A Comparison of Fixed-Bearing and Mobile-Bearing Total Knee Arthroplasty at a Minimum Follow-up of 4.5 Years

Bhan, Surya; Malhotra, Rajesh; Kiran, E. Krishna; Shukla, Sagrika; Mahesh, Bijjawara

doi:10.2106/jbjs.d.02221

Cited by 97 publications

(44 citation statements)

References 28 publications

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“…Concerning OXF scores, the literature reports a slightly worse [22] or comparable outcome compared to this study (21–24 for FB, 21–26 for MB after 1–4 years) [25] and concerning ROM, smaller flexion angles in 6 cases [22, 25, 29, 30, 33, 37] and higher ones in 9 cases [27, 28, 31, 32, 34, 36, 38, 40]. …”

Section: Discussionsupporting

confidence: 63%

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One Year After Navigated Total Knee Replacement, No Clinically Relevant Difference Found Between Fixed Bearing and Mobile Bearing Knee Replacement in a Double-Blind Randomized Controlled Trial

Lampe

Sufi-Siavach²,

Bohlen³

et al. 2011

TOORTHJ

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Background:The mobile bearing designs have not yet been shown to improve clinical outcome of total knee arthroplasty (TKA). In this prospective randomized study, we compared the short-term clinical results of a mobile bearing implant with those of the fixed bearing version of the same implant.Methods:We randomized 100 knees into two double-blind groups who received either the fixed (FB, 52 knees) or the mobile bearing (MB, 48 knees) version of the same implant. We used navigation to standardize the surgical technique. For up to one year, we recorded the Knee Society (KSS) and Oxford (OXF) scores. We performed an exploratory analysis of variance (ANOVA) to determine the influence of baseline scores as covariate and the extent of improvement in clinical outcome over time.Results:After one year, we did not detect any statistically significant difference between the two groups. The KSS scores differed by 2 points, the OXF scores by 1.1 points.Conclusion:Even with identical geometry of implant surfaces and a navigated surgical technique, first-year results do not support a preference for either a fixed or a mobile design.

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Section: Discussionsupporting

confidence: 63%

“…Regarding implant-specific complications leading to revisions, 7 studies report inlay dislocations [22, 31, 33, 35, 36], occurring both with posterior stabilized and cruciate retaining implant designs, and all within the first six months. We did not encounter this implant-specific complication.…”

Section: Discussionmentioning

confidence: 99%

One Year After Navigated Total Knee Replacement, No Clinically Relevant Difference Found Between Fixed Bearing and Mobile Bearing Knee Replacement in a Double-Blind Randomized Controlled Trial

Lampe

Sufi-Siavach²,

Bohlen³

et al. 2011

TOORTHJ

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“…The difference in tray surface makes it difficult to conclude any differences between fixed bearing and rotating platform knees. No clinical differences in wear‐related failures have been noted between fixed bearing and rotating platform knees …”

Section: Discussionmentioning

confidence: 97%

Contribution of micro‐motion to backside wear in a fixed bearing total knee arthroplasty

Levine

Lewicki

Currier

et al. 2016

Journal Orthopaedic Research

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This study seeks to identify important factors related to backside wear of tibial inserts in vivo and determine an appropriate wear model for backside wear. An IRB approved database was queried for tibial inserts of a single design from one manufacturer that exhibited evidence of rotatory motion on the backside of the polyethylene. These devices were measured for volumetric wear using a previously established protocol. Features including the change in locking lip width and measurement of micro-motion marks were used to describe the motion pattern. Volumetric wear and implant characteristics were compared using linear regressions by modeling wear theories suggested by Archard and Wang to determine the most appropriate model for backside wear. The Wang model showed that duration, adjusted sliding distance, and cross-shear index accounted for approximately 58% of the volumetric wear variation while adjusted sliding distance and duration in vivo accounted for approximately 35% of the volumetric wear variation in the Archard model. Patient weight (p = 0.750), patient BMI (p = 0.680), and backside area (p = 0.784) of the tibial insert were all found to be non-significant in the Wang model. Similarly, patient weight (p = 0.233), patient BMI (p = 0.162), and backside area (p = 0.796) were found to be non-significant in the Archard model. Multidirectional micro-motion appears to contribute significantly to the wear of these components, supporting the Wang theory of cross-shear for polyethylene wear. Cross-shear of polymers on an unpolished titanium tray can lead to an increase in wear debris in the body. Care should be taken when designing locking mechanisms and tray designs. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1933-1940, 2016.

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“…Bilateral studies have the advantage of minimizing patient, surgeon, and observer-related bias. Bhan et al 70 compared the LCS RP vs the Insall Burnstein-II knee (Zimmer) in 32 patients; mean patient age was 63 years at the time of surgery, and mean follow-up was 6 years. Clinical and radiographic outcomes showed no difference; no revisions were performed for loosening or wear.…”

Section: Clinical Outcomementioning

confidence: 99%

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

Zürcher¹,

Stiehl²,

Pöll³

2016

Orthopedics

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Low-contact-stress mobile-bearing (MB) total knee arthroplasty (TKA) can rely on a long history. Its concept comprises a combination of high condylar congruency and compensatory bearing rotation to promote load sharing. However, other MB designs have become available, and critical points have been raised about the benefit of MB in general. Although there is kinematic and kinetic support for the low-contact-stress concept, there is no tribologic or clinical proof of its superiority over fixed-bearing concepts. Further study should be controlled for differences in polyethylene quality and need to provide a measure of condylar congruency to differentiate authentic low-contact-stress variants form others. [Orthopedics. 2016; 39(3):e402-e412.].

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A Comparison of Fixed-Bearing and Mobile-Bearing Total Knee Arthroplasty at a Minimum Follow-up of 4.5 Years

Abstract: Therapeutic Level II.

Cited by 97 publications

References 28 publications

One Year After Navigated Total Knee Replacement, No Clinically Relevant Difference Found Between Fixed Bearing and Mobile Bearing Knee Replacement in a Double-Blind Randomized Controlled Trial

One Year After Navigated Total Knee Replacement, No Clinically Relevant Difference Found Between Fixed Bearing and Mobile Bearing Knee Replacement in a Double-Blind Randomized Controlled Trial

Contribution of micro‐motion to backside wear in a fixed bearing total knee arthroplasty

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

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