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
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 sec...
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Medical Journals Sweden
2025-01-01
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| Series: | Acta Orthopaedica |
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| Online Access: | https://actaorthop.org/actao/article/view/42744 |
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| author | Raymond Puijk Lennard A Koster Bart G C W Pijls Jiwanjot Singh Marjolein Schager Bart L Kaptein Peter A Nolte |
| author_facet | Raymond Puijk Lennard A Koster Bart G C W Pijls Jiwanjot Singh Marjolein Schager Bart L Kaptein Peter A Nolte |
| author_sort | Raymond Puijk |
| collection | DOAJ |
| description |
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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| format | Article |
| id | doaj-art-8734376e70e9466688ff4f5df4bd24d8 |
| institution | Kabale University |
| issn | 1745-3674 1745-3682 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj-art-8734376e70e9466688ff4f5df4bd24d82025-01-13T13:39:12ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822025-01-019610.2340/17453674.2024.427445-year migration and inducible displacement of the uncemented LCS and ATTUNE rotating platform knee systems: a secondary report of a randomized controlled RSA trialRaymond Puijk0https://orcid.org/0000-0002-0953-0070Lennard A Koster1https://orcid.org/0000-0002-5874-389XBart G C W Pijls2https://orcid.org/0000-0001-5351-5057Jiwanjot Singh3Marjolein Schager4Bart L Kaptein5https://orcid.org/0000-0001-8772-9985Peter A Nolte6Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the NetherlandsDepartment of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Orthopaedics, Spaarne Gasthuis, Hoofddorp; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands 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. https://actaorthop.org/actao/article/view/42744ArthroplastyImplantsKneeOsteoarthrosis |
| spellingShingle | Raymond Puijk Lennard A Koster Bart G C W Pijls Jiwanjot Singh Marjolein Schager Bart L Kaptein Peter A Nolte 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 Acta Orthopaedica Arthroplasty Implants Knee Osteoarthrosis |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Arthroplasty Implants Knee Osteoarthrosis |
| url | https://actaorthop.org/actao/article/view/42744 |
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