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Beiene ZA, Tanghe KK, Neitzke CC, Hidaka C, Lyman S, Gausden EB, McLawhorn AS. Patient Selection in Randomized Controlled Trials of Total Knee Arthroplasty: A Systematic Review Assessing Inclusion Criteria. J Bone Joint Surg Am 2024; 106:553-563. [PMID: 38252710 DOI: 10.2106/jbjs.23.00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Patients undergo total knee arthroplasty (TKA) at widely disparate stages of osteoarthritis, raising the possibility of high heterogeneity among patients enrolled in TKA research studies. Obscuration of treatment effectiveness and other problems that may stem from cohort heterogeneity can be controlled in clinical studies by rigorously defining target patients. The purpose of this review was to determine the extent to which randomized controlled trials (RCTs) on TKA use osteoarthritis severity, as defined by radiographic grade or patient-reported outcome measures (PROMs), in their inclusion criteria, and to investigate potential impact on outcome. METHODS A search of PubMed, Embase, Scopus, Web of Science, and Cochrane databases used a combination of terms involving TKA, PROMs, and radiographic scoring. A total of 1,227 studies were independently reviewed by 2 screeners for the above terms. RCTs with ≥100 patients (236) and with <100 patients (325) undergoing TKA were analyzed with regard to the specific inclusion criteria and recruitment process. RESULTS Among the identified RCTs with ≥100 patients, 18 (<8%, with a total of 2,952 randomized patients) used specific radiographic scoring or PROM thresholds in their inclusion criteria. Eleven of the 18 studies used specific radiographic scoring, such as the Kellgren-Lawrence or Ahlbäck classifications. Three studies used preoperative PROM thresholds: Knee Society Knee Score of <60, Knee Society Function Score of <60, Oxford Knee Score of <20, and Hospital for Special Surgery Score of <60. Among studies with <100 patients, 48 (<15%) used specific inclusion criteria. CONCLUSIONS The vast majority of RCTs (>85%) did not enroll patients based on disease severity, as measured by PROM score thresholds or radiographic classifications, in their inclusion criteria. The lack of consistent inclusion criteria likely results in heterogeneous cohorts, potentially undermining the validity of RCTs on TKA. LEVEL OF EVIDENCE Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Zodina A Beiene
- Department of Anesthesiology and Critical Care, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Colin C Neitzke
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Chisa Hidaka
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Stephen Lyman
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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McNamara I, Pomeroy V, Clark AB, Creelman G, Whitehouse C, Wells J, Harry B, Smith TO, High J, Swart AM, Clarke C. Comparison of the Journey II bicruciate stabilised (JII-BCS) and GENESIS II total knee arthroplasty for functional ability and motor impairment: the CAPAbility, blinded, randomised controlled trial. BMJ Open 2023; 13:e061648. [PMID: 36599639 PMCID: PMC9815016 DOI: 10.1136/bmjopen-2022-061648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II). SETTING Patients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory. PARTICIPANTS 80 participants undergoing single-stage TKR. INTERVENTIONS Patients were randomised to receive either the Journey II BCS (JII-BCS) or Genesis II TKR. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the Oxford Knee Score (OKS), at 6 months. Secondary outcomes were: OKS Activity and Participation Questionnaire, EQ-5D-5L and UCLA Activity scores, Timed Up and Go Test, 6 min walk test, lower limb kinematics and lower limb muscle activity during walking and balance. RESULTS This study found no difference in the OKS between groups. The OKS scores for the JII-BCS and Genesis II groups were mean (SD) 42.97 (5.21) and 43.13 (5.20) respectively, adjusted effect size 0.35 (-2.01,2.71) p=0.771In secondary outcome measures, the Genesis II group demonstrated a significantly greater walking range-of-movement (50.62 (7.33) vs 46.07 (7.71) degrees, adjusted effect size, 3.14 (0.61,5.68) p=0.02) and higher peak knee flexion angular velocity during walking (mean (SD) 307.69 (38.96) vs 330.38 (41.40) degrees/second, adjusted effect size was 21.75 (4.54,38.96), p=0.01) and better postural control (smaller resultant centre of path length) during quiet standing than the JII-BCS group (mean (SD) 158.14 (65.40) vs 235.48 (176.94) mm, adjusted effect size, 59.91 (-105.98, -13.85) p=0.01.). CONCLUSIONS In this study population, the findings do not support the hypothesis that the Journey II BCS produces a better outcome than the Genesis II for the primary outcome of the OKS at 6 months after surgery. TRIAL REGISTRATION NUMBER ISRCTN32315753.
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Affiliation(s)
- Iain McNamara
- Norfolk and Norwich University Hospital, Norwich, UK
- University of East Anglia, Norwich, UK
| | | | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - J Wells
- University of East Anglia, Norwich, UK
| | - B Harry
- Department of clinical neurosciences, University of Cambridge, Cambridge, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Ann Marie Swart
- University of East Anglia, Norwich, UK
- Health Sciences, University of East Anglia, Norwich, UK
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No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3138-3154. [PMID: 35861866 PMCID: PMC9418337 DOI: 10.1007/s00167-022-07065-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE Level I.
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Hantouly AT, Ahmed AF, Alzobi O, Toubasi A, Salameh M, Elmhiregh A, Hameed S, Ahmed GO, Alvand A, Al Dosari MAA. Mobile-bearing versus fixed-bearing total knee arthroplasty: a meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:481-495. [PMID: 34021791 PMCID: PMC8924090 DOI: 10.1007/s00590-021-02999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
Objective The purpose of this study was to perform a meta-analysis comparing mobile-bearing with fixed-bearing total knee arthroplasty (TKA) in terms of all-cause revision rates, aspetic loosening, knee functional scores, range of motion and radiographic lucent lines and osteolysis. Methods PubMed, Cochrane Library, Google Scholar and Web of Science were searched up to January 2020. Randomized controlled trials that compared primary mobile-bearing with fixed-bearing TKA, reporting at least one of the outcomes of interest, at a minimum follow-up of 12 months were included. All outcomes of interest were pooled at short-term (< 5 years), mid-term (5 to 9 years) and long-term (> = 10 years) follow-up intervals. Results A total of 70 eligible articles were included in the qualitative and statistical analyses. There was no difference between mobile-bearing or fixed-bearing TKA at short-term, mid-term and long-term follow-ups in all outcome measures including all-cause revision rate, aseptic loosening, oxford knee score, knee society score, Hospital for Special Surgery score, maximum knee flexion, radiographic lucent lines and radiographic osteolysis. Conclusion The current level of evidence demonstrated that both mobile-bearing and fixed-bearing designs achieved excellent outcomes, yet it does not prove the theoretical advantages of the mobile-bearing insert over its fixed-bearing counterpart. The use of either design could therefore be supported based on the outcomes assessed in this study. Level of Evidence: Level II, Therapeutic Supplementary information The online version contains supplementary material available at (10.1007/s00590-021-02999-x).
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Toubasi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Aissam Elmhiregh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Shamsi Hameed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib O Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Gilmour A, MacLean AD, Rowe PJ, Banger MS, Donnelly I, Jones BG, Blyth MJG. Robotic-Arm-Assisted vs Conventional Unicompartmental Knee Arthroplasty. The 2-Year Clinical Outcomes of a Randomized Controlled Trial. J Arthroplasty 2018; 33:S109-S115. [PMID: 29627257 DOI: 10.1016/j.arth.2018.02.050] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) for treatment of medial compartment osteoarthritis has potential benefits over total knee arthroplasty but UKA has a higher revision rate. Robotic-assisted UKA is increasingly common and offers more accurate implant positioning and limb alignment, lower early postoperative pain but evidence of functional outcome is lacking. The aim was to assess the clinical outcomes of a single-centre, prospective, randomised controlled trial, comparing robotic-arm-assisted UKA with conventional surgery. METHODS A total of 139 participants were recruited and underwent robotic-arm-assisted (fixed bearing) or conventional (mobile bearing) UKA. Fifty-eight patients in the robotic-arm-assisted group and 54 in the manual group at 2 years. The main outcome measures were the Oxford Knee Score, American Knee Society Score and revision rate. RESULTS At 2 years, there were no significant differences for any of the outcome measures. Sub-group analysis (n = 35) of participants with a preoperative University of California Los Angeles Activity Scale >5 (more active) was performed. In this sub-group, the median Oxford Knee Score at 2 years was 46 (IQR 42.0-48.0) for robotic-arm-assisted and 41 (IQR 38.5-44.0) for the manual group (P = .036). The median American Knee Society Score was 193.5 (IQR 184.0-198.0) for the robotic-arm-assisted group and 174.0 (IQR 166.0-188.5) for the manual group (P = .017). Survivorship was 100% in robotic-arm-assisted group and 96.3% in the manual group. CONCLUSION Overall, participants achieved an outcome equivalent to the most widely implanted UKA in the United Kingdom. Sub-group analysis suggests that more active patients may benefit from robotic-arm- assisted surgery. Long term follow-up is required to evaluate differences in survivorship.
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Affiliation(s)
- Alisdair Gilmour
- Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Angus D MacLean
- Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Philip J Rowe
- Biomedical Engineering Department, University of Strathclyde, Glasgow, Scotland, UK
| | - Matthew S Banger
- Biomedical Engineering Department, University of Strathclyde, Glasgow, Scotland, UK
| | - Iona Donnelly
- Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Bryn G Jones
- Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Mark J G Blyth
- Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Heesterbeek PJC, van Houten AH, Klenk JS, Eijer H, Christen B, Wymenga AB, Schuster AJ. Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1524-1531. [PMID: 28389879 DOI: 10.1007/s00167-017-4542-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/04/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Only few long-term data on ligament-balanced cruciate-retaining total knee arthroplasty (CR TKA) are currently available. Either a mobile- or fixed-bearing insert can be chosen, which showed good mid-term outcome and few complications and revisions. This multi-centre retrospective cross-sectional cohort study investigated the 12-year results of primary TKA using a balancing gap technique and compared survival and clinical outcome between fixed and mobile inserts. METHODS In this retrospective cross-sectional cohort study, 557 cases of three clinics (2 Swiss, 1 Dutch) operated between 1998 and 2003 with the first series of a TKA implanted with a balanced gap technique (433 (77.7%) fixed, 124 (22.3%) mobile (anterior-posterior gliding (7-9 mm) and rotational (15°) degrees of freedom) inserts) were included for survival analysis (Kaplan-Meier, by insert type). At the 12-year follow-up (FU) examination of 189 cases, range of motion, knee society score (KSS), numeric rating scale (NRS) for pain and satisfaction were determined and radiographs were evaluated by median tests, by insert type. RESULTS Of 521 cases available for analysis, 28 (5.4%; 11 fixed, 17 mobile bearing) were revised. Mean cumulative survival after 12.4 years was 97.0% (95% CI 94.7-98.4) for fixed bearings and 85.4% (95% CI 77.5-90.7) after 12.2 years for mobile bearings, p < 0.0001. Patients' mean age at 11.0 years FU (n = 189) was 78.0 (range 54.5-97.3) years. Mean total KSS was 157.8 (24-200) points, and mean passive flexion was 114° (45-150); no clinical score differed significantly between fixed and mobile bearings. CONCLUSION This study showed a superior survival for fixed bearing compared with mobile bearing in a CR TKA using a ligament-balanced technique after more than 12 years. Clinical outcomes are excellent to good after long-term follow-up, and similar for fixed and mobile bearing. LEVEL OF EVIDENCE Therapeutic studies-retrospective cohort study, Level III.
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Affiliation(s)
| | | | - J S Klenk
- Orthopädische Klinik orthosiloah Bern-Gümligen, Bern, Switzerland
| | - H Eijer
- Regionalspital Emmental AG, Burgdorf, Switzerland
| | - B Christen
- Orthopädische Klinik Bern, Bern, Switzerland
| | - A B Wymenga
- Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A J Schuster
- Orthopädische Klinik orthosiloah Bern-Gümligen, Bern, Switzerland
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No differences between fixed- and mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1757-1777. [PMID: 27324479 DOI: 10.1007/s00167-016-4195-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 06/07/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE For years, numerous studies have been performed to determine whether mobile-bearing total knee arthroplasty (MB-TKA) or fixed-bearing total knee arthroplasty (FB-TKA) is the preferential design in total knee arthroplasty. Reviews and meta-analyses on this subject have focused on a relatively small number of randomised controlled trials, possibly missing important results of smaller studies. The goal of this review was to provide a comprehensive overview of all literature comparing MB-TKA and FB-TKA in the treatment of osteoarthritis of the knee. METHODS An extensive literature search was performed in the PubMed database. All studies that compared MB-TKA with FB-TKA and looked at one of four theorised advantages (insert wear, signs of loosening, survival rate of the prosthesis and clinical outcome) were included. RESULTS The initial search yielded 258 articles, of which 127 were included after the first screening. The included studies consisted of 9 meta-analyses, 3 systematic reviews, 48 RCT's, 44 comparative studies, 10 reviews and 13 studies that examined patients who received bilateral TKA (one MB-TKA and one FB-TKA). Combining the results of all studies showed that almost all studies found no difference between MB-TKA and FB-TKA. CONCLUSIONS Even when examining all different types of studies on MB-TKA and FB-TKA, the results of this review showed no difference in insert wear, risk of loosening, survivorship or clinical outcome. In daily practice, the choice between MB-TKA and FB-TKA should be based on the experience and judgment of the surgeon, since no clear differences are observed in the scientific literature. LEVEL OF EVIDENCE III.
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Capella M, Dolfin M, Saccia F. Mobile bearing and fixed bearing total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:127. [PMID: 27162777 DOI: 10.21037/atm.2015.12.64] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience.
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Affiliation(s)
- Marcello Capella
- Orthopedics and Traumatology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Marco Dolfin
- Orthopedics and Traumatology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Francesco Saccia
- Orthopedics and Traumatology Unit, San Giovanni Bosco Hospital, Turin, Italy
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Different femorotibial contact points between fixed- and mobile-bearing TKAs do not show clinical impact. Knee Surg Sports Traumatol Arthrosc 2015; 23:3368-74. [PMID: 25038883 DOI: 10.1007/s00167-014-3178-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE In anteroposterior (AP)-gliding mobile-bearing total knee arthroplasty (TKA), the femoral component can theoretically slide forward resulting in a more anterior contact point, causing pain due to impingement. A lower lever arm of the extensor apparatus can also attribute to higher patella pressures and pain. The goal of this study was to determine the contact point in a cohort of mobile- and fixed-bearing TKAs, to determine whether the contact point lies more anteriorly in mobile-bearing TKA and to confirm whether this results in anterior knee pain. METHODS We used 38 fixed-bearing TKA and 40 mobile-bearing TKA from a randomized trial with straight lateral knee X-rays and measured the contact point. The functional outcome was measured by Knee Society Score at 12 months postoperatively. Pain scores were analysed using a VAS score (0-100 mm) in all patients at rest and when moving. Difficulty at rising up out of a chair was also assessed using a VAS score. RESULTS The contact point in mobile-bearing TKA was situated at 59.5 % of the AP distance of the tibia and in the fixed-bearing TKA group at 66.1 % (P< 0.05). Patients with mobile- and fixed-bearing TKAs had similar knee scores, pain scores and difficulty in chair rise. No significant correlation was found between contact point and knee pain. CONCLUSION The hypothesis of a more anterior contact point in the mobile-bearing cohort was confirmed but no correlation with functional and pain scores in this cohort could be found. The tibiofemoral contact point could not be correlated with a different clinical outcome and higher incidence of anterior knee pain. This study further adds to the knowledge on possible differences between mobile- and fixed-bearing prostheses. Next to that, bad outcomes could not be explained by CP. LEVEL OF EVIDENCE Case series, Level IV.
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In vitro kinematics of fixed versus mobile bearing in unicondylar knee arthroplasty. Arch Orthop Trauma Surg 2015; 135:871-7. [PMID: 25877013 DOI: 10.1007/s00402-015-2214-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Indexed: 02/09/2023]
Abstract
PURPOSE When performing unicondylar knee arthroplasty (UKA), the surgeon can choose between two fundamentally different designs: a mobile-bearing (MB) inlay with high conformity, or a low-conformity, fixed bearing (FB) inlay. There is an ongoing debate in the orthopaedic community about which design is superior. To date, there have been no comparative biomechanical studies regarding each system's effects on the quadriceps force and the medial contact pressure. The purpose of this study was to investigate these alterations in vitro before and after UKA with two prosthesis systems, representing the MB and FB designs. METHODS FB and MB unicondylar knee prosthesis designs were tested in sequence under isokinetic extension in an in vitro simulator. In each case, the required quadriceps extension force was determined before and after implantation of a medial UKA. Furthermore, the tibiofemoral contact pressures were evaluated for both prosthesis designs. RESULTS The quadriceps force maximum was achieved at 106° and 104° of flexion with the FB and MB designs, respectively. Implantation of the FB UKA resulted in a significant increase in the necessary maximum quadriceps force (p = 0.006). In addition, implantation of the MB UKA resulted in a significantly higher extension force (p = 0.03). The difference between the two groups was statistically significant in deep flexion (p = 0.03), with higher forces in MB UKA. CONCLUSION The MB design showed significantly increased quadriceps extension force compared with the FB inlay in deep flexion. Although the FB design showed higher maximum peak pressures concentrated on a smaller area, the pressure introduction in deep flexion was lower, compared to MB inserts.
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Bailey O, Ferguson K, Crawfurd E, James P, May PA, Brown S, Blyth M, Leach WJ. No clinical difference between fixed- and mobile-bearing cruciate-retaining total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2015; 23:1653-9. [PMID: 24509880 DOI: 10.1007/s00167-014-2877-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE It is hypothesized that mobile polyethylene bearings in total knee arthroplasty (TKA) may confer benefits with regard to range of motion and have improved clinical outcome scores in comparison with an arthroplasty with a fixed-bearing design. Our study compares clinical outcomes between patients who undergo TKA with either a rotating platform or fixed bearing using a posterior cruciate-retaining design. METHODS Three hundred and thirty-one patients were randomized to receive either a rotating-platform (161 patients) or a fixed-bearing (170 patients) implant. All patients were assessed pre-operatively and at 1 and 2 years post-operatively using standard tools (range of movement, Oxford Knee Score, American Knee Society Score, SF12 and Patella Score). RESULTS There was no difference in pre- to 2-year post-operative outcomes between the groups with regard to improvement in range of motion (10° ± 16 vs. 9° ± 15), improvement in Oxford Knee Score (-17.6 ± 9.9 vs. -19.1 ± 8.4), improvement in American Knee Society Score (49.5 ± 24.7 vs. 50.7 ± 21.0), function (23.6 ± 19.6 vs. 25.0 ± 22.5) and pain (34.9 ± 16.2 vs. 35.8 ± 14.1) subscores, improvement in SF12 Score (10.0 ± 16.3 vs. 12.3 ± 15.8) or improvement in Patella Score (9.7 ± 7.4 vs. 10.6 ± 7.1). CONCLUSION No difference was demonstrated in clinical outcome between patients with a rotating-platform and fixed-bearing posterior cruciate-retaining TKA at 2-year follow-up. LEVEL OF EVIDENCE I.
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Affiliation(s)
- O Bailey
- Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK,
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12
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Hofstede SN, Nouta KA, Jacobs W, van Hooff ML, Wymenga AB, Pijls BG, Nelissen RGHH, Marang-van de Mheen PJ. Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 2015; 2015:CD003130. [PMID: 25650566 PMCID: PMC10960232 DOI: 10.1002/14651858.cd003130.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear whether there are differences in benefits and harms between mobile and fixed prostheses for total knee arthroplasty (TKA). The previous Cochrane review published in 2004 included two articles. Many more trials have been performed since then; therefore an update is needed. OBJECTIVES To assess the benefits and harms of mobile bearing compared with fixed bearing cruciate retaining total knee arthroplasty for functional and clinical outcomes in patients with osteoarthritis (OA) or rheumatoid arthritis (RA). SEARCH METHODS We searched The Cochrane Library, PubMed, EMBASE, CINAHL and Web of Science up to 27 February 2014, and the trial registers ClinicalTrials.gov, Multiregister, Current Controlled Trials and the World Health Organization (WHO) International Clinical Trials Registry Platform for data from unpublished trials, up to 11 February 2014. We also screened the reference lists of selected articles. SELECTION CRITERIA We selected randomised controlled trials comparing mobile bearing with fixed bearing prostheses in cruciate retaining TKA among patients with osteoarthritis or rheumatoid arthritis, using functional or clinical outcome measures and follow-up of at least six months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS We found 19 studies with 1641 participants (1616 with OA (98.5%) and 25 with RA (1.5%)) and 2247 knees. Seventeen new studies were included in this update.Quality of the evidence ranged from moderate (knee pain) to low (other outcomes). Most studies had unclear risk of bias for allocation concealment, blinding of participants and personnel, blinding of outcome assessment and selective reporting, and high risk of bias for incomplete outcome data and other bias. Knee painWe calculated the standardised mean difference (SMD) for pain, using the Knee Society Score (KSS) and visual analogue scale (VAS) in 11 studies (58%) and 1531 knees (68%). No statistically significant differences between groups were reported (SMD 0.09, 95% confidence interval (CI) -0.03 to 0.22, P value 0.15). This represents an absolute risk difference of 2.4% points higher (95% CI 0.8% lower to 5.9% higher) on the KSS pain scale and a relative percent change of 0.22% (95% CI 0.07% lower to 0.53% higher). The results were homogeneous. Clinical and functional scores The KSS clinical score did not differ statistically significantly between groups (14 studies (74%) and 1845 knees (82%)) with a mean difference (MD) of -1.06 points (95% CI -2.87 to 0.74, P value 0.25) and heterogeneous results. KSS function was reported in 14 studies (74%) with 1845 knees (82%) as an MD of -0.10 point (95% CI -1.93 to 1.73, P value 0.91) and homogeneous results. In two studies (11%), the KSS total score was favourable for mobile bearing (159 vs 132 for fixed bearing), with MD of -26.52 points (95% CI -45.03 to -8.01, P value 0.005), but with a wide 95% confidence interval indicating uncertainty about the estimate.Other reported scoring systems did not show statistically significant differences: Hospital for Special Surgery (HSS) score (seven studies (37%) in 1021 knees (45%)) with an MD of -1.36 (95% CI -4.18 to 1.46, P value 0.35); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (two studies (11%), 167 knees (7%)) with an MD of -4.46 (95% CI -16.26 to 7.34, P value 0.46); and Oxford total (five studies (26%), 647 knees (29%) with an MD of -0.25 (95% CI -1.41 to 0.91, P value 0.67). Health-related quality of lifeThree studies (16%) with 498 knees (22%) reported on health-related quality of life, and no statistically significant differences were noted between the mobile bearing and fixed bearing groups. The Short Form (SF)-12 Physical Component Summary had an MD of -1.96 (95% CI -4.55 to 0.63, P value 0.14) and heterogeneous results. Revision surgeryTwenty seven revisions (1.3%) were performed in 17 studies (89%) with 2065 knees (92%). In all, 13 knees were revised in the fixed bearing group and 14 knees in the mobile bearing group. No statistically significant differences were found (risk difference 0.00, 95% CI -0.01 to 0.01, P value 0.58), and homogeneous results were reported. MortalityIn seven out of 19 studies, 13 participants (37%) died. Two of these participants had undergone bilateral surgery, and for seven participants, it was unclear which prosthesis they had received; therefore they were excluded from the analyses. Thus our analysis included four out of 191 participants (2.1%) who had died: one in the fixed bearing group and three in the mobile bearing group. No statistically significant differences were found. The risk difference was -0.02 (95% CI -0.06 to 0.03, P value 0.49) and results were homogeneous. Reoperation ratesThirty reoperations were performed in 17 studies (89%) with 2065 knees (92%): 18 knees in the fixed bearing group (of the 1031 knees) and 12 knees in the mobile group (of the 1034 knees). No statistically significant differences were found. The risk difference was -0.01 (95% CI -0.01 to 0.01, P value 0.99) with homogeneous results. Other serious adverse eventsSixteen studies (84%) reported nine other serious adverse events in 1735 knees (77%): four in the fixed bearing group (of the 862 knees) and five in the mobile bearing group (of the 873 knees). No statistically significant differences were found (risk difference 0.00, 95% CI -0.01 to 0.01, P value 0.88), and results were homogeneous. AUTHORS' CONCLUSIONS Moderate- to low-quality evidence suggests that mobile bearing prostheses may have similar effects on knee pain, clinical and functional scores, health-related quality of life, revision surgery, mortality, reoperation rate and other serious adverse events compared with fixed bearing prostheses in posterior cruciate retaining TKA. Therefore we cannot draw firm conclusions. Most (98.5%) participants had OA, so the findings primarily reflect results reported in participants with OA. Future studies should report in greater detail outcomes such as those presented in this systematic review, with sufficient follow-up time to allow gathering of high-quality evidence and to inform clinical practice. Large registry-based studies may have added value, but they are subject to treatment-by-indication bias. Therefore, this systematic review of RCTs can be viewed as the best available evidence.
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Key Words
- humans
- knee prosthesis
- arthritis, rheumatoid
- arthritis, rheumatoid/surgery
- arthroplasty, replacement, knee
- arthroplasty, replacement, knee/adverse effects
- arthroplasty, replacement, knee/instrumentation
- arthroplasty, replacement, knee/mortality
- bias
- health status
- knee joint
- osteoarthritis, knee
- osteoarthritis, knee/surgery
- prosthesis design
- prosthesis design/methods
- quality of life
- randomized controlled trials as topic
- range of motion, articular
- reoperation
- reoperation/statistics & numerical data
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Affiliation(s)
- Stefanie N Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, Postzone J10-s, room J10-88, P.O. Box 9600, Leiden, Netherlands, 2300 RC.
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van Stralen RA, Anderson PG, Wymenga AB. The self-aligning knee prosthesis: clinical and radiological outcome and survival analysis of a cruciate retaining meniscal bearing knee at 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2014; 22:2728-34. [PMID: 23839209 DOI: 10.1007/s00167-013-2601-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 06/26/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Previously, the clinical and radiological results of the self-aligning cruciate retaining total knee prosthesis at 5-years follow-up were described. The 10-year follow-up is now reported to determine the clinical and radiological results and the survival of the prosthesis. METHODS A 10-year follow-up was performed in this prospectively followed cohort of 246 (232 patients) self-aligning, cruciate retaining total knee arthroplasties performed between 1995 and 1998. Because patients had died and others suffered from comorbidities making them unable to attend a follow-up consultation, data could be obtained for 105 prostheses. Clinical results were evaluated by the Knee Society Score, and radiological follow-up was performed on standard AP and lateral X-rays. All radiographs were evaluated for the presence of radiolucencies, osteolysis and wear. RESULTS At the 10-year follow-up, there were no new cases of revision so that the cumulative survival rate at 10 years remains 95%. The 10-year follow-up shows good clinical results with an average Knee Society Score of 154 (SD 35.7) and an average range of motion of 109° (SD 13.7). After excluding 25 prostheses for comorbidities, the mean 10-year KSS score increased from 154 to 163 (SD 26.2). On the other hand, for the ROM, the exclusion of the 25 prostheses had no influence on the mean ROM value of 109°. At the 10-year follow-up, none of the 100 available radiographs showed any radiolucencies >2 mm on any component. CONCLUSIONS Long-term follow-up of the mobile bearing, cruciate retaining, SAL-II total knee arthroplasty shows excellent clinical and radiological results without bearing dislocation. LEVEL OF EVIDENCE Prospective cohort, Level IV.
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Affiliation(s)
- R A van Stralen
- Sint Maartenskliniek, Hengstdal 3, Postbus 9011, Nijmegen, 6500 GM, The Netherlands,
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Solarino G, Spinarelli A, Carrozzo M, Piazzolla A, Vicenti G, Moretti B. Long-term outcome of low contact stress total knee arthroplasty with different mobile bearing designs. JOINTS 2014; 2:109-14. [PMID: 25606553 DOI: 10.11138/jts/2014.2.3.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE to evaluate the differences in clinical outcome and survivorship of three different mobile bearings for total knee arthroplasty. METHODS a retrospective study was conducted in 60 patients (53 females, 7 males, mean age: 68 years and 5 months) each submitted to total knee replacement using one of the three different mobile bearings of the LCS system (Depuy Johnson & Johnson, Warsaw, IN). The diagnosis was knee osteoarthritis in 57 cases and rheumatoid arthritis in three cases. Three different groups of 20 cases each were identified: total knee arthroplasties with mobile menisci (group 1); total knee arthroplasties with the rotating platform (group 2); and total knee arthroplasties with the anteroposterior glide platform (group 3). As regards the component fixation, 33 implants were cementless, three were cemented, and in 24 only the tibial component was cemented. The patella was not replaced. RESULTS although the duration of follow-up differed between the three groups, the clinical and radiological results at final follow-up showed no revision of femoral and/or tibial components for mechanical or septic reasons, and no signs of impending failure. One meniscal bearing, showing polyethylene wear after 17 years, was successfully replaced. CONCLUSIONS the present retrospective study confirmed the long-term effectiveness of knee implants with mobile bearings, in which the congruity of the surfaces makes it possible to overcome the problem of high contact stresses that may result in polyethylene wear and osteolysis; at the same time, these implants eliminate constraint forces thereby reducing the risk of mechanical loosening. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Giuseppe Solarino
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Spinarelli
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Piazzolla
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Biagio Moretti
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
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Dynamic finite element analysis of mobile bearing type knee prosthesis under deep flexional motion. ScientificWorldJournal 2014; 2014:586921. [PMID: 25133247 PMCID: PMC4124825 DOI: 10.1155/2014/586921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/22/2014] [Indexed: 11/17/2022] Open
Abstract
The primary objective of this study is to distinguish between mobile bearing and fixed bearing posterior stabilized knee prostheses in the mechanics performance using the finite element simulation. Quantifying the relative mechanics attributes and survivorship between the mobile bearing and the fixed bearing prosthesis remains in investigation among researchers. In the present study, 3-dimensional computational model of a clinically used mobile bearing PS type knee prosthesis was utilized to develop a finite element and dynamic simulation model. Combination of displacement and force driven knee motion was adapted to simulate a flexion motion from 0° to 135° with neutral, 10°, and 20° internal tibial rotation to represent deep knee bending. Introduction of the secondary moving articulation in the mobile bearing knee prosthesis has been found to maintain relatively low shear stress during deep knee motion with tibial rotation.
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16
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Rotating-platform TKA no different from fixed-bearing TKA regarding survivorship or performance: a meta-analysis. Clin Orthop Relat Res 2014; 472:2185-93. [PMID: 24590838 PMCID: PMC4048397 DOI: 10.1007/s11999-014-3539-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mobile bearings have been compared with fixed bearings used in TKA. However, rotating platforms, a specific type of mobile bearing, have not been compared with fixed-bearings using meta-analysis. QUESTIONS/PURPOSES We asked whether the performance of a rotating-platform bearing is superior to, comparable to, or worse than a fixed bearing. Four areas were investigated: clinical performance, component alignment, adverse event rates, and revision rates. METHODS Searches of Medline, EMBASE, Google Scholar, and the Cochrane databases, combined with reference lists from published meta-analyses and systematic reviews of mobile-bearing versus fixed-bearing prostheses used in TKAs, provided 17 nonlanguage-restricted studies consisting of 1910 TKAs (966 rotating platform versus 944 fixed bearing). Random-effect modeling was used for all meta-analyses, thereby mitigating possible effects of heterogeneity among studies. All meta-analyses were examined for publication bias using funnel plots; publication bias was not detected for any meta-analysis. RESULTS There were no statistically or clinically significant differences in clinical performance (clinical scores, ROM, and radiographic evaluation), component alignment, revision rates, or adverse event rates except for tibial component alignment in the AP plane, which favored TKA with fixed-bearings (p = 0.020; standardized mean difference, 0.229; 95% CI, 0.035-0.422), but the effect size was small enough that it was not considered clinically important. CONCLUSIONS Based on our findings, which agree substantially with those of prior systematic reviews of TKAs with mobile-bearing versus fixed-bearing prostheses, there is no compelling case for either rotating-platform or fixed-bearing implant design in terms of clinical performance, component alignment, adverse event frequencies, or survivorship. This dataset, which was limited to a maximum 6 years followup, is insufficient to address questions related to wear or late revisions. We therefore suggest that implant choice should be made on the basis of other factors, perhaps including cost or surgeon experience.
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No difference in clinical outcome between fixed- and mobile-bearing TKA: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22:565-75. [PMID: 23212187 DOI: 10.1007/s00167-012-2313-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/19/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the clinical and radiographic results of fixed-bearing and mobile-bearing total knee arthroplasty (TKA). METHODS We searched the PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases from 1966 to January 2012. No language restriction was applied. Reference lists of all the selected articles were hand-searched for any additional trials. Trial quality was assessed using the modified Jadad scale. Two authors independently extracted data from all eligible studies, including study design, participants, interventions, and outcomes (Knee Society Score, range of movement, radiolucent line, patient preference, walking support, pain score, and complications). The data were using fixed-effects or random-effects models with mean differences and risk ratios for continuous and dichotomous variables, respectively. RESULTS A total of 24 studies involving 2,799 patients were identified in this analysis. Meta-analysis showed lower pain score (OR, 0.66, 95% CI 0.46, 0.94) in mobile-bearing TKA than fixed-bearing TKA. There was no significant difference between the two treatment groups regarding Knee Society Score (SMD, -0.17, 95% CI: -0.60, 0.26), range of movement (SMD, -0.05, 95% CI: -0.63, 0.53), radiolucent line (OR, 1.03, 95% CI 0.74, 1.44), patient preference (OR, 1.15, 95% CI 0.82, 1.61), walking support (OR, 1.07, 95% CI 0.68, 1.70), and complications (OR, 0.85, 95% CI 0.59, 1.21). CONCLUSIONS The available evidence suggested that there was no significant difference between clinical and radiographic results of fixed-bearing and mobile-bearing TKA except for pain score. Regarding clinical relevance, the less incidence of pain could be the advantage for selecting mobile-bearing TKA. LEVEL OF EVIDENCE II.
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18
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Urwin SG, Kader DF, Caplan N, St Clair Gibson A, Stewart S. Gait analysis of fixed bearing and mobile bearing total knee prostheses during walking: do mobile bearings offer functional advantages? Knee 2014; 21:391-5. [PMID: 24238651 DOI: 10.1016/j.knee.2013.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 10/02/2013] [Accepted: 10/17/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Limited previous findings have detailed biomechanical advantages following implantation with mobile bearing (MB) prostheses after total knee replacement (TKR) surgery during walking. The aim of this study was to compare three dimensional spatiotemporal, kinematic, and kinetic parameters during walking to examine whether MBs offer functional advantages over fixed bearing (FB) designs. METHODS Sixteen patients undergoing primary unilateral TKR surgery were randomised to receive either a FB (n=8) or MB (n=8) total knee prosthesis. Eight age and gender matched controls underwent the same protocol on one occasion. A 12 camera Vicon system integrated with four force plates was used. Patients were tested pre-surgery and nine months post-surgery. RESULTS No significant differences between FB and MB groups were found at any time point in the spatiotemporal parameters. The MB group was found to have a significantly reduced frontal plane knee range of motion (ROM) at pre-surgery than the FB group (FB=14.92±4.02°; MB=8.87±4.82°), with the difference not observed post-surgery. No further significant kinematic or kinetic differences were observed between FB and MB groups. Fixed bearing and MB groups both displayed spatiotemporal, kinematic, and kinetic differences when compared to controls. Fixed bearing and MB groups differed from controls in six and five parameters at nine months post-surgery, respectively. CONCLUSIONS No functional advantages were found in knees implanted with MB prostheses during walking, with both groups indicative of similar differences when compared to normal knee biomechanics following prosthesis implantation. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Samuel G Urwin
- Department of Sport, Exercise, and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; Orthopaedic and Sports Injury Research Group, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK.
| | - Deiary F Kader
- Orthopaedics and Trauma, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK; Orthopaedic and Sports Injury Research Group, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - Nick Caplan
- Department of Sport, Exercise, and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; Orthopaedic and Sports Injury Research Group, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - Alan St Clair Gibson
- Department of Sport, Exercise, and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; Orthopaedic and Sports Injury Research Group, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - Su Stewart
- Department of Sport, Exercise, and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; Orthopaedic and Sports Injury Research Group, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
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Ferguson KB, Bailey O, Anthony I, James PJ, Stother IG, M J G B. A prospective randomised study comparing rotating platform and fixed bearing total knee arthroplasty in a cruciate substituting design--outcomes at two year follow-up. Knee 2014; 21:151-5. [PMID: 24145068 DOI: 10.1016/j.knee.2013.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/22/2013] [Accepted: 09/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fixed bearing (FB) total knee replacement is a well established technique against which new techniques must be compared. Mobile bearing (MB) prostheses, in theory, reduce polyethylene wear but the literature is yet to provide evidence that they are superior in terms of function or long-term survivorship. In addition there has been no comparison of patella resurfacing on the outcome of either design. The aims of this randomised prospective study were firstly to determine whether a mobile bearing prosthesis produced better clinical outcome and range of motion at two year follow-up and secondly to assess the effect of patella resurfacing on the outcomes of both types of bearing design. METHODS Three hundred fifty-two patients were randomised into receiving either a PFC Sigma© cruciate sacrificing total knee arthroplasty either with a mobile bearing or a fixed bearing, with a sub-randomisation to either patella resurfacing or patella retention. All patients participated with standard clinical outcome measures and had their range of motion measured both pre-operatively and at follow-up. RESULTS The mobile bearing TKR design had no impact on range of motion; Oxford Knee Score and American Knee Society knee and function scores when compared to its fixed bearing equivalent. CONCLUSIONS At two year follow-up there was no difference between the PFC Sigma© fixed and mobile bearing designs. With no clinical difference between the cohorts, we cannot recommend one design over the other. Long term benefits, particularly with regards to polyethylene wear, may yet be demonstrated. Level of evidence--1B.
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Affiliation(s)
- K B Ferguson
- Department of Orthopaedics and Trauma, Glasgow Royal Infirmary, United Kingdom
| | - O Bailey
- Department of Orthopaedics and Trauma, Glasgow Royal Infirmary, United Kingdom
| | - I Anthony
- Department of Orthopaedics and Trauma, Glasgow Royal Infirmary, United Kingdom
| | - P J James
- Department of Orthopaedics and Trauma, Nottingham City Hospital, United Kingdom
| | - I G Stother
- Department of Orthopaedics and Trauma, Glasgow Royal Infirmary, United Kingdom
| | - Blyth M J G
- Department of Orthopaedics and Trauma, Glasgow Royal Infirmary, United Kingdom.
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Delport HP. The Advantage of a Total Knee Arthroplasty with Rotating Platform is Only Theoretical: Prospective Analysis of 1,152 Arthroplasties. Open Orthop J 2013; 7:635-40. [PMID: 24339844 PMCID: PMC3856387 DOI: 10.2174/1874325001307010635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 10/08/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022] Open
Abstract
Background: The aim of total knee surgery is to provide patients with end-stage osteoarthritis of the knee with both pain relief and a functional range of motion with a securely fixed prosthesis for the long term. Many types of implants are designed to achieve these goals. Only clinical outcome studies are able to substantiate the superiority of one design over another. Our primary research question was to determine whether patients receiving a rotating platform implant had a better functional outcome. Methods: A total of 1,152 Performance Total Knee Arthroplastiesin 943 patients were studied prospectively. In 561 cases, the cruciate retaining model (CR) was used. In 591 cases the cruciate substituting with posterior-stabilized model (PS) was implanted (324 cases with a fixed bearing (PSFB) and 267 cases with a rotating platform (PSRP)). Results: The Clinical KSS score was similar for the three types at 1, 5, 10 and 15 years post-operatively. The Functional score also remained similar for all types until 10 years; at 15 years functional results of the CR group decreased. Conclusions: Neither clinically nor radiographically did the use of a rotating platform prove to be more advantageous than fixed bearing tibial components. Thus, the advantage of a Total Knee Arthroplasty with Rotating Platform remains theoretical.
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Affiliation(s)
- H P Delport
- Department of Orthopaedic Surgery, AZ Nikolaas, SintNiklaas, Belgium
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21
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van der Voort P, Pijls BG, Nouta KA, Valstar ER, Jacobs WCH, Nelissen RGHH. A systematic review and meta-regression of mobile-bearing versus fixed-bearing total knee replacement in 41 studies. Bone Joint J 2013; 95-B:1209-16. [PMID: 23997134 DOI: 10.1302/0301-620x.95b9.30386] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mobile-bearing (MB) total knee replacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical advantages of mobile- over fixed-bearing (FB) TKR have been found. In this study we evaluated whether mobile bearings have an advantage over fixed bearings with regard to revision rates and clinical outcome scores. Furthermore, we determined which modifying variables affected the outcome. A systematic search of the literature was conducted to collect clinical trials comparing MB and FB in primary TKR. The primary outcomes were revision rates for any reason, aseptic loosening and wear. Secondary outcomes included range of movement, Knee Society score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score and radiological parameters. Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1827 publications, of which 41 studies met our inclusion criteria, comprising over 6000 TKRs. Meta-analyses showed no clinically relevant differences in terms of revision rates, clinical outcome scores or patient-reported outcome measures between MB and FB TKRs. It appears that theoretical assumptions of superiority of MB over FB TKR are not borne out in clinical practice.
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Affiliation(s)
- P van der Voort
- Leiden University Medical Center, Biomechanics and Imaging Group, Department of Orthopaedics, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, the Netherlands.
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Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX. Is there reduced polyethylene wear and longer survival when using a mobile-bearing design in total knee replacement? Bone Joint J 2013; 95-B:1057-63. [PMID: 23908420 DOI: 10.1302/0301-620x.95b8.31310] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to undertake a meta-analysis to determine whether there is lower polyethylene wear and longer survival when using mobile-bearing implants in total knee replacement when compared with fixed-bearing implants. Of 975 papers identified, 34 trials were eligible for data extraction and meta-analysis comprising 4754 patients (6861 knees). We found no statistically significant differences between the two designs in terms of the incidence of radiolucent lines, osteolysis, aseptic loosening or survival. There is thus currently no evidence to suggest that the use of mobile-bearing designs reduce polyethylene wear and prolong survival after total knee replacement. Cite this article: Bone Joint J 2013;95-B:1057–63.
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Affiliation(s)
- Y. Zeng
- West China Hospital, Department
of Orthopaedic Surgery, West China Medical
School, Sichuan University, 37#
Guoxue Road, Chengdu, Sichuan
Province 610041, China
| | - B. Shen
- West China Hospital, Department
of Orthopaedic Surgery, West China Medical
School, Sichuan University, 37#
Guoxue Road, Chengdu, Sichuan
Province 610041, China
| | - J. Yang
- West China Hospital, Department
of Orthopaedic Surgery, West China Medical
School, Sichuan University, 37#
Guoxue Road, Chengdu, Sichuan
Province 610041, China
| | - Z. K. Zhou
- West China Hospital, Department
of Orthopaedic Surgery, West China Medical
School, Sichuan University, 37#
Guoxue Road, Chengdu, Sichuan
Province 610041, China
| | - P. D. Kang
- West China Hospital, Department
of Orthopaedic Surgery, West China Medical
School, Sichuan University, 37#
Guoxue Road, Chengdu, Sichuan
Province 610041, China
| | - F. X. Pei
- West China Hospital, Department
of Orthopaedic Surgery, West China Medical
School, Sichuan University, 37#
Guoxue Road, Chengdu, Sichuan
Province 610041, China
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Cheng M, Chen D, Guo Y, Zhu C, Zhang X. Comparison of fixed- and mobile-bearing total knee arthroplasty with a mean five-year follow-up: A meta-analysis. Exp Ther Med 2013; 6:45-51. [PMID: 23935716 PMCID: PMC3735548 DOI: 10.3892/etm.2013.1122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/23/2013] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
- Mengqi Cheng
- Department of Orthopedics, The Sixth Affiliated People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai 200233
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Fixed versus mobile weight-bearing prosthesis in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20:2519-27. [PMID: 22419265 DOI: 10.1007/s00167-012-1946-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study was designed to compare clinical, radiological, and general health results of two prostheses (mobile vs. fixed weight-bearing devices) that are used in total knee arthroplasty with a 5-year follow-up. METHODS This randomized controlled study was conducted from 2004 to 2010 in the Department of Orthopedic Surgery at two university hospitals in Isfahan, Iran. Three hundred patients with expected primary total knee arthroplasty (TKA) without severe deformity (a fixed varus or valgus deformity greater than 20°) received fixed weight-bearing (n = 150) or mobile weight-bearing (n = 150) devices. Clinical, radiological, and quality of life outcomes were compared between the two groups at six-month intervals for the first year, after which the comparisons were made annually for the next 4 years. RESULTS Both groups had similar baseline characteristics. Although there was significant improvement in both groups, there was no significant difference between the groups with regard to the means of the Knee Society Scores, which were 92 (SD: 12.1) for the fixed weight-bearing device and 93 (SD: 14.2) for the mobile weight-bearing device (n.s.) at the final follow-up point. Radiographs showed that there was no significant difference in prosthetic alignment and no evidence of loosening. After TKA, the SF-36 score increased in both groups, but there was no statistical difference between the groups in quality of life at the final follow-up (62 (12.2) vs. 64 (14.3), n.s.). There was no revision after 5 years. CONCLUSIONS In terms of clinical, radiological or general health outcomes for people who underwent TKA, the results of this study showed no clear advantage of mobile weight-bearing over the fixed weight-bearing prosthesis at the five-year follow-up. LEVEL OF EVIDENCE I.
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