82(1):112–118Google Scholar
  20. 20.
    Thienpont E, Opsomer G, Koninckx A, Houssiau F (2013) Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint Score. J Arthroplasty 29(1):48–51CrossRefGoogle Scholar
  21. 21.
    Thompson SM, Salmon LJ, Webb JM, Pinczewski LA, Roe JP (2015) Construct validity and test re-test reliability of the Forgotten Joint Score. J Arthroplasty 30(11):1902–1905CrossRefGoogle Scholar
  22. 22.
    Thomsen MG, Husted H, Otte KS, Holm G, Troelsen A (2013) Do patients care about higher flexion in total knee arthroplasty? A randomized, controlled, double-blinded trial. BMC Musculoskelet Disord 14:127CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Vanden ETA, Schwab BPE, Cornu JPFO (2016) Joint awareness in osteoarthritis of the hip and knee evaluated with the ‘Forgotten Joint’ Score before and after joint replacement. Knee Surg Sports Traumatol Arthrosc 24(10):3346–3351CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyKantonsspital St. GallenSt. GallenSwitzerland

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