Design and rationale of the ATtune Knee Outcome Study (ATKOS): multicenter prospective evaluation of a novel uncemented rotating platform knee system

Abstract

Background: Total Knee Arthroplasty (TKA) remains the gold standard for treatment of debilitating symptoms of knee osteoarthritis (OA). Even though providing satisfactory results for the majority of patients, some studies report dissatisfaction after TKA to be as high as 20%. Among other things, pain catastrophising and self-efficacy are thought to compromise results of TKA. Implant manufacturers keep improving upon their designs in an attempt to improve functional outcomes. One of these novel knee systems is the Attune. To our knowledge, there are no clinical follow-up studies reporting results of the uncemented version. The main objective of this multicentre prospective observational study is to evaluate revision rate, complications, radiographic outcomes (i.e. alignment and radiolucent lines) and patient reported outcomes of the uncemented Attune mobile bearing TKA. Secondary objectives are (1) to assess physical function, return to sport and return to work after TKA and (2) to evaluate the long-term effect of preoperative psychological factors on satisfaction after TKA.

Methods: All patients presenting in the participating centres with knee pathology warranting joint replacement therapy will be considered for inclusion, an absolute indication for cemented fixation is the only exclusion criterium. Evaluation of clinical and radiographic performance (e.g. radiolucent lines) is done at 6 weeks, 6 months, 1 year, 5 years and 10 years after surgery using validated patient reported outcome measures. Cumulative revision rates are calculated after 5 and 10 years using Kaplan-Meier methods. Physical function is assessed with performance based measurements before and 1 year after surgery. Return to sports is assessed using the Tegner and University of California Los Angeles (UCLA) activity rating scale before and 1 year after surgery. Return to work is evaluated by inviting patients of working age to complete a short questionnaire 1 year after surgery. Psychologic factors are assessed using questionnaires for pain catastrophising, pain self-efficacy and mental health before, 5 years and 10 years after surgery. Preoperative psychologic scores are correlated to functional outcomes.

Discussion: The current study aims to report the clinical performance of a novel implant and can help provide insight in factors that play a role in satisfaction after TKA.

Trial registration: ClinicalTrials.gov identifier: NCT04247672 (January 30, 2020).

Keywords: Attune; Pain catastrophizing; Pain self-efficacy; Patient reported outcome measures; Sport; Survivorship; Total knee arthroplasty; Uncemented; Work.

Fig. 1

Oblique (a) and anteroposterior (b) view with landmark features of the uncemented Attune mobile bearing (“rotating platform”) implant (DePuy Synthes, Warsaw, Indiana, USA). A gradually reducing radius of the femoral component (1) allows for more stability during flexion. The patellofemoral surface of the femoral component mimic the original anatomy more closely (2), providing more natural kinematics and patellar tracking during knee flexion. A porous coating on the 4 pegs and proximal part of the central cone provides an ideal environment for fixation (3). Images provided courtesy of DePuy Synthes