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Modern implants in total knee arthroplasty are more patellofemoral joint friendly compared to their traditional design: a systematic review and meta-analysis

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other.

Methods

A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case–control studies).

Results

This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus.

Conclusions

The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups.

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Availability of data and materials

All included studies used in this systematic review and meta-analysis are available online. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request. Data regarding this study are not available in any electronic databases.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India

    Arghya Kundu Choudhury, Kshitij Gupta, Sajid Ansari, Balgovind S. Raja, Souvik Paul & Roop Bhushan Kalia

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  1. Arghya Kundu Choudhury
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  2. Kshitij Gupta
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  3. Sajid Ansari
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  4. Balgovind S. Raja
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  5. Souvik Paul
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Contributions

AKC Planning of study, literature search, writing the manuscript, quality assessment of the included studies. KG Data management, outcome assessment, manuscript preparation, revising the manuscript. SA Literature search, writing the manuscript, quality assessment of the included studies. BSR Data management, outcome assessment, manuscript preparation. SP Literature search, writing the manuscript, quality assessment of the included studies. RBK Planning of study, quality assessment of the included studies, writing and revising the manuscript.

Corresponding author

Correspondence to Roop Bhushan Kalia.

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Choudhury, A.K., Gupta, K., Ansari, S. et al. Modern implants in total knee arthroplasty are more patellofemoral joint friendly compared to their traditional design: a systematic review and meta-analysis. Arch Orthop Trauma Surg 143, 5873–5889 (2023). https://doi.org/10.1007/s00402-023-04832-y

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