The incidence of anterior knee pain (AKP) with PFC Sigma (DePuy Synthes, Warsaw, IN, USA) design has been reported to be as high as 9% and that of patellofemoral crepitus (PCr) requiring surgery as high as 2%. 1) Such patellofemoral complications have been a drawback of the otherwise widely accepted and extensively used posterior- stabilized PFC Sigma design. One of the goals of the At- Comparison of Patellofemoral Outcomes between Attune and PFC Sigma Designs: A Prospective Matched-Pair Analysis Rajesh Navin Maniar, MCh* ,† , Nishit Bhatnagar, MS ‡ , Rohan Bidwai, MS § , Ankur Dhiman, MS ΙΙ , Debashish Chanda, MS ¶ , Nishant Sanghavi, DNB † *Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, † Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, ‡ Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India, § Department of Orthopaedics, Wrightington Hospital, Wrightington, UK, ΙΙ Department of Orthopaedics, AIIMS Hospital, New Delhi, ¶ Department of Orthopaedics, CK Birla Hospital, Haryana, India Background: Attune (DePuy Synthes) prosthesis was designed to overcome patellofemoral complications associated with PFC Sigma (DePuy Synthes) prosthesis. The aim of our study was to compare the incidence of anterior knee pain (AKP), patellofemoral crepitus (PCr), and functional outcome between them. Methods: This prospective matched-pair study was conducted between January 2014 and June 2015, during which 75 consecu- tive Attune total knee arthroplasties (TKAs) were matched with 75 PFC Sigma TKAs based on age, sex, body mass index, pathology, and deformity. A single surgeon performed all the operations with aid of computer navigation, using a posterior-stabilized pros- thesis with patellar resurfacing. Outcome was assessed by new Knee Society Score (NKSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. AKP and PCr were assessed by a patient-administered questionnaire till 2 years of follow-up. Three pairs were lost to follow-up and finally 72 pairs were analyzed. Results: One patient in each group reported AKP and 1 patient from each group had PCr at 2 years postoperatively. None of these patients required additional surgery. The incidence of lateral retinacular release was higher with PFC Sigma (5/72) than Attune (2/72); however, this was statistically not significant ( p = 0.4). The Attune group had a significantly greater range of motion (ROM) at 3 months postoperatively ( p = 0.049). At final follow-up, ROM was comparable between two prosthesis designs. NKSS and WOMAC scores were also comparable between the groups. Conclusions: We observed that both Attune and PFC Sigma had a low and comparable incidence of AKP and PCr up to 2 years of follow-up. The Attune group achieved a significantly greater ROM at 3 months postoperatively. At 2 years of follow-up, both pros- theses had excellent and comparable clinical and functional results. Keywords: Knee, Prosthesis design, Patellofemoral joints, Arthroplasty, Anterior knee pain syndrome Original Article Clinics in Orthopedic Surgery Published Online • https://doi.org/10.4055/cios20130 Copyright © 2021 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinics in Orthopedic Surgery • pISSN 2005-291X eISSN 2005-4408 Received May 25, 2020; Accepted September 2, 2020 Correspondence to: Rajesh Navin Maniar, Mch Department of Orthopaedics, Lilavati Hospital and Research Centre and Breach Candy Hospital Trust, Nook, 2nd Floor, S.V. Rd, North Avenue Junction, Santacruz (W), Mumbai 400054, India Tel: +98-2142224 E-mail: drmaniar@jointspeciality.com