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

Abstract

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. 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). 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. 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.