ArticleInternational orthopaedics2026
Assessing the suitability of the Triathlon total knee replacement system as an alternative for former users of PFC; a single surgeon prospective cohort study.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionTotal Knee Replacement (TKR) implant selection is of paramount importance. The PFC TKR (DePuy Synthes), was a popular TKRs in the UK. As PFC has been phased out, surgeons have had to select a new implant. The replacement Attune system had some early concerns about loosening. Triathlon (Stryker), is another popular TKR in the UK. The aim of the project is to evaluate the Triathlon Knee system's introduction to an experienced PFC utilising team and asses whether PROMs and long term survival are comparable.
methodsWe performed a prospective cohort study assessing 38 PFC and 45 Triathlon TKRs performed by a single surgical team form 2014-2015, at separate elective sites. Oxford Knee Score (OKS) at 4.5 months and one year were compared. Survival in terms of risk of revision was studied up to ten years.
results83 TKRs were included; 38 PFC and 45 Triathlon. Mean age of both groups was 68, and mean ASA grade was 2.2 and 2 respectively. There was no statistical difference in group demographics. At 4 ½ months mean OKS of PFC was 31.9 compared to 28 for Triathlon. By one year this difference narrowed, with similar scores; 31.2 PFC, 31.1 Triathlon. At ten years only one (Triathlon) TKR was revised, due to infection. 11 patients underwent sequential bilateral total knee replacements with one side PFC and the other Triathlon. There was no significant difference in PROMS at 4 ½ months 17 vs 14.3 for PFC and Triathlon respectively (p value 0.49) or one year (p value 0.78), with OKS of 18.1 vs 19.6. for PFC and Triathlon. DISCUSSION: Overall, our study should support surgeons in deciding on implant choice post PFC withdrawal. Amongst the alternative systems available, that may well be suitable implants to use, the Triathlon is a valid choice. While NJR data already demonstrates excellent survival of Triathlon, our study demonstrates a smooth transition of the lead surgeon and wider team, to using Triathlon, having been experienced in PFC.
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