Kantonsspital St.Gallen

No difference in radiolucent lines after TKA: a matched-pair analysis of the classic implant and its evolutional design

Henrik Behrend, Bettina Hochreiter, Primoz Potocnik, Yassir El Baz, Vilijam Zdravkovic & Thiago Tomazi


Total knee arthroplasty (TKA) designs evolve continuously to improve patient outcomes. However, incidences of radiolucent lines (RLL) in the latest TKA system have recently been reported, raising concerns. The purpose of the current study was to compare radiographic outcomes of this new TKA implant to its predecessor design.

A group of 100 patients undergoing TKA using the newer design (Attune) was matched by age and gender to 191 patients with the classic design (LCS). All patients underwent computer-navigated primary TKA by the same surgeon using the same technique. Radiographs were taken before discharge, and 2 and 12 months postoperatively. Radiographic analysis was performed independently by three assessors, using the Modern Knee Society Radiographic Evaluation System and Methodology (MKSRES).

At 12 months postoperatively, the incidence of RLL did not statistically differ between the two implants (14%, n = 14 Attune vs. 8% n = 17 LCS, n.s.). The posterior femoral flange was most commonly affected (12%; n = 12 Attune vs. 7.9%; n = 15 LCS, n.s.) followed by the anterior flange (1%; n = 1 Attune vs. 3.1%; n = 6 LCS, n.s.). The tibial baseplate was only affected in 1% (n = 1) of the Attune and 2.6% (n = 5) of the LCS (n.s.).

At 12 months follow-up we found no significant difference in RLL between the two implants. Both Attune and LCS TKA systems showed RLL predominantly at the posterior femoral flange. The reasons for the RLL remain a matter of speculation; however, shortcomings in surgical and cementing techniques seem to be more important than implant-related factors.

citation Behrend H, Hochreiter B, Potocnik P, El Baz Y, Zdravkovic V, Tomazi T. No difference in radiolucent lines after TKA: a matched-pair analysis of the classic implant and its evolutional design. Knee Surg Sports Traumatol Arthrosc 2020; 28:3962-3968.
type journal paper/review (English)
date of publishing 15-02-2020
journal title Knee Surg Sports Traumatol Arthrosc (28/12)
ISSN electronic 1433-7347
pages 3962-3968
PubMed 32062683
DOI 10.1007/s00167-020-05894-w