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Proving The Promise

Proving the Promise



ATTUNE® Knee System Linked to Improvements in Patient Quality of Life and Reduced Length of Hospital Stay

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ATTUNE® Knee System Value Analysis Brief

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The ATTUNE Knee is a total primary knee system designed with the goal of addressing the clinical needs of patients, surgeons and hospital providers around the world.

Extensive research and science has been included in the design to help improve functional outcomes for patients, performance for surgeons, and efficiency for providers.

The ATTUNE Knee is one of the largest research and development projects in the history of DePuy Synthes and combines the latest in design, kinematics, engineering and materials to deliver stability and motion .


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ATTUNE total knee system was designed with the goal of addressing unmet clinical needs, helping improve outcomes and positively impacting patient satisfaction.



1. Association of American Retired Persons (AARP). Joint Replacement Surgery Patient Survey. 2007 September. Conducted in Boston, MA; September 6-8, 2007.

2. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The Role of Pain and Function in Determining Patient Satisfaction After Total Knee Replacement. JBJS-Br. 2007; 89-B(7): 893-900


Developing a new system

DePuy Synthes is world renowned for its knowledge and development of successful knee replacement systems. Some of the iconic DePuy Synthes primary knees include the SIGMA® Knee System and the LCS™ Knee System.

Total knee replacement surgery can be a highly successful procedure . However, it is also a complex procedure. Surgeons are faced with varying patient anatomies and difficult intra-operative decisions each time they enter the operating room (OR).

At the same time, patients seek to return to the normal and active lifestyle they enjoyed prior to the onset of their joint disease.

Unfortunately, total knee patients are not always satisfied with their outcome and report differing levels of satisfaction following surgery. It is the goal of DePuy Synthes to design total knee systems that work with the surgeon to positively impact patient satisfaction .


Extensive research and science combining the latest in design kinematics, engineering and materials has been incorporated in the ATTUNE Knee System to deliver a high level of STABILITY IN MOTION .



To better understand what factors may lead to improved patient satisfaction, DePuy Synthes embarked on one of the largest research and development projects in its history.

DePuy Synthes' clinical heritage in knee replacement design is recognized in the industry. With this foundation in clinically proven design principles, the design team re-examined every aspect of knee implant and instrument design.

A world class surgeon team was assembled and working relationships with leading research facilities were established to study areas such as kinematics, anthropometrics, polyethylene wear, and instrument design.

The following system goals were established:

  • Improve function through motion and stability
  • Improve patient fit
  • Improve patello-femoral function
  • Improve design and materials for implant durability
  • Advance surgical process for implant positioning



The patented ATTUNE GRADIUS Curve is designed with a gradually reducing femoral radius. This curve creates a smooth transition during knee bending and produces high stability of the knee by minimizing unnatural sliding of the femur on the tibia.

Click to view animation

SOFCAM™ Contact

For the Posterior Stabilized design, the interaction between the cam and spine, the articular surface geometry, and the collateral ligaments is complex and essential to the function of the knee in deep flexion. The proprietary s-curve design of the SOFCAM Contact provides a smooth engagement for gradual femoral rollback and stability in flexion, while reducing the forces transferred to the tibial spine.3

Click to view animation

LOGICLOCK™ Tibial Base

Differentiated to current offerings, surgeons are able to match the femoral size to the insert size every time to achieve the highest conformity and optimized stability in early flexion.4

Click to view animation

GLIDERIGHT™ Articulation

The patello-femoral interaction is one of the more challenging aspects of total knee arthroplasty.5 The GLIDERIGHT Articulation encompasses a trochlear groove designed to accommodate patient variation and soft tissue interaction, and patella components designed to optimize patella tracking while maintaining bone coverage.

Click to view animation


To provide implant sizes that were reflective of the global patient population, DePuy Synthes collaborated with University College Dublin to conduct extensive anthropometric research. The ATTUNE Knee Femoral Sizing Line was created to accommodate the global patient population and avoid mediolateral overhang.

Click to view animation


The INTUITION™ Instruments were developed to deliver efficiencies for all stakeholders and an intuitive surgical process.

These innovative instruments work with the advancements in the implant design to help balance the soft tissues and precisely control the implant position and fit for each patient.

Click to view Precise Control Animation
Click to view Efficient Path Animation
Click to view Design Clarity Animation
  1. 3 Fitzpatrick, C. K., Clary, C. W., & Rullkoetter, P. J. (2012). Post-cam engagement during dynamic activity with current posterior stabilized TKR. 18th European Society of Biomechanics, Presentation Number 1700, Lisbon, Portugal
  2. 4 Fitzpatrick, C. K., Clary, C. W., & Rullkoetter, P. J. (2012). The influence of design on TKR mechanics during activities of daily living. Orthopaedic Research Society, 58th Annual Meeting, Poster Number 2034, San Francisco, CA
  3. 5 Amis, A. A., Senavongse, W., Bull, A. M. J. (2006). Patellofemoral kinematics during knee flexion-extension: an in vitro study. Journal of Orthopaedic Research, 24, 2201-2211


The ATTUNE evidence generation programme is the largest and most extensive in DePuy Synthes history.

Clinical Outcomes

Functional Outcomes

  • Learning Curve with a New Primary TKA Implant: A Worldwide Perspective with more than 2000 Patients
  • Patient Reported Outcomes in TKA Among Currently Available Products: A Large Sample Prospective Worldwide Study
  • Early Outcomes with a New Primary Total Knee Arthroplasty System vs. Contemporary TKA: Interim Results of Two Worldwide, Multi-Center Prospective Studies
  • An Early Outcome Study of the ATTUNE® Knee System vs. the SIGMA® CR150 Knee System
  • ATTUNE® Knee System Value Analysis Brief
  • Review of Dr. Takagi's Case Series Report of ATTUNE® Knee System

Early User Studies

  • Outcome of the First 500 Cases of a New Total Knee Replacement Prosthesis
  • An Early Outcome Study of the ATTUNE® Knee System vs. the SIGMA® CR150 Knee System
  • ATTUNE® Knee System Early Performance: Minimum Two Year Clinical Results White Paper
  • ATTUNE® Improved Survivorship Clinical Outcomes Over P.F.C. Sigma

Health Economics & Market Access (HEMA)

  • The Impact of Implant Design on Hospital Length of Stay and Discharge Destination ‐ Evidence Summary Report
  • Hospital Length of Stay and Discharge Dispositon after Primary Total Knee Arthroplasty – Whitepaper
  • Improving the Value of Primary Total Knee Arthroplasty: the ATTUNE Knee System
  • Comparitive Effectiveness of the ATTUNE Knee System vs the Triathlon Knee System – Whitepaper 
  • April 2017 Orthopedics Today ATTUNE Knee Supplement
  • Improving Patient Satisfaction Through Total Knee Athroplasty Design - Orthopedics today supplement 2014


  • United Kingdom Joint Registry Data
  • Early Results Confirm Clinical and Economic Value of the ATTUNE® Knee System

National Joint Registry Data

  • Analysis of Total Knee Replacement using the ATTUNE Knee System in the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Pre-Clinical Research & Development

  • Orthopedic Research Society - The ATTUNE Knee System: Conference Abstracts
  • ATTUNE Knee System: Stability in Total Knee Replacement - White Paper
  • ATTUNE Knee System: LOGICLOCK Tibial Base Central Locking Design - White Paper
  • ATTUNE Knee System: Cruciate Retaining Fixed Bearing Insert Wear – Whitepaper
  • ATTUNE Knee System: SOFCAM Contact – Whitepaper
  • ATTUNE Knee System: Cruciate Sacrificing Fixed Bearing – Whitepaper
  • Tibial Base Design Factors Affecting Tibial Coverage after total knee Arthroplasty Symmetric Versus Asymmetric Bases
  • ATTUNE Knee System: ATTUNE GRADIUS Curve – Whitepaper
  • ATTUNE Knee System: Gilderight Articulation - Whitepaper

Additional Resources

  • ATTUNE® Knee System Surgical Technique
  • The ATTUNE® Knee RSA Fixation Study and the Canadian RSA Network


DePuy Synthes value based healthcare team aim to improve clinical outcomes and patient experiences whilst improving efficiencies.



Our mission is to provide Hospitals with value-based healthcare solutions that augments the provision of "best-in-class" products, helping customers achieve the goals of the Triple Aim performance – sustainably.


eSIMS Advanced Inventory Management Solution

Is designed to aid in the management and ordering of DePuy Synthes inventory by utilising the barcodes printed on sterile and non-sterile product packaging.

The eSIMS software is designed to improve efficiencies and optimise the supply chain by greatly reducing time, costs, resources, and errors throughout the inventory management and procurement process, helping to create the ‘perfect order’.


Care4Today® Orthopedic Solutions is an end-to-end technology-enabled patient pathway program build on the principles of enhanced recovery. The solution is built around a modular approach: Audit, Change Management, Patient Education, Digital Patient Engagement, and PROMs, where we aim to design the best program to meet your needs.

Through this program we aim to deliver improved clinical outcomes, improved patient satisfaction and experience, and reduced costs.

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Johnson and Johnson Medical Devices and DePuy Synthes share a common vision – providing the technologies and surgical training needed to improve the lives of patients all around the world. The best patient outcomes are achieved when surgeons have the right products along with the knowledge to use them safely and effectively. That’s why we’ve developed extensive professional education programs which have made us one of the leaders in surgeon training.


Visitation Centres (VCs) are an established part of the DePuy Synthes Professional Education Pathway for Healthcare Professionals (HCPs). They provide the respective HCP with an opportunity to visit a recognized Key Opinion Leader (KOL) at their practice/centre of excellence in small groups of 2 – 4 HCPs. The objective of each VC is to enable the visiting HCP to have a better understanding of a specific technique/procedure that may have previously been introduced at a DePuy Synthes course or on-line at

Educational Information

  • Guidance For Cementing Primary Total Knee Replacements
  • TKR Cementing Technique - Prof D Barrett


For additional information about any of the DePuy Synthes events please contact your local DePuy Synthes representative


There are multiple global, comprehensive studies, both company and independent initiated, designed to provide evidence in support of the ATTUNE Knee System.


DePuy Synthes EMEA Launches ATTUNE® Revision Knee System to Deliver Stability in Motion for More Patients

Barcelona, Spain – 31 May 2018 – Comprehensive revision system designed to address broad range of Complex Primary and Revision procedures

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2018 News Articles

ATTUNE® Knee System Linked to Improvements in Patient Quality of Life and Reduced Length of Hospital Stay

Leeds, UK – 10 May 2018 – Recent Evidence Shows Potential Positive Impact of Implant Design on Functional Outcomes and Hospital Discharge Status [Read more...]

2017 News Articles

ATTUNE® Knee System Four-Year Revision Rate is Lower Than Total Knee Class, According to New & Independent Joint Registry Data

Vienna, AT – 31 May 2017 – DePuy Synthes, part of the Johnson & Johnson Family of Companies, today announced new ATTUNE® Knee implant survivorship data based on an Implant Summary Report obtained from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR). [Read more...]


National Joint Registry releases its Implant Summary Report for primary knee implants.

London, UK – 27 April 2017 – Today, the National Joint Registry released its Implant Summary Report for primary knee implants. [Read more...]


New report demonstrates the clinical and economic value of the ATTUNE® Knee System in today’s value-based environment

London, UK – 20 April 2017 – Today, DePuy Synthes, part of the Johnson & Johnson Family of Companies, released the report, “Improving the Value of Primary Total Knee Arthroplasty: the ATTUNE® Knee System,” that analyzes the ATTUNE Knee’s current clinical and economic data. [Read more...]

2016 News Articles

Latest Australian Joint Registry Data Confirm Positive Early Results For the ATTUNE® Knee System.

Solothurn, Switzerland - 19 December 2016, DePuy Synthes, part of the Johnson & Johnson Family of Companies, today announced that implant survivorship [Read more...]


Latest UK joint registry data confirms positive early results for the DePuy Synthes ATTUNE® Knee System.

Solothurn, Switzerland – 29 November 2016, DePuy Synthes Joint Reconstruction, today announced the latest clinical evidence of the performance of the [Read more...]



Feeling comfortable in hospital

Knee replacements are very common these days and specialists often have the experience of hundreds and thousands of procedures.

Patients are usually told at their initial consultation who will be performing the operation, and again at the pre-operative assessment, but if you’re not told please ask. Your team will most probably include:

  • A consultant (a senior-level surgeon who will lead the procedure)
  • A team of junior doctors (to support the consultant)
  • An anaesthetist (to manage your pain)
  • A physiotherapist (to get you as fit as possible before and after replacement surgery)

Pre-operative assessment

This will help to ensure you feel comfortable and well-informed going into surgery – because we know it can be scary – but it also helps reduce your risks.

You will undergo a few necessary tests relevant to your procedure, for example:

  • Blood test
  • Skin swab
  • Heart rhythm test (ECG)

You might also be asked some general questions such as:

  • What is your general medical history?
  • Have you had any operations and/or complications?
  • Are you currently on any medications? (if yes, please bring a list with you)

Evaluation and preparation

Your surgeon, or a member of their team, will ask you a few questions about your knee, as well as your health generally, to confirm that knee replacement surgery is right for you.

Medical history

A careful review of your entire medical history will help the surgeon understand your pain and physical limitations, as well as the progression of your knee problem.

Physical exam

A physical exam will measure the range of motion of your knee and evaluate your muscle strength. The surgeon will observe how you walk, sit, bend, and move.

X-ray review

Previous knee X-rays will help your surgeon plan the surgery and evaluate the fit of your new knee prosthesis. Be prepared for new X-rays to be taken as part of your physical exam.

Lifestyle management

Other factors such as alcohol consumption, obesity and smoking can also impact your mobility and quality of life, so your surgeon will advise you to monitor these.

Preparing yourself and your home

  • Arrange for friends and/or family to help you out at home after you come out of hospital
  • Arrange a lift home from hospital
  • Cook some meals in advance for the freezer
  • Make your home as tidy and organised as possible, with all of your vital bits and pieces (phone, keys, money, address book) in easy-tofind places
  • Buy items such as a long-handled sponge, a footstool and grabbing tool to make your life as easy as possible

Some tips to make your home recovery-friendly

  • Convert a ground-floor room into a temporary bedroom
  • Remove any mats or rugs that you could slip on, or that could get caught on the tip of a walking aid or a crutch, and use non-slip mats in the bath
  • Repair loose carpeting. Mark changes in the floor levels in some obvious way (e.g. bright, non-slip tape)
  • Securely fasten all electrical and phone cords around the edges of the room
  • Move furniture around to clear easy paths throughout your house
  • Make sure your stairway bannisters are secure
  • Add a couple of nightlights around the house, especially in your bedroom
  • Remove all unnecessary clutter: clear countertops; organise your daily items within arm’s reach to reduce the need to reach up or bend down;
  • install slide-out shelving and adjustable rods; invest in baskets and other storage solutions

Consider the following in your bathroom:

  • Install an elevated toilet seat
  • Add a shower seat or transfer bench
  • For safety and support, install grab bars in the shower, by the bath
  • and near the toilet
  • Replace fixed shower heads with hand-held shower heads

Your GP, surgeon and hospital team will be able to help you with much more advice and practical support, so please ask them about post-operative care during one of your appointments.

Knee exercises to help you prepare for surgery

Trying to stay as mobile and active as possible is one of the most effective ways of preparing for a knee replacement, as well as limiting the pain you feel because of your condition.

It might be tough as you approach the date of your operation, but even doing a few minutes per day can really make a difference.

Swimming and cycling are ideal, because both allow you to exercise your knee without exerting unnecessary strain on it. Because water is buoyant, swimming also relieves some of the pressure on your joints.

Please see below for some low impact stretches and movements that have been specifically developed to ease knee pain.

Knee bends

  • Stand close to a wall with your knees shoulder-width apart
  • Lean against the wall, and slide your back down by slowly bending your knees
  • Let your knees point slightly outwards in line with your feet as they start to support your weight
  • Return slowly up to your starting position, feeling your hamstrings tense
  • Repeat 10 times

Leg raise

  • Sit upright in a firm chair
  • Slowly straighten and raise your left leg until your hips and leg are in line
  • with the chair seat
  • Hold for 5 seconds before slowly returning to your starting position
  • Repeat 10 times, alternating legs

Thigh stretch

  • Sit on the edge of a firm chair and hold your back straight
  • Keep your right leg bent and extend your left leg out, resting your left heel on the ground
  • Bend your whole body forwards over your left leg, keeping your hamstring tense
  • Repeat 10 times, alternating legs

Single leg squat

  • Stand with both feet pointing outwards, shoulder-width apart
  • Slowly raise your right leg off the ground and balance on your left leg
  • Now bend your left leg slowly and lower yourself 6 inches, all the while keeping your foot straight
  • Return slowly to your starting position
  • Repeat 10 times, alternating legs

Recovery and discharge

Recovery times obviously differ from procedure-to-procedure and person to- person, but regardless of how you feel, it’s important to try not to do anything too quickly.

However, hospital support staff will want you to be feeling good as soon as possible, so don’t be surprised if they want you to straighten your knee and try to get up on your feet again within a day or two.

Generally, after knee surgery, people leave hospital after 3 to 5 days. You will be able to move around with the help of a walking frame or crutches and will need to continue using one of these walking aids for the next 4 weeks.

Other types of movement, such as stretching and turning, will also be restricted for some time as your body recovers and regains its strength.

There will be some discomfort and swelling when you get up and start moving around again. You might be given some painkillers to relieve the pain or antibiotics to help protect you from infection.

Weeks 1 to 6

You will continue the knee exercises you began in hospital and gradually increase the number and duration of the exercises. If you used a continuous passive motion machine in the hospital, your healthcare team may ask you to continue with it at home.

You will also be advised to gradually increase household activities such as cooking, cleaning, and doing laundry.

Weeks 6 to 12

New exercises may be added to your regimen at this point, including:

  • Toe and heel raises – alternating between rising up on toes and heels while standing
  • Partial knee bends – bending your knees slowly up and down while standing
  • Leg balance – standing on one foot at a time
  • Step-ups – raising alternating feet onto a step and straightening your leg
  • Bicycle – riding a stationary bicycle

Your GP will be able to help you with much more advice and practical support – as will your hospital team – so please ask them about post-operative care during one of your appointments.

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