Total knee arthroplasty (TKA) systems are designed to maximize the longevity of the implant. However, an unusually high rate of aseptic tibial tray loosening was observed in the DePuy ATTUNE® total knee arthroplasty system (DePuy Synthes, Warsaw, USA). Affected patients noted symptoms of instability and reproducible pain at the bone-implant interface. However, there was no radiographic evidence of lucency or implant failure. Intra-operatively, the tibial component was grossly loose and lacked adhered cement. We hypothesize that the loosening is due to the smooth architecture of the undersurface of the tibial component, lacking either grit blasting or porous coating.