Comparison of Midterm Results between the ATTUNE and PFC Sigma Total Knee Arthroplasty Systems

Thomas Strudwick; James Sires; Paul N. Smith; Emma Jackman; Carl Holder; Christopher Wilson

doi:10.1055/a-2716-4635

The Journal of Knee Surgery, Table of Contents

J Knee Surg
DOI: 10.1055/a-2716-4635

Original Article

Comparison of Midterm Results between the ATTUNE and PFC Sigma Total Knee Arthroplasty Systems

Authors

Thomas Strudwick

¹College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
James Sires

¹College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

²Department of Orthopaedics, Flinders Medical Centre, Adelaide, South Australia, Australia
Paul N. Smith

³Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Australia

⁴School of Medicine and Psychology, College of Science and Medicine, Australian National University, Canberra, ACT, Australia
Emma Jackman

¹College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
Carl Holder

⁵South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
Christopher Wilson

¹College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

²Department of Orthopaedics, Flinders Medical Centre, Adelaide, South Australia, Australia

Abstract

Total knee arthroplasty systems are continually being updated. Evaluating these new systems for their effectiveness, and potential complications is vital, and is closely monitored by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The ATTUNE Knee System was released in 2013, and some early studies reported on an increase in rates of aseptic loosening. This study aims to investigate the revision rates of the ATTUNE Knee System and its predecessor the PFC Sigma utilizing registry data. Data were collected from AOANJRR. All ATTUNE and PFC Sigma primary total knee replacements (TKR) performed between September 1999 until 2021 were included. The primary outcome measures were revision rates and indications for revision. A total of 38,407 primary TKRs were included in the study (24,863 ATTUNE, 13,544 PFC Sigma). The cumulative percentage revision (CPR) at 8 years was 3.3% (95% confidence interval [CI]: 2.6, 4.1) for the ATTUNE Knee System and 3.2% (95% CI: 2.9, 3.5) for the PFC Sigma Knee System (p = 0.144). The proportion of revisions due to aseptic loosening was 20.5% for the ATTUNE Knee System and 21.5% for the PFC Sigma Knee System. Midterm revision rates of the ATTUNE and PFC Sigma Knee Systems are not significantly different. Additionally, the percentage of revisions due to aseptic loosening of the implant were not significantly different between the two knee systems.

Keywords

total knee replacement - ATTUNE - PFC sigma - revision - outcomes

Full Text

References

References
1 Ackerman IN, Bohensky MA, Zomer E. et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 2019; 20 (01) 90
2 Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393 (10172): 655-663
3 Willburger RE, Oberberg S. Early and mid-term results with the ATTUNE total knee replacement system compared to PFC Sigma: a prospective comparative study. J Orthop Surg Res 2022; 17 (01) 509
4 Vanitcharoenkul E, Unnanuntana A. Midterm functional recovery of total knee arthroplasty patients compared between the ATTUNE knee system and the press fit condylar (PFC) SIGMA knee system. BMC Musculoskelet Disord 2021; 22 (01) 620
5 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
6 Pennington M, Grieve R, Black N, van der Meulen JH. Cost-effectiveness of five commonly used prosthesis brands for total knee replacement in the UK: a study using the NJR dataset. PLoS One 2016; 11 (03) e0150074
7 ATTUNE Knee System. Johnson & Johnson Med Tech. Published 2023. Accessed September 10, 2025. https://www.jnjmedtech.com/en-US/product/attune-knee-system
8 SIGMA Total Knee System. Johnson & Johnson Med Tech. Published 2023. Accessed September 10, 2025 at: https://www.jnjmedtech.com/en-US/product/sigma-total-knee-system
9 Bonutti PM, Khlopas A, Chughtai M. et al. Unusually high rate of early failure of tibial component in ATTUNE total knee arthroplasty system at implant-cement interface. J Knee Surg 2017; 30 (05) 435-439
10 Staats K, Wannmacher T, Weihs V, Koller U, Kubista B, Windhager R. Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1148-1155
11 Giaretta S, Berti M, Micheloni GM, Ceccato A, Marangoni F, Momoli A. Early experience with the ATTUNE total knee replacement system. Acta Biomed 2019; 90 (12-S): 98-103
12 Torino D, Damsgaard C, Kolessar DJ. et al. Tibial baseplate-cement interface debonding in the ATTUNE total knee arthroplasty system. Arthroplast Today 2022; 17: 165-171
13 Carey BW, Harty J. A comparison of clinical- and patient-reported outcomes of the cemented ATTUNE and PFC sigma fixed bearing cruciate sacrificing knee systems in patients who underwent total knee replacement with both prostheses in opposite knees. J Orthop Surg Res 2018; 13 (01) 54
14 Panchani SK, Divecha HM, Lafferty R. et al. Early functional outcomes after evolutionary total knee arthroplasty: a randomized controlled trial. Is new always better?. JBJS Open Access 2021; 6 (03) e21.00016
15 Lewis P, Gill D, McAuliffe M. et al. Hip, Knee and Shoulder Arthroplasty. Annual Report. Australian Orthopaedic Association National Joint Replacement Registry 2024; 2024 . Accessed February 26, 2025
16 21st Annual Report. National Joint Registry for England, Wales and Northern Ireland. 2024 . Accessed September 10, 2025. https://www.njrcentre.org.uk/
17 Kanna R, Murali SM, Ramanathan AT, Pereira L, Yadav CS, Anand S. Cruciate retaining total knee arthroplasty has a better 10 year survival than posterior stabilized total knee arthroplasty: a systematic review and meta-analysis. J Exp Orthop 2023; 10 (01) 19