A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty

Lennard A. Koster, Rachid Rassir, Bart L. Kaptein, Inger N. Sierevelt, Marjolein Schager, Rob G. H. H. Nelissen, Peter A. Nolte

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


AIMS: The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs. METHODS: A total of 61 TKAs were analyzed in this randomized clinical RSA trial. RSA examinations were performed one day and three, six, 12, and 24 months postoperatively. The maximal total point motion (MPTM), translations, and rotations of the components were analyzed. PROMs and clinical data were collected preoperatively and at six weeks and three, six, 12, and 24 months postoperatively. Linear mixed effect modelling was used for statistical analyses. RESULTS: The mean MTPM two years postoperatively (95% confidence interval (CI)) of the Attune femoral component (0.92 mm (0.75 to 1.11)) differed significantly from that of the LCS TKA (1.72 mm (1.47 to 2.00), p < 0.001). The Attune femoral component subsided, tilted (anteroposteriorly), and rotated (internal-external) significantly less. The mean tibial MTPM two years postoperatively did not differ significantly, being 1.11 mm (0.94 to 1.30) and 1.17 mm (0.99 to 1.36, p = 0.447) for the Attune and LCS components, respectively. The rate of migration in the second postoperative year was negligible for the femoral and tibial components of both designs. The mean pain-at-rest (numerical rating scale (NRS)-rest) in the Attune group was significantly less compared with that in the LCS group during the entire follow-up period. At three months postoperatively, the Knee injury and Osteoarthritis Outcome Physical Function Shortform score, the Oxford Knee Score, and the NRS-activity scores were significantly better in the Attune group. CONCLUSION: The mean MTPM of the femoral components of the cementless rotating platform Attune was significantly less compared with that of the LCS design. This was reflected mainly in significantly less subsidence, posterior tilting, and internal rotation. The mean tibial MTPMs were not significantly different. During the second postoperative year, the components of both designs stabilized and low risks for the development of aseptic loosening are expected.Cite this article: Bone Joint J 2023;105-B(2):148-157.

Original languageEnglish
Pages (from-to)148-157
Number of pages10
JournalBone & joint journal
Issue number2
Publication statusPublished - 1 Feb 2023


  • Aseptic loosening
  • Attune
  • Cementless
  • LCS
  • NRS
  • Oxford Knee Score
  • Radiostereometric analysis
  • Rotating platform
  • Total knee arthroplasty
  • femoral components
  • osteoarthritis (OA)
  • patient-reported outcome measures (PROMs)
  • radiostereometric analysis (RSA)
  • randomized controlled trial
  • tibial components
  • total knee arthroplasties (TKAs)

Cite this