“Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis”
Abstract Background Patellar component design in total knee arthroplasty (TKA) can influence patellofemoral kinematics and clinical outcomes. The medialized dome design (MDD) aligns the patella apex more medially, while the anatomic patella design (APD) aims to replicate the native patella’s shape a...
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| Format: | Article |
| Language: | English |
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BMC
2025-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05858-1 |
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| author | Sina Hajiaghajani Omid Bahrami Mohammadhossein Hefzosseheh Maryam Alaei Amir Mehrvar Mohammad Poursalehian |
| author_facet | Sina Hajiaghajani Omid Bahrami Mohammadhossein Hefzosseheh Maryam Alaei Amir Mehrvar Mohammad Poursalehian |
| author_sort | Sina Hajiaghajani |
| collection | DOAJ |
| description | Abstract Background Patellar component design in total knee arthroplasty (TKA) can influence patellofemoral kinematics and clinical outcomes. The medialized dome design (MDD) aligns the patella apex more medially, while the anatomic patella design (APD) aims to replicate the native patella’s shape and tracking. Although biomechanical studies suggest potential benefits of APD, clinical evidence remains inconclusive. Methods A systematic review and meta-analysis following PRISMA guidelines was conducted to compare the clinical outcomes of MDD and APD in a modern posterior-stabilized TKA (ATTUNE system). We searched PubMed, Scopus, Embase, and Web of Science on January 10, 2025, without language or date restrictions. Eligible studies included randomized controlled trials (RCTs) and comparative cohort designs evaluating patient-reported outcome measures (PROMs), revisions, complications, range of motion (ROM), and radiologic measures of patellar stability. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for cohort studies. Pooled effect sizes were calculated using Hedges’s g and random-effects modeling. Results Seven studies, including three RCTs and four cohort studies, with a total of 1,069 patients and 1,113 knees (507 APD vs. 606 MDD), were included. The meta-analysis demonstrated no significant difference in PROMs (Hedges’s g = 0.09; 95% CI [–0.04 to 0.22]; P = 0.17) or ROM (Hedges’s g = 0.02; 95% CI [–0.21 to 0.26]; P = 0.83) between APD and MDD. While revision rates and complications were higher for APD, the differences were not statistically significant compared to MDD (14 vs 9). Radiographic measures showed inconsistencies and did not definitively favor either design. Conclusions Current evidence suggests that APD offers no clear clinical advantage over MDD in the ATTUNE posterior-stabilized TKA. Both designs yield broadly comparable PROMs and knee function outcomes. Larger RCTs with extended follow-up are warranted to clarify the safety of APD. Level of evidence III. |
| format | Article |
| id | doaj-art-c4005d324a37446ebc167acd3533bc3b |
| institution | OA Journals |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-c4005d324a37446ebc167acd3533bc3b2025-08-20T02:10:56ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-05-0120111110.1186/s13018-025-05858-1“Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis”Sina Hajiaghajani0Omid Bahrami1Mohammadhossein Hefzosseheh2Maryam Alaei3Amir Mehrvar4Mohammad Poursalehian5Student Research Committee, School of Medicine, Shahid Beheshti University of Medical SciencesStudent Research Committee, School of Medicine, Tehran University of Medical SciencesStudent Research Committee, Shiraz University of Medical ScienceSchool of Medicine, Shahid Beheshti University of Medical SciencesClinical Research Development Unit (CRDU), Taleghani Hospital, Shahid Beheshti University of Medical SciencesJoint Reconstruction Research Center, Tehran University of Medical SciencesAbstract Background Patellar component design in total knee arthroplasty (TKA) can influence patellofemoral kinematics and clinical outcomes. The medialized dome design (MDD) aligns the patella apex more medially, while the anatomic patella design (APD) aims to replicate the native patella’s shape and tracking. Although biomechanical studies suggest potential benefits of APD, clinical evidence remains inconclusive. Methods A systematic review and meta-analysis following PRISMA guidelines was conducted to compare the clinical outcomes of MDD and APD in a modern posterior-stabilized TKA (ATTUNE system). We searched PubMed, Scopus, Embase, and Web of Science on January 10, 2025, without language or date restrictions. Eligible studies included randomized controlled trials (RCTs) and comparative cohort designs evaluating patient-reported outcome measures (PROMs), revisions, complications, range of motion (ROM), and radiologic measures of patellar stability. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for cohort studies. Pooled effect sizes were calculated using Hedges’s g and random-effects modeling. Results Seven studies, including three RCTs and four cohort studies, with a total of 1,069 patients and 1,113 knees (507 APD vs. 606 MDD), were included. The meta-analysis demonstrated no significant difference in PROMs (Hedges’s g = 0.09; 95% CI [–0.04 to 0.22]; P = 0.17) or ROM (Hedges’s g = 0.02; 95% CI [–0.21 to 0.26]; P = 0.83) between APD and MDD. While revision rates and complications were higher for APD, the differences were not statistically significant compared to MDD (14 vs 9). Radiographic measures showed inconsistencies and did not definitively favor either design. Conclusions Current evidence suggests that APD offers no clear clinical advantage over MDD in the ATTUNE posterior-stabilized TKA. Both designs yield broadly comparable PROMs and knee function outcomes. Larger RCTs with extended follow-up are warranted to clarify the safety of APD. Level of evidence III.https://doi.org/10.1186/s13018-025-05858-1Patellar resurfacingAnatomic patellaMedialized domeTotal knee arthroplasty |
| spellingShingle | Sina Hajiaghajani Omid Bahrami Mohammadhossein Hefzosseheh Maryam Alaei Amir Mehrvar Mohammad Poursalehian “Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis” Journal of Orthopaedic Surgery and Research Patellar resurfacing Anatomic patella Medialized dome Total knee arthroplasty |
| title | “Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis” |
| title_full | “Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis” |
| title_fullStr | “Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis” |
| title_full_unstemmed | “Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis” |
| title_short | “Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis” |
| title_sort | anatomic patella design versus medialized dome design in the modern posterior stabilized attune total knee arthroplasty a systematic review and meta analysis |
| topic | Patellar resurfacing Anatomic patella Medialized dome Total knee arthroplasty |
| url | https://doi.org/10.1186/s13018-025-05858-1 |
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