Fixed- vs Mobile-Bearing Total Knee Arthroplasty

Harrington, Melvyn A.; Hopkinson, William; Hsu, Patricia; Manion, Leslie

doi:10.1016/j.arth.2009.04.031

Cited by 73 publications

(9 citation statements)

References 10 publications

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“…Other authors have recently reported similar 10-year survival rates for the PFC prosthesis: 97% survival for aseptic loosening (Santini and Raut 2008) and 97% survival for revision with any reason other than infection as endpoint (Dalury et al 2008). The functional results of the PFC prosthesis in our study were also comparable to those in previous reports (Dalury et al 2008, Harrington et al 2009, Hanusch et al 2010). …”

Section: Discussionsupporting

confidence: 92%

“…The excellent clinical scores of the PFC prosthesis do not leave a lot of room for improvement, which is probably why recent RCTs have failed to show a superior design (Harrington et al 2009, Choi et al 2010, Rahman et al 2010). Subtle differences in outcome after TKA require more sensitive instruments.…”

Section: Discussionmentioning

confidence: 99%

“…Many randomized studies of TKAs with different bearings (Harrington et al 2009, Rahman et al 2010), cruciate-retaining or -substituting devices (Kim et al 2009), gender-specific designs (Kim et al 2010), and high-flex designs (McCalden et al 2009, Choi et al 2010, Mehin et al 2010) generally fail to show superiority of one of the devices over the other. We therefore hypothesized that the seemingly small differences in design between the CKS and PFC system would not lead to differences in clinical outcome in our study.…”

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confidence: 99%

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Similar TKA designs with differences in clinical outcome

Meijerink¹,

Loon

Hannink

et al. 2011

Acta Orthopaedica

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Background and purpose To try to improve the outcome of our TKAs, we started to use the CKS prosthesis. However, in a retrospective analysis this design tended to give worse results. We therefore conducted a randomized, controlled trial comparing this CKS prosthesis and our standard PFC prosthesis. Because many randomized studies between different TKA concepts generally fail to show superiority of a particular design, we hypothesized that these seemingly similar designs would not lead to any difference in clinical outcome.Patients and methods 82 patients (90 knees) were randomly allocated to one or other prosthesis, and 39 CKS prostheses and 38 PFC prostheses could be followed for mean 5.6 years. No patients were lost to follow-up. At each follow-up, patients were evaluated clinically and radiographically, and the KSS, WOMAC, VAS patient satisfaction scores and VAS for pain were recorded.Results With total Knee Society score (KSS) as primary endpoint, there was a difference in favor of the PFC group at final follow-up (p = 0.04). Whereas there was one revision in the PFC group, there were 6 revisions in the CKS group (p = 0.1). The survival analysis with any reoperation as endpoint showed better survival in the PFC group (97% (95% CI: 92–100) for the PFC group vs. 79% (95% CI: 66–92) for the CKS group) (p = 0.02).Interpretation Our hypothesis that there would be no difference in clinical outcome was rejected in this study. The PFC system showed excellent results that were comparable to those in previous reports. The CKS design had differences that had considerable negative consequences clinically. The relatively poor results have discouraged us from using this design.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Similar TKA designs with differences in clinical outcome

Meijerink¹,

Loon

Hannink

et al. 2011

Acta Orthopaedica

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“…During the short-term follow-up period, no significant difference in clinical improvement has been demonstrated between MB- and FB-implant groups (11–16). In a prospective study, Hanusch et al (15) demonstrated that there was no significant difference in the mean range of motion (ROM) or Knee Society score (KSS) between MB and FB implants, at a mean follow-up of 13.4 months.…”

Section: Introductionmentioning

confidence: 93%

Comparison of fixed- and mobile-bearing total knee arthroplasty with a mean five-year follow-up: A meta-analysis

Cheng¹,

Chen²,

Guo³

et al. 2013

Experimental and Therapeutic Medicine

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Controversy exists regarding the clinical and radiological differences in outcomes between fixed-bearing (FB) and mobile-bearing (MB) total knee arthroplasties (TKAs) at the mid- or long-term follow-up. We therefore conducted a meta-analysis and systematic review of randomized controlled trials (RCTs) that have evaluated FB and MB TKAs. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline and Embase. The data, including demographic information, methodological quality, duration of follow-up, clinical and radiographical outcomes, patient preferences and complications, were extracted. The methodological quality of the studies was assessed in accordance with the guidelines presented in the Cochrane Handbook for Systematic Reviews of Interventions. Nine trials, studying 1,821 knees, were eligible for data extraction and meta-analysis. The Knee Society score and the maximum knee flexion demonstrated no difference between the FB and MB groups (P=0.47 and P=0.72, respectively). Similarly, no difference was revealed between the groups for radiological outcomes or general health results. An increased number of high-quality RCTs with long-term follow-ups are required to validate the results.

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“…Furthermore, nondiabetic patients may be at a higher risk for stress-related periprosthetic joint infection than diabetic patients at a given level of hyperglycemia 3 . Previous studies also have suggested that male sex 10 - 13 , younger age 14 , 15 , obesity 4 , 11 , 15 - 17 , and revision procedures 7 , 18 are related to higher rates of periprosthetic joint infection. The present study suggests that hyperglycemia represents a common link between these factors.…”

mentioning

confidence: 93%

Postoperative Hyperglycemia Can Be Safely and Effectively Controlled in Both Diabetic and Nondiabetic Patients with Use of a Subcutaneous Insulin Protocol

Gallagher

Erich

Gattermeyer

et al. 2017

JBJS OA

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Background:Postoperative hyperglycemia related to stress has been shown to be an independent risk factor for periprosthetic joint infection. In a non-intensive care, general-surgery setting, a standardized postoperative insulin protocol has been shown to decrease the rate of wound infections. We hypothesized that the use of a similar protocol is both safe and effective for controlling hyperglycemia in patients who have undergone total joint replacement.Methods:We performed a retrospective cohort study of 489 consecutive patients who underwent primary or revision total hip or knee arthroplasty between January 2008 and April 2013. All patients were tested with point-of-care (finger-stick) glucose determinations postoperatively and were started on a subcutaneous insulin protocol if they had postoperative stress hyperglycemia of >140 mg/dL when fasting or >180 mg/dL after meals. Insulin was discontinued when blood glucose decreased to <100 mg/dL.Results:Of the 489 patients, 301 (62%) qualified for the insulin protocol. Thirty-seven (17%) of the 220 patients for whom the hemoglobin A1c level was available were diabetic, and 21 (11%) of the 187 patients for whom body mass index data were available were morbidly obese (body mass index, ≥40 kg/m2). Diabetes (p < 0.001), revision surgery (p < 0.001), male sex (p = 0.0110), and obesity (including morbid obesity) (p = 0.0051) were independent factors resulting in significant glycemic elevation. A trend toward hyperglycemia occurred in younger patients but did not reach significance (p = 0.063). The glucose levels of patients in all of these groups responded well to insulin. None of the patients who were managed with the insulin experienced a periprosthetic joint infection. There were no injuries related to hypoglycemia.Conclusions:The findings of the present study suggest that hyperglycemia is a common link between seemingly disparate factors related to the increased prevalence of periprosthetic joint infection. The standardized subcutaneous insulin protocol was both safe and effective for the treatment of hyperglycemia for nondiabetic as well as diabetic patients. Patients who have undergone total joint replacement, especially those with revision procedures, male sex, morbid obesity, and diabetes, should be evaluated for hyperglycemia starting in the post-anesthesia care unit and should be managed with the insulin protocol when that risk is identified.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Fixed- vs Mobile-Bearing Total Knee Arthroplasty

Cited by 73 publications

References 10 publications

Similar TKA designs with differences in clinical outcome

Similar TKA designs with differences in clinical outcome

Comparison of fixed- and mobile-bearing total knee arthroplasty with a mean five-year follow-up: A meta-analysis

Postoperative Hyperglycemia Can Be Safely and Effectively Controlled in Both Diabetic and Nondiabetic Patients with Use of a Subcutaneous Insulin Protocol

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