Combined Advantages of the Mobile Bearing Design and Cementless Fixation Technique for Total Knee Arthroplasty

AbstractDespite the success of total knee arthroplasty (TKA), more than 20,000 revision TKA procedures are performed annually. In an effort to decrease failures due to loosening in the past, cementless fixation of TKA was suggested. The preliminary results of cementless fixation for TKA proved to be discouraging, with midterm results linking the use of uncemented components to early aseptic loosening. While cemented TKA has remained the gold standard fixation technique, the changing demographics of the average TKA patient have led some surgeons to revisit cementless fixation as an option.

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Long-term follow up of Navigation TKA using multi directional mobile bearing design

10.29007/3724 ◽

2018 ◽

Author(s):

Eun-Kyoo Song ◽

Jong-Keun Seon ◽

Dong-Hyun Lee ◽

Je-Hyoung Yeo

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Survival Rates ◽

Mobile Bearing ◽

Long Term Follow Up ◽

Total Knee ◽

Bearing Design

Total knee arthroplasty using navigation system is known to be more effective than conventional methods in achieving more accurate bone resection and neutral alignment.1 Mobile bearing is also known to reduce wear and automatically correct rotational malalignment of the tibia but the long-term follow-up results of more than 10 years are extremely rare.2, 3 The purpose of this study is to investigate the results of clinical and radiologic long-term follow-up and complications of total knee arthroplasty using navigation and multi-directional mobile bearing.From 2003 to 2006, a total of 111 navigation TKAs using multi-directional mobile bearing design were carried out and reviewed retrospectively. TKAs were performed by two experienced surgeons at one institute. Of the 111 patients, 102 were women and 9 were men. The mean duration of follow-up was 11.4 ± 1.0 years (range, 10.1 to 14.08 years). Clinical outcomes were evaluated in terms of Knee Society Score, Hospital for Special Surgery score, Western Ontario and McMaster University (WOMAC) score, range of motion and complications. Long-term radiological outcomes and survival rates were evaluated at least 10 years.Average preoperative HSS score was 66.5 ± 9.8 and KSS pain and function score were 25.0 ± 11.8 and 44.5 ± 12.3, respectively. Scores improved to 94.1 ± 8.2, 46.6 ± 11.6 and 88.2 ± 14.6 at the last follow up, respectively. Mean preoperative WOMAC scores of 75.8 ± 16.5 improved to 13.8 ± 16.0 at last follow-up. Five knees required re-operation, two for liner breakage, one for liner wear, one for distal femoral fracture and one for infection. The estimated 10-year prosthesis survival rates for any reason and for prosthesis-related problems were 95.5% and 97.4% , respectively.TKAs using each techniques resulted in similar good clinical outcomes and postoperative leg alignments. Robotic and navigation TKA appeared to reduce the number of postoperative leg alignment outliers and revision rate compared to conventional TKA.

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A randomized controlled trial of fixed- versus mobile-bearing total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b7.bjj-2017-1473.r1 ◽

2018 ◽

Vol 100-B (7) ◽

pp. 925-929 ◽

Cited By ~ 13

Author(s):

M. P. Abdel ◽

M. E. Tibbo ◽

M. J. Stuart ◽

R. T. Trousdale ◽

A. D. Hanssen ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Randomized Controlled Trial ◽

Knee Arthroplasty ◽

Controlled Trial ◽

Mobile Bearing ◽

Fixed Bearing ◽

Randomized Controlled ◽

Total Knee ◽

Bearing Design ◽

Ks Function

Aims It has been suggested that mobile-bearing total knee arthroplasty (TKA) might lead to better outcomes by accommodating some femorotibial rotational mismatch, thereby reducing contact stresses and polyethylene wear. The aim of this study was to determine whether there is a difference between fixed- and mobile-bearing versions of a contemporary TKA with respect to durability, range of movement (ROM) and function, ten years postoperatively. Patients and Methods A total of 240 patients who were enrolled in this randomized controlled trial (RCT) underwent a primary cemented TKA with one of three tibial components (all-polyethylene fixed-bearing, modular metal-backed fixed-bearing and mobile-bearing). Patients were reviewed at a median follow-up of ten years (IQR 9.2 to 10.4). Results There was no difference in durability, as measured by survivorship free of revision for any reason, nor in mean maximal ROM at ten years (p = 0.8). There was also no difference in function, as measured by Knee Society (KS) function scores (p = 0.63) or the prevalence of patellar tilt (p = 0.12). Conclusion In this clinical RCT, the mobile-bearing design of TKA was found to be reliable and durable, but did not provide better maximum knee flexion, function or durability ten years postoperatively compared with a posterior-stabilized, fixed-bearing design incorporating either an all-polyethylene or a modular-metal-backed tibial component. Cite this article: Bone Joint J 2018;100-B:925–9.

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Fixed-bearing vs mobile-bearing prostheses for total knee arthroplasty after approximately 10 years of follow-up: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02560-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dongsheng Hao ◽

Junjie Wang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Mobile Bearing ◽

Complication Rates ◽

Fixed Bearing ◽

Significant Difference ◽

Total Knee ◽

Bearing Design

Abstract Background The benefits and risks of fixed-bearing and mobile-bearing designs for total knee arthroplasty (TKA) were compared, and long-term functional, clinical and radiological outcomes were analysed. Methods A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane Central databases was conducted to identify randomized controlled trials (RCTs) comparing fixed-bearing and mobile-bearing designs with no less than 9 years of follow-up. Primary outcome measures were Knee Society Scores (KSSs), range of motion (ROM) in knee joint values, complication rates and revision rates. The final search was performed on 23 April 2021. Results Six RCTs were included. A total of 451 patients with 612 knees met the inclusion criteria. The mobile-bearing design, in contrast to the fixed-bearing design, can clearly increase the KSFSs, especially with posterior cruciate retention. There was no significant difference in the KSKSs, ROM values, revision rates or complication rates between the two bearing design groups. Conclusion After approximately 10 years of follow-up, the mobile-bearing design has advantages in KSFSs over the fixed-bearing design. The mobile-bearing design may also have advantages in the revision rates over the fixed-bearing design when the posterior cruciate ligament is substituted. There may be no clear difference in KSKSs, ROM values or complication rates between these two designs.

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