J Knee Surg 2018; 31(08): 811-814
DOI: 10.1055/s-0037-1608945
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Response to: Confidence in the ATTUNE Knee is Driven by Real-World Scientific Evidence: Response to Bonutti et al. Article

Peter Bonutti
1  Department of Orthopaedic Surgery, Bonutti Orthopedic Services, LTD, Effingham, Illinois
› Author Affiliations
Further Information

Publication History

12 October 2017

27 October 2017

Publication Date:
28 December 2017 (eFirst)

In a letter to clinicians dated June 14, 2017 (“the DePuy Letter”),[1] Dr. Daniel Funk (US Franchise Medical Director for DePuy Synthes) and Mr. Joshua Bridgens (EMEA Franchise Medical Director for DePuy Synthes) wrote a four-page commentary on the article published in the Journal of Knee Surgery using terms such as “inaccurate” and “misleading” and provided 19 references to support their letter.[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] This is a response to this DePuy commentary.

The article by Bonutti et al points to design issues in the DePuy ATTUNE tibial baseplate DePuy Synthes which may lead to early failure of the tibial component (i.e., cement debonding at the tibial implant cement interface at short-term follow-up). It identifies 15 cases of catastrophic tibial component debonding with tibial component pistoning off the cement mantle and failure of cement fixation to the tibial implant. In these cases, the tibia could simply be lifted off the cement mantle manually ([Figs. 1] [2] [3]). The authors of this article identified several possible design deficiencies, which could contribute to early failure, and these appear to have been confirmed by DePuy's recent launch of the ATTUNE S+ tibia for their fixed bearing system. The ATTUNE RP tibia may also have issues with cement fixation and we have identified severe backside polyethylene wear in this revision series ([Figs. 4] and [5]).

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Fig. 1 ATTUNE Rotating Platform baseplate.
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Fig. 2 Backside of baseplate. No polymethyl methacrylate fixation.
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Fig. 3 Tibial cement mantle completely intact. Implant loose and pistoning off cement.
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Fig. 4 Backside of poly bearing. Severe erosions, wear, and pitting.
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Fig. 5 Additional view of backside poly wear.