Radiolucent lines and revision risk in total knee arthroplasty using the conventional versus the Attune S+ tibial baseplate.

This multicentre retrospective observational study's aims were to investigate whether there are differences in the occurrence of radiolucent lines (RLLs) following total knee arthroplasty (TKA) between the conventional Attune baseplate and its successor, the novel Attune S+, independent from other potentially influencing factors; and whether tibial baseplate design and presence of RLLs are associated with differing risk of revision. A total of 780 patients (39% male; median age 70.7 years (IQR 62.0 to 77.2)) underwent cemented TKA using the Attune Knee System) at five centres, and with the latest radiograph available for the evaluation of RLL at between six and 36 months from surgery. Univariate and multivariate logistic regression models were performed to assess associations between patient and implant-associated factors on the presence of tibial and femoral RLLs. Differences in revision risk depending on RLLs and tibial baseplate design were investigated with the log-rank test. The conventional and novel Attune baseplates were used in 349 (45%) and 431 (55%) patients, respectively. At a median follow-up of 14 months (IQR 11 to 25), RLLs were present in 29% (n = 228/777) and 15% (n = 116/776) of the tibial and femoral components, respectively, and were more common in the conventional compared to the novel baseplate. The novel baseplate was independently associated with a lower incidence of tibial and femoral RLLs (both regardless of age, sex, BMI, and time to radiograph). One- and three-year revision risk was 1% (95% CI 0.4% to 1.9%)and 6% (95% CI 2.6% to 13.2%), respectively. There was no difference between baseplate design and the presence of RLLs on the the risk of revision at short-term follow-up. The overall incidence of RLLs, as well as the incidence of tibial and femoral RLLs, was lower with the novel compared to the conventional tibial Attune baseplate design, but higher than in the predecessor design and other commonly used TKA systems.

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© 2024 The British Editorial Society of Bone & Joint Surgery.

Déclaration de conflit d'intérêts

S. Donner reports payments for lectures and Instructional courses from DePuy Synthes and Mathys/Enovis, and payment for participation on Smith & Nephew's Female Global Advisory Board, unrelated to this study. M. T. Hirschmann reports consulting fees and speaker payments or honoraria from Smith & Nephew, Depuy Synthes, and Symbios, all unrelated to this study. M. T. Hirschmann also holds leadership or fiduciary roles in the German Knee Society, the Personalized Arthroplasty Society, and ESSKA. A. Leithner reports institutional education grants from Alphamed, Johnson & Johnson, and Medacta, unrelated to this study. T. Renkawitz reports speaker payments or honoraria from Arbeitsgemeinschaft Endoprothetik (AE), BVOU, DGOU, DePuy International, DGOOC, Otto Bock Foundation, Deutsche Arthrose Hilfe, Aesculap, Zimmer, Stiftung Oskar Helene Heim Berlin, Vielberth Foundation Regensburg, the German Ministry of Education and Research, and the German Federal Ministry of Economic Cooperation and Development, all unrelated to this study. T. Renkawitz is also Medical Director and Chair of the Orthopaedic Department of Heidelberg University Hospital, Vice President of BVOU, a board member of DGOOC, and President of AOUC. P. Sadoghi received industrial grants from DePuy Synthes, Medacta, and Implantcast, unrelated to this study, and is an editorial board member for KSSTA, JOA, and Arthroscopy. M. A. Smolle reports support for attending meetings and/or travel from Implantcast, Alphamed Fischer, and Pharmamar, unrelated to this study. R. Windhager reports consulting fees from Johnson & Johnson and Stryker European Operations, a product development agreement with DePuy Synthes, and medical education and life case observation agreements with Johnson & Johnson, all unrelated to this study.