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Wagner A, Wittig U, Leitner L, Vielgut I, Hauer G, Ortmaier R, Leithner A, Sadoghi P. Comparison of revision rates and epidemiological data of a single total knee arthroplasty system of different designs (cruciate retaining, posterior stabilized, mobile bearing, and fixed bearing): a meta-analysis and systematic review of clinical trials and national arthroplasty registries. Arch Orthop Trauma Surg 2024; 144:1997-2006. [PMID: 38570357 PMCID: PMC11093798 DOI: 10.1007/s00402-024-05286-6] [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] [Received: 11/29/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND This study aimed to meta-analyze epidemiological data, revision rates, and incidences of different designs of a single Total Knee Arthroplasty System and compare these factors across different countries. METHODS A systematic review was conducted on clinical studies and arthroplasty registries of ATTUNE TKA from 1999 to 2020. The main endpoints analyzed were revision rates and epidemiological data. RESULTS The average age of patients was 67.8 years, with a gender distribution of 60% female and 40% male. The pooled average BMI was 29.4 kg/m2. Eight clinical studies showed a pooled revision rate per 100 observed CY of 0.5 (n = 1343 cases). Cumulative revision rates after 1, 3, and 5 years varied among registries, with the Swiss registry having the highest revision data (after 5 years: 6.3%) and the American registry having the lowest revision data (after 5 years: 1.7%). A comparison of the revision rates of mobile bearing and fixed bearing (41,200 cases) as well as cruciate retaining and posterior stabilized (n = 123,361 cases) showed no significant advantage in the first 5 years after implantation. CONCLUSION In conclusion, pooled data from 41,200 cases of TKA with a single Total Knee Arthroplasty System in two arthroplasty registries revealed that there was no significant difference in revision rates between the mobile bearing and fixed bearing design within the first 5 years after implantation. In addition, a comparison of the revision rates in n = 123,361 cases showed no significant advantage for cruciate retaining or posterior stabilized in the first 5 years after implantation.
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Affiliation(s)
- Anton Wagner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Ulrike Wittig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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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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3
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Sappey-Marinier E, Swan J, Maucort-Boulch D, Batailler C, Malatray M, Neyret P, Lustig S, Servien E. No significant clinical and radiological differences between fixed versus mobile bearing total knee replacement using the same semi-constrained implant type: a randomized controlled trial with mean 10 years follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:603-611. [PMID: 33151364 DOI: 10.1007/s00167-020-06346-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare the long-term clinical and radiological results between fixed (FB) and mobile bearing (MB) implants with identical design from the same manufacturer. METHODS From March 2007 to May 2009, we recruited 160 patients in a prospective, single centered, randomized controlled trial. The authors compared 81 FB total knee arthroplasty (TKA) versus 79 MB with medial compartment osteoarthritis. The same posterior stabilized HLS Noetos knee prosthesis (CORIN) was used in all patients. The two groups only differed by the tibial insert (fixed or mobile). The authors compared the postoperative Knee Society Score (KSS), the passive clinical and active radiological knee flexion, the implant survivorship, the complications, and the presence of radiolucent lines. RESULTS At mean 10.5 years' follow-up (range 8-12.1 years) no significant differences were found in clinical scores (KSS (p = 0.54), pain score (p = 0.77), stair climbing (p = 0.44), passive maximum flexion (p = 0.5)) or for radiological analyses (maximum active radiological flexion (p = 0.06), presence of progressive radiolucent lines (5 (MB group) versus 6 (FB group); p = 0.75)) between groups. No significant difference was found in overall implant survivorship (82% (MB group) versus 78% (FB group) p = 0.58) or complication rate (p = 0.32) at the last follow-up. CONCLUSION No significant clinical and radiological differences were found between fixed and mobile bearing TKA using the same semi-constrained implant type with comparable overall survivorship. The choice between a fixed or mobile bearing implant should be based on surgeon preference and experience with the selected implant. LEVEL OF EVIDENCE Prospective randomized controlled trial, Level II.
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Affiliation(s)
- E Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France.
| | - J Swan
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - D Maucort-Boulch
- Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003, Lyon, France
- Université de Lyon, 69000, Lyon, France
- Université Lyon 1, 69100, Villeurbanne, France
- CNRS, UMR5558, Laboratoire de Biométrie Et Biologie Évolutive, Équipe Biostatistique-Santé, 69100, Villeurbanne, France
| | - C Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - M Malatray
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - P Neyret
- Infirmerie Protestante Lyon Caluire, 3 chemin du Penthod, 69300, Caluire et cuire, France
| | - S Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - E Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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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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Wang K, Zhang FF, Yan X, Shen Y, Cai W, Xu J, Mei J. Superior Mid- to Long-Term Clinical Outcomes of Mobile-Bearing Total Knee Arthroplasty Compared to Fixed-Bearing: A Meta-Analysis Based on a Minimum of 5 Years of Study. J Knee Surg 2021; 34:1368-1378. [PMID: 32503063 DOI: 10.1055/s-0040-1709490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As more patients undergo total knee arthroplasty (TKA) each year, and the average age of patients gets younger, the patients are generally more active requiring a greater physiological demand and increasing range of motion on the prosthesis than the previous patients. However, there is no consensus on the optimal TKA tibial bearing design. We performed this systematic review to compare the clinical differences between mobile and fixed bearing constructs used in contemporary TKA. We searched PubMed, EMBASE, and Cochrane Library databases, identifying 515 total publications, including 17 randomized controlled trials (RCTs). A meta-analysis was performed, while the quality and bias of the evidence were rated according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) guidelines and the Cochrane Database questionnaire. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seventeen studies were included, with a total of 1505 knees receiving a mobile bearing TKA and 1550 knees receiving a fixed bearing TKA. The meta-analysis compared clinical outcomes between mobile bearing (MB)-TKA and fixed bearing (FB)-TKA using postoperative Knee Society Score, postoperative ROM, and survivorship and showed that there was a distinct difference in Knee Society Score between the mobile-bearing and fixed-bearing groups (overall standardized mean difference = 1.38; 95% confidence interval (CI): 0.50-2.25; p = 0.002; I2 = 60%). Patients treated with mobile-bearing prostheses were more likely to report good or excellent range of motion results (overall standardized mean difference = 2.06; 95% CI: 0.65-3.47; p = 0.004). No difference in implant survivorship or reoperation rate were identified. The fixed-bearing and mobile-bearing TKA designs are both capable of producing excellent long-term results with excellent clinical outcomes if properly implanted; however, the mobile-bearing TKA have superiority in mid- to long-term clinical results. Trial registration number for PROSPERO was CRD42019126402.
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Affiliation(s)
- Kaiyang Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Fang Zhang
- Department of Orthopedic Surgery, Tongji University School of Medicine, Tongji Hospital, Shanghai, China
| | - Xu Yan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yifan Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijie Cai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiaming Xu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiong Mei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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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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The High Flex Total Knee Arthroplasty-Higher Incidence of Aseptic Loosening and No Benefit in Comparison to Conventional Total Knee Arthroplasty: Minimum 16-Years Follow-Up Results. Indian J Orthop 2020; 55:76-80. [PMID: 34122758 PMCID: PMC8149562 DOI: 10.1007/s43465-020-00276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE This prospective randomized study compares the clinical and radiographic long-term results at least 16 years after total knee arthroplasty (TKA) between a mobile-bearing high flex and a fixed-bearing posterior-stabilized knee. METHODS In 2000, we included 60 patients who underwent a TKA. Patients were divided into two groups. At the time of the follow-up after a minimum of 16 years (16.5 years ± 0.6), 16 patients had died for causes unrelated to the operation, 15 were lost to the follow-up. Five patients of the high flex group had a revision. The final evaluation included the hospital for special surgery score (HSS) and radiographs. Using the X-rays and the Knee Society Roentgenographic Evaluation and Scoring System, radiolucent lines and the maximal knee flexion were determined. RESULTS No significant differences between the two groups were found. The mean HSS score of LPS group patients was 87.9 (± 10.6) points and that of the high flex group was 93.1 (± 7.4) points. Five patients of the high flex group had undergone a reoperation. One knee was revised for painful mid-flexion instability and the others for symptomatic aseptic loosening of the components. CONCLUSION The long-term follow-up does not show any clear benefits and even a higher incidence of implant loosening using the mobile-bearing high-flex knee.
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Sappey-Marinier E, de Abreu FGA, O'Loughlin P, Gaillard R, Neyret P, Lustig S, Servien E. No difference in patellar position between mobile-bearing and fixed-bearing total knee arthroplasty for medial osteoarthritis: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1542-1550. [PMID: 31218390 DOI: 10.1007/s00167-019-05565-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) is the treatment of choice for severe osteoarthritis of the knee. Many studies have been performed comparing mobile- and fixed-bearing designs; however, there are insufficient data regarding the patellar position in either system. This study aimed to compare the resultant patellar position with a mobile- versus a fixed-bearing TKA and the influence of both designs on clinical outcomes. MATERIALS AND METHODS In this prospective randomized study, between 2007 and 2009, 160 TKA patients were assessed; 79 received a mobile-bearing and 81 received a fixed-bearing implant, for medial compartment osteoarthritis. A posteriorly stabilized, HLS Noetos knee prosthesis (Tornier, Saint-Ismier, France) was used in all cases. The only difference between the groups was whether the tibial component incorporated a fixed or mobile bearing. The patella was resurfaced in all cases. The International Knee Society Score (KSS) and the patellar tilt and translation were compared post-operatively. Patellar translation and patellar tilt analyses were subdivided into two subgroups (< 5 mm vs > 5 mm and < 5° vs > 5°). RESULTS The KSS was not statistically different between the groups at a mean follow-up of 7.4 years (range 5-11 years). Patellar translation and patellar tilt were not statistically different between the groups. When considering the patellar translation subgroup analysis, a significantly increased risk of patellar translation, greater than 5 mm, was found in the mobile-bearing group compared to fixed-bearing group (OR = 2.3; p = 0.048) without generating any meaningful difference in clinical outcomes. CONCLUSION The theoretical advantages of mobile-bearing implants compared to fixed-bearing implants were not demonstrated in this randomized study, at mid-term follow-up. In daily practice, the choice between mobile-bearing and fixed-bearing designs should be based on the experience and clinical judgment of the surgeon. LEVEL OF EVIDENCE Prospective randomized study, level I.
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Affiliation(s)
- Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
| | - Felipe Galvão A de Abreu
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
- Orthopaedic Department, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Padhraig O'Loughlin
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Romain Gaillard
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - Philippe Neyret
- Clinique Genolier, 3 route du muids, 1272, Genolier, Switzerland
| | - Sebastien Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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Stilling M, Mechlenburg I, Jepsen CF, Rømer L, Rahbek O, Søballe K, Madsen F. Superior fixation and less periprosthetic stress-shielding of tibial components with a finned stem versus an I-beam block stem: a randomized RSA and DXA study with minimum 5 years' follow-up. Acta Orthop 2019; 90:165-171. [PMID: 30669918 PMCID: PMC6461099 DOI: 10.1080/17453674.2019.1566510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The stem on the tibial component of total knee arthroplasty provides mechanical resistance to lift-off, shear forces, and torque. We compared tibial components with finned stems (FS) and I-beam block stems (IS) to assess differences in implant migration. Patients and methods - In a patient-blinded RCT, 54 patients/knees (15 men) with knee osteoarthritis at a mean age of 77 years (70-90) were randomly allocated to receive tibial components with either a FS (n = 27) or an IS (n = 27). Through 5 to 7 years' follow-up, implant migration was measured with RSA, periprosthetic bone mineral density (BMD) was measured with DXA, and surgeons reported American Knee Society Score (AKSS). Results - At minimum 5 years' follow-up, maximum total point motion (MTPM) was higher (p = 0.04) for IS (1.48 mm, 95% CI 0.81-2.16) than for FS (0.85 mm, CI 0.38-1.32) tibial components. Likewise, total rotation (TR) was higher (p = 0.03) for IS (1.51˚, CI 0.78-2.24) than for FS (0.81˚, CI 0.36-1.27). Tibial components with IS externally rotated 0.50° (CI -0.06 to 1.06) while FS internally rotated 0.09° (CI -0.20 to 0.38) (p = 0.03). Periprosthetic bone stress-shielding was higher (p < 0.01) up to 2 years' follow-up for IS compared with FS in the regions medial to the stem (-13% vs. -2%) and posterior to the stem (-13% vs. -2%). Below the stem bone loss was also higher (p = 0.01) for IS compared with FS (-6% vs. +1%) up to 1-year follow-up. Knee score improved similarly in both groups up to 5 years' follow-up. Interpretation - Periprosthetic bone stress-shielding medial and posterior to the stem until 2 years, and tibial component migration at 5 years, was less for a finned compared with an I-shaped block stem design.
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Affiliation(s)
- Maiken Stilling
- Orthopaedic Research Unit, Aarhus University Hospital;; ,Department of Orthopaedic Surgery, Aarhus University Hospital; ,Department of Clinical Medicine, Aarhus University, Denmark,Correspondence:
| | - Inger Mechlenburg
- Orthopaedic Research Unit, Aarhus University Hospital;; ,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University;
| | | | - Lone Rømer
- Department of Radiology, Aarhus University Hospital;
| | - Ole Rahbek
- Department of Orthopaedic Surgery, Aarhus University Hospital; ,Department of Clinical Medicine, Aarhus University, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital; ,Department of Clinical Medicine, Aarhus University, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital;
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Makaram N, Clement ND, Hoo T, Nutton R, Burnett R. Survival of the low contact stress rotating platform total knee replacement is influenced by age: 1058 implants with a minimum follow-up of 10 years. Knee 2018; 25:1283-1291. [PMID: 30232026 DOI: 10.1016/j.knee.2018.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/19/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The low contact stress (LCS) mobile-bearing total knee replacement (TKR) was designed to minimise polyethylene wear, aseptic loosening and osteolysis. However, registry data suggests there is a significantly greater revision rate associated. The primary aim of this study was to assess long-term survivorship of the LCS TKR performed at a single high-volume centre. Secondary aims were to assess survival by mechanism of failure and identify predictors of revision. METHODS During a 13-year period (1993-2006) 1091 LCS TKRs were performed by two senior surgeons. Thirty-three with incomplete data were excluded. The patients were retrospectively identified from an arthroplasty register. Mean age was 69 (range 30-96) years. Five hundred seventy-seven TKRs were performed in females, 481 in males. Mean follow-up was 14 years (SD 4.3). RESULTS There were 59 revisions during the study period: 14 (23.7%) for infection, 18 (30.5%) for instability, and 27 (45.8%) for polyethylene wear. Three hundred ninety-two patients died. All-cause survival at 10 years was 95% (95%CI 91.7-98.3) and at 15 years was 93% (95%CI 88.6-97.8). Survival at 10 years according to mechanism of failure was: infection 99% (95%CI 94-100%), instability 98% (95%CI 94-100%), and polyethylene wear 98% (95%CI 92-100). Of the 27 with polyethylene wear, only 19 (70.4%) had osteolysis requiring component revision, the other eight (29.6%) had polyethylene exchanges. Cox regression analysis identified younger age as the only predictor of revision (HR 0.96, 95%CI 0.94-0.99, p = 0.003), with a four percent decreased risk of revision for each increase in year of age. CONCLUSIONS The LCS TKR demonstrates excellent long-term survivorship with a low rate of revision for osteolysis, however this risk is increased in younger patients.
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Affiliation(s)
- N Makaram
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - N D Clement
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - T Hoo
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - R Nutton
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - R Burnett
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
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11
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Abdel MP, Tibbo ME, Stuart MJ, Trousdale RT, Hanssen AD, Pagnano MW. A randomized controlled trial of fixed- versus mobile-bearing total knee arthroplasty: a follow-up at a mean of ten years. Bone Joint J 2018; 100-B:925-929. [PMID: 29954199 DOI: 10.1302/0301-620x.100b7.bjj-2017-1473.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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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Affiliation(s)
- M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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12
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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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13
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Wall PDH, Richards BL, Sprowson A, Buchbinder R, Singh JA. Do outcomes reported in randomised controlled trials of joint replacement surgery fulfil the OMERACT 2.0 Filter? A review of the 2008 and 2013 literature. Syst Rev 2017; 6:106. [PMID: 28558822 PMCID: PMC5450048 DOI: 10.1186/s13643-017-0498-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is not known, whether outcome reporting in trials of total joint arthroplasty in the recent years is adequate or not. Our objective was to assess whether outcomes reported in total joint replacement (TJR) trials fulfil the Outcome Measures in Rheumatology (OMERACT) Filter 2.0. METHODS We systematically reviewed all TJR trials in adults, published in English in 2008 or 2013. Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Two authors independently applied the inclusion criteria for the studies, and any disagreement was resolved with a third review author. All outcome measures were abstracted using a pre-piloted standardised data extraction form and assessed for whether they mapped to one of the three OMERACT Filter 2.0 core areas: pathophysiological, life impact, and death. RESULTS From 1635 trials identified, we included 70 trials (30 in 2008 and 40 in 2013) meeting the eligibility criteria. Twenty-two (31%) trials reported the three essential OMERACT core areas. Among the 27 hip replacement surgery trials and 39 knee replacement surgery trials included, 11 hip (41%) and nine knee (23%) trials reported all three essential OMERACT core areas. The most common outcome domains/measures were pain (20/27, 74%) and function (23/27, 85%) in hip trials and pain (26/39, 67%) and function (27/39, 69%) in knee trials. Results were similar for shoulder and hand joint replacement trials. CONCLUSIONS We identified significant gaps in the measurement of OMERACT core outcome areas in TJR trials, despite the majority reporting outcome domains of pain and function. An international consensus of key stakeholders is needed to develop a core domain set for reporting of TJR trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009216.
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Affiliation(s)
- Peter D H Wall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Bethan L Richards
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andrew Sprowson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Frankston, VIC, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, VIC, Australia
| | - Jasvinder A Singh
- Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Mayo Clinic School of Medicine, Rochester, MN, USA.
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14
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Richards BL, Wall PDH, Sprowson AP, Singh JA, Buchbinder R. Outcome Measures Used in Arthroplasty Trials: Systematic Review of the 2008 and 2013 Literature. J Rheumatol 2017; 44:1277-1287. [PMID: 28507180 DOI: 10.3899/jrheum.161477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previously published literature assessing the reporting of outcome measures used in joint replacement randomized controlled trials (RCT) has revealed disappointing results. It remains unknown whether international initiatives have led to any improvement in the quality of reporting and/or a reduction in the heterogeneity of outcome measures used. Our objective was to systematically assess and compare primary outcome measures and the risk of bias in joint replacement RCT published in 2008 and 2013. METHODS We searched MEDLINE, EMBASE, and CENTRAL for RCT investigating adult patients undergoing joint replacement surgery. Two authors independently identified eligible trials, extracted data, and assessed risk of bias using the Cochrane tool. RESULTS Seventy RCT (30 in 2008, 40 in 2013) met the eligibility criteria. There was no significant difference in the number of trials judged to be at low overall risk of bias (n = 6, 20%) in 2008 compared with 2013 [6 (15%); chi-square = 0.302, p = 0.75]. Significantly more trials published in 2008 did not specify a primary outcome measure (n = 25, 83%) compared with 18 trials (45%) in 2013 (chi-square = 10.6316, p = 0.001). When specified, there was significant heterogeneity in the measures used to assess primary outcomes. CONCLUSION While less than a quarter of trials published in both 2008 and 2013 were judged to be at low overall risk of bias, significantly more trials published in 2013 specified a primary outcome. Although this might represent a temporal trend toward improvement, the overall frequency of primary outcome reporting and the wide heterogeneity in primary outcomes reported remain suboptimal.
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Affiliation(s)
- Bethan L Richards
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Peter D H Wall
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Andrew P Sprowson
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Jasvinder A Singh
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA. .,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015.
| | - Rachelle Buchbinder
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
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15
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Riaz O, Aqil A, Sisodia G, Chakrabarty G. P.F.C Sigma ® cruciate retaining fixed-bearing versus mobile-bearing knee arthroplasty: a prospective comparative study with minimum 10-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1145-1149. [PMID: 28210821 DOI: 10.1007/s00590-017-1920-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
AIMS To prospectively compare long-term clinical and radiological outcomes following a cruciate retaining fixed-bearing (FB) and a mobile-bearing (MB) primary total knee replacement (TKR). METHODS We prospectively reviewed 113 TKRs in 99 patients (14 bilateral) with a PFC sigma cruciate retaining rotating platform system, at an average follow-up of 11.1 years (range 10-12). Results were contrasted with those from 89 TKRs in 72 patients (17 bilateral) with a PFC sigma cruciate fixed-bearing prosthesis, at an average follow-up of 12.1 years (range 10-14.1). Outcomes collected included pre- and post-operative range of motion, Oxford Knee Scores, complications encountered, as well as radiographical assessments of polyethylene wear. RESULTS In the MB group, mean Oxford Knee Scores improved from 16 pre-operatively to 42 at final follow-up. The mean range of motion was 115° (75-130). In the FB group, mean Oxford Knee Scores improved from 16.2 pre-operatively to 42.5 at final follow-up. The mean range of motion was 111.2 (80-135) degrees at final follow-up. CONCLUSION We failed to elicit an objectively demonstrable clinical difference between the MB- and FB-implanted knees. Similarly, radiological benefits of the MB implants with regard to polyethylene wear were not evident at a minimum 10-year follow-up.
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Affiliation(s)
- O Riaz
- The West Riding Knee Unit, Huddersfield Royal Infirmary, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, HD3 3EA, UK.
| | - A Aqil
- The West Riding Knee Unit, Huddersfield Royal Infirmary, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, HD3 3EA, UK
| | - G Sisodia
- The West Riding Knee Unit, Huddersfield Royal Infirmary, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, HD3 3EA, UK
| | - G Chakrabarty
- The West Riding Knee Unit, Huddersfield Royal Infirmary, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, HD3 3EA, UK
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16
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Haller CS, Delhumeau C, De Pretto M, Schumacher R, Pielmaier L, Rebetez MML, Haller G, Walder B. Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury. Brain Inj 2017; 31:319-328. [DOI: 10.1080/02699052.2016.1255777] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chiara S. Haller
- Department of Psychology, Harvard University, Cambridge, Boston, MA, USA
- Division of Public Psychiatry, Massachusetts Mental Health Center, Boston, MA, USA
| | - Cecile Delhumeau
- Division of Anaesthesiology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Michael De Pretto
- Division of Anaesthesiology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Rahel Schumacher
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | | - Guy Haller
- Division of Anaesthesiology, University Hospitals of Geneva (HUG), Geneva, Switzerland
- Division of Clinical Epidemiology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology, University Hospitals of Geneva (HUG), Geneva, Switzerland
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17
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Mehtani A, Prakash J. Letter to Editor: "Does Insert Type Affect Clinical and Functional Outcome in Total Knee Arthroplasty? A Randomised Controlled Clinical Trial With 5-Year Follow-Up". J Arthroplasty 2016; 31:1614-5. [PMID: 27113942 DOI: 10.1016/j.arth.2015.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/28/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Anil Mehtani
- Department of orthopedics, Lady Hardinge Medical College, New Delhi, India
| | - Jatin Prakash
- Department of orthopedics, Lady Hardinge Medical College, New Delhi, India
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18
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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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19
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Fransen BL, Hoozemans MJM, Keijser LCM, van Lent MET, Verheyen CCPM, Burger BJ. Does Insert Type Affect Clinical and Functional Outcome in Total Knee Arthroplasty? A Randomised Controlled Clinical Trial With 5-Year Follow-Up. J Arthroplasty 2015; 30:1931-7. [PMID: 26096070 DOI: 10.1016/j.arth.2015.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 02/01/2023] Open
Abstract
New insert types have been developed to improve clinical and functional outcome in mobile bearing (MB-TKA) and fixed bearing total knee arthroplasty (FB-TKA). A prospective single blinded randomised controlled clinical trial was performed to evaluate 2 types of MB-TKA inserts and 2 types of FB-TKA inserts of the Genesis II prosthesis (Smith & Nephew) in 146 patients with 5-years follow-up. A significant difference (P=.042) between the MB-TKA inserts was found in KSS function scores, but clinical significance is expected to be limited. Goniometry, temporal gait parameters and QoL were similar in all groups. Survival was significantly better (P=.047) for FB-TKA. The comparable outcome and higher revision rate in MB-TKA indicate that FB-TKA may be preferential for the Genesis II implant system.
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Affiliation(s)
- B L Fransen
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
| | - Marco J M Hoozemans
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands; Move Research Institute, Faculty of Human Movement Sciences, VU University, Van der Boechorststraat 7, Amsterdam, The Netherlands
| | - Lucien C M Keijser
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
| | | | - Cees C P M Verheyen
- Department of Orthopaedic Surgery and Traumatology, Isala Hospital, Dokter van Heesweg 2, Zwolle, The Netherlands
| | - Bart J Burger
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
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20
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Ulivi M, Orlandini L, Meroni V, Consonni O, Sansone V. Survivorship at minimum 10-year follow-up of a rotating-platform, mobile-bearing, posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:1669-75. [PMID: 24938395 DOI: 10.1007/s00167-014-3118-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate prospectively the long-term clinical and radiographic results and survivorship of a rotating-platform, posterior-stabilised knee prosthesis at minimum 10 years (mean 11.5 ± 1.41 years), and to test the hypothesis that this design would have a mechanical survivorship greater than 95%. METHODS Between 2000 and 2002, 160 consecutive patients (166 knees) underwent total knee arthroplasty using a rotating-platform, posterior-stabilised prosthesis, and clinical and radiographic follow-up data were gathered prospectively. RESULTS One hundred and seven patients (112 knees) were available for final follow-up. Five patients (3%) had undergone revision surgery, giving a Kaplan-Meier survival rate of 96.6% for all causes of failure. No spin-out of the polyethylene insert was observed. The mean visual analogue scale, Knee Society and Oxford Knee Scores showed statistically significant improvements (p < 0.001). On radiographs, two cases (2.4%) had radiolucent lines >2 mm, and no patient had osteolysis. CONCLUSIONS The absence of osteolysis at minimum 10 years seems to support our hypothesis that this design may be able to reduce peri-prosthetic bone resorption in the long term. The survivorship was greater than 95% and is comparable to the best results reported for this type of knee prosthesis in the literature. The clinical scores are reasonable, given the presence of various disabling concomitant pathologies and the relatively advanced mean age of the study population. This study is clinically relevant because it adds valuable information to the limited data regarding the long-term survivorship and performance of rotating-platform knee prostheses and, more specifically, of a single knee design. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michele Ulivi
- Istituto Ortopedico Galeazzi IRCCS, Via R Galeazzi 4, 20161, Milan, Italy
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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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22
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Bercovy M, Langlois J, Beldame J, Lefebvre B. Functional Results of the ROCC® Mobile Bearing Knee. 602 Cases at Midterm Follow-Up (5 to 14 Years). J Arthroplasty 2015; 30:973-9. [PMID: 25686786 DOI: 10.1016/j.arth.2015.01.003] [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: 09/09/2014] [Revised: 12/21/2014] [Accepted: 01/02/2015] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED We report midterm results of a prospective continuous cohort of ROCC® Total Knee Arthroplasties (TKA). Between 2001 and 2008, all primary TKA patients (n=500) received 602 ROCC saddle-shaped rotating platform TKAs. Mean follow-up was 7.5 years (5-13) (>10 years in 123 knees). 82 patients (93 knees) died; 20 patients (21 knees) were lost to follow-up. Active flexion improved from 119° (10°-150°) to 127° (90°-155°) and Knee Society knee score from 39±11 to 94±9. Two knees were reoperated for aseptic loosening: Kaplan-Meier 14-year survivorship with aseptic loosening as end-point was 99.4% (95% CI, 99.8-100). UCLA mean score increased from 3.8/10 at baseline to 7.3/10 at last FU, 91% recovering pre-disease activity, and 27% with UCLA score ≥8/10. ROCC TKA demonstrated solid midterm survivorship without activity-related complications. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
| | - Jean Langlois
- Centre Hospitalier Universitaire Cochin, Paris, France
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Poirier N, Graf P, Dubrana F. Mobile-bearing versus fixed-bearing total knee implants. Results of a series of 100 randomised cases after 9 years follow-up. Orthop Traumatol Surg Res 2015; 101:S187-92. [PMID: 25890808 DOI: 10.1016/j.otsr.2015.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS Mobile-bearing total knee arthroplasty (TKA) implants were developed as an alternative to fixed-bearing implants because of their theoretical advantages related to wear and range of motion. For all that, none of the short-term and medium-term studies published so far have reported a significant clinical improvement related to these mobile bearings. The goal of this study was to compare the outcomes of fixed and mobile bearings in the same type of TKA model after a longer follow-up. MATERIAL AND METHODS This series initially comprised 100 patients with a mean age of 73 years who were operated by a single surgeon. The patients were randomised to receive either a fixed bearing TKA implant or a mobile one; their outcomes evaluated after a mean of 9 years (7.2-12.2) follow-up. Twenty-two patients died before the final review, 15 were lost to follow-up and 2 were excluded. This resulted in 30 patients with a mobile-bearing knee and 31 with a fixed-bearing knee being available for analysis. RESULTS There were no significant clinical differences between the groups receiving a fixed or mobile bearing in terms of the range of motion, subjective outcomes or validated outcomes measured, such as the self-reported Oxford or the IKS. Conversely, there was a significantly higher rate of osteolysis in the fixed-bearing group, but it was not clinically relevant. CONCLUSION This study, which has the longest published follow-up, confirms the results found in the seven randomised studies published up to now: there are no significant differences in the clinical outcomes between fixed-bearing and mobile-bearing inserts of the same TKA model. Although the mobile bearing knees had a better radiographic appearance, this did not translate to better clinical outcomes. In practice, the superiority of mobile bearings is solely theoretical. LEVEL OF EVIDENCE II Prospective randomised study.
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Affiliation(s)
- N Poirier
- Faculty of Medicine, université de Bretagne-Occidentale, 22, avenue Camille-Desmoulins, CS 93837, 29238 Brest cedex 3, France; Department of Orthopaedic Surgery, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - P Graf
- Clinique Pasteur-Lanroze, 32, rue Auguste-Kervern, 29200 Brest, France
| | - F Dubrana
- Faculty of Medicine, université de Bretagne-Occidentale, 22, avenue Camille-Desmoulins, CS 93837, 29238 Brest cedex 3, France; Department of Orthopaedic Surgery, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
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Graves S, Sedrakyan A, Baste V, Gioe TJ, Namba R, Cruz OM, Stea S, Paxton E, Banerjee S, Isaacs AJ, Robertsson O. International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses. J Bone Joint Surg Am 2014; 96 Suppl 1:59-64. [PMID: 25520420 PMCID: PMC4271421 DOI: 10.2106/jbjs.n.00556] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design. METHODS Aggregated registry data were collected with a distributed health data network that was developed by the International Consortium of Orthopaedic Registries to reduce barriers to participation (e.g., security, proprietary, legal, and privacy issues) that have the potential to occur with the alternate centralized data warehouse approach. A distributed health data network is a decentralized model that allows secure storage and analysis of data from different registries. Each registry provided data on mobile and fixed-bearing posterior-stabilized prostheses implanted between 2001 and 2010. Only prostheses associated with primary total knee arthroplasties performed for the treatment of osteoarthritis were included. Prostheses with all types of fixation were included except for those with the rarely used reverse hybrid (cementless tibial and cemented femoral components) fixation. The use of patellar resurfacing was reported. The outcome of interest was time to first revision (for any reason). Multivariate meta-analysis was performed with linear mixed models with survival probability as the unit of analysis. RESULTS This study includes 137,616 posterior-stabilized knee prostheses; 62% were in female patients, and 17.6% had a mobile bearing. The results of the fixed-effects model indicate that in the first year the mobile-bearing posterior-stabilized prostheses had a significantly higher hazard ratio (1.86) than did the fixed-bearing posterior-stabilized prostheses (95% confidence interval, 1.28 to 2.7; p = 0.001). For all other time intervals, the mobile-bearing posterior-stabilized prostheses had higher hazard ratios; however, these differences were not significant. CONCLUSIONS Mobile-bearing posterior-stabilized prostheses had an increased rate of revision compared with fixed-bearing posterior-stabilized prostheses. This difference was evident in the first year.
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Affiliation(s)
- Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | - Art Sedrakyan
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Valborg Baste
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Mollendalsbakken 11, N-5021 Bergen, Norway
| | - Terence J. Gioe
- Department of Orthopaedic Surgery, Section 112E, Minneapolis VAMC, 1 Veterans Drive, Minneapolis, MN 55417
| | | | - Olga Martínez Cruz
- Àmbit d’Avaluació, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Departament de Salut - Generalitat de Catalunya, Carrer de Roc Boronat, 81-95 (edifice Salvany), 08005 Barcelona, Spain
| | - Susanna Stea
- Register of the Orthopaedic Prosthetic Implants (RIPO), c/o Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Elizabeth Paxton
- Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Samprit Banerjee
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Abby J. Isaacs
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Clinical Sciences, SUS/Lund University Hospital, 221 85 Lund, Sweden
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Kim YH, Park JW, Kim JS, Kulkarni SS, Kim YH. Long-term clinical outcomes and survivorship of press-fit condylar sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients. J Bone Joint Surg Am 2014; 96:e168. [PMID: 25274796 DOI: 10.2106/jbjs.m.01130] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We are aware of no study that has compared press-fit condylar Sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients after more than ten years of follow-up. The purpose of the current study was to compare these two implants with respect to the functional and radiographic results, prevalence of osteolysis, and overall revision rates at a mean of 12.1 years of follow-up. METHODS The study consisted of a consecutive series of 444 patients (mean age [and standard deviation], 66.5 ± 7.4 years) who underwent simultaneous bilateral total knee arthroplasty, with one side treated immediately after the other. All of the patients received a press-fit condylar Sigma mobile-bearing prosthesis on one side and a press-fit condylar Sigma fixed-bearing prosthesis on the contralateral side. The minimum duration of follow-up was ten years (mean, 12.1 years; range, ten to thirteen years). At the time of each follow-up visit, the patients were assessed clinically and radiographically. RESULTS Postoperative total knee scores (95 and 94 points), Western Ontario and McMaster Universities Osteoarthritis Index (19 and 18 points), University of California, Los Angeles activity score (both prostheses, 5 points), range of motion (129° ± 6.3° and 127° ± 6.8°), and radiographic findings did not differ significantly between the press-fit condylar Sigma mobile and fixed-bearing designs at the final follow-up. The prevalence of aseptic loosening (1.4% and 1.8%) did not differ significantly between the mobile and fixed-bearing implant designs. No knee in either group had osteolysis. The estimated survival rate with revision as the end point was 98.2% (95% confidence interval, 91% to 99%) and 97.5% (95% confidence interval, 91% to 99%) at 12.1 years for the mobile and fixed-bearing implant groups, respectively. CONCLUSIONS The results of the present long-term clinical study suggest that excellent clinical and radiographic results were achieved with both the press-fit condylar Sigma mobile and fixed-bearing cruciate-retaining total knee designs. We found no significant clinical advantage for a mobile-bearing over a fixed-bearing total knee prosthesis. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young-Hoo Kim
- Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, 911-1, MokDong, YangChun-Ku, Seoul, Republic of Korea 158-710. E-mail address for Young-Hoo Kim:
| | - Jang-Won Park
- Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, 911-1, MokDong, YangChun-Ku, Seoul, Republic of Korea 158-710. E-mail address for Young-Hoo Kim:
| | - Jun-Shik Kim
- Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, 911-1, MokDong, YangChun-Ku, Seoul, Republic of Korea 158-710. E-mail address for Young-Hoo Kim:
| | - Sourabh S Kulkarni
- Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, 911-1, MokDong, YangChun-Ku, Seoul, Republic of Korea 158-710. E-mail address for Young-Hoo Kim:
| | - Yoon-Hong Kim
- Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, 911-1, MokDong, YangChun-Ku, Seoul, Republic of Korea 158-710. E-mail address for Young-Hoo Kim:
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Hopley CDJ, Dalury DF. A systematic review of clinical outcomes and survivorship after total knee arthroplasty with a contemporary modular knee system. J Arthroplasty 2014; 29:1398-411. [PMID: 24582161 DOI: 10.1016/j.arth.2014.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 11/20/2013] [Accepted: 01/14/2014] [Indexed: 02/01/2023] Open
Abstract
A systematic review appraising the clinical performance and safety of the primary SIGMA modular knee system (DePuy-Synthes, Warsaw, Ind.) found 5 registry reports and 53 journal publications reporting survivorship or postoperative increase in Knee Society scores on 241632 primary SIGMA knee arthroplasties. Pooled data from national joint registries and clinical studies on primary SIGMA knee survivorship were comparable. Both were higher than for all other knees in 5 national joint registries up to 5 years. Compared with pooled data from 2 independent systematic reviews of primary non-SIGMA knees, the SIGMA system provided comparable postoperative changes in Knee Society knee score and a nonsignificant trend of higher postoperative changes in Knee Society function score. This finding suggests that this knee system provides excellent durable results.
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Mobile bearing or fixed bearing? A meta-analysis of outcomes comparing mobile bearing and fixed bearing bilateral total knee replacements. Knee 2014; 21:374-81. [PMID: 24380804 DOI: 10.1016/j.knee.2013.10.002] [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: 09/12/2012] [Revised: 10/13/2013] [Accepted: 10/16/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare outcomes between mobile-bearing (MB) and fixed-bearing (FB) in bilateral total knee replacements. METHODS The MEDLINE, EMBASE and Cochrane Library databases were searched. Randomized controlled trials of bilateral total knee arthroplasty with one of each design implanted were identified. Weighted mean differences (WMDs) and pooled risk ratios (RRs) were calculated using fixed- or random-effects models. RESULTS Twelve studies were identified with a total of 807 patients and 1614 knees. All RCTs were of high quality with a low risk of bias. No statistical difference was found between MB and FB at 2- to 5-year follow-up in terms of America Knee Society score (WMD: -1.29, 95% CI: -5.65 to 3.06), pain score (WMD: -3.26, 95% CI: -10.45 to 3.93), range of motion (WMD: -4.16, 95% CI: -9.97 to 1.66), reoperation (RR: 1.00, 95% CI: 0.28 to 3.60), and radiolucent lines (RR: 1.51, 95% CI: 0.70 to 3.24). The results were similar at 1-, 5- to 8-, or >8-year follow-up. Patient's satisfaction (RR: 0.85, 95% CI: 0.54 to 1.34), and complication (≤2-year, RR: 0.55, 95% CI: 0.29 to 1.04; >2-year, RR: 1.0, 95% CI=0.73 to 1.38) also showed no difference between two groups. CONCLUSIONS Based on this meta-analysis we are unable to detect the superiority of MB as compared to FB. More randomized trials with a larger sample size and longer follow-up are needed to evaluate these two kinds of prosthesis. LEVEL OF EVIDENCE Therapeutic Level II.
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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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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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31
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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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Arami A, Vallet A, Aminian K. Accurate Measurement of Concurrent Flexion–Extension and Internal–External Rotations in Smart Knee Prostheses. IEEE Trans Biomed Eng 2013; 60:2504-10. [DOI: 10.1109/tbme.2013.2259489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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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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In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. INTERNATIONAL ORTHOPAEDICS 2012; 36:2465-71. [PMID: 23081946 DOI: 10.1007/s00264-012-1673-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study was to evaluate the in vivo knee kinematics to assess the available functional motion of the characteristic mobile-bearing prosthesis design and to examine whether the artificial joint would work in vivo according to its design concept. METHODS We studied 14 knees (11 patients) implanted with the Vanguard RP Hi-Flex prosthesis. This prosthesis has a highly original form of post-cam called a PS saddle design with high compatibility, and with a rotating plate mobile-bearing mechanism. The cylinder-type post-cam is designed to enable contact in early flexion ranges, and to prevent paradoxical anterior femoral component movement. Each patient performed weight-bearing deep knee bending under fluoroscopic surveillance. Motion between each component including the polyethylene insert was analyzed using the 2D/3D registration technique. RESULTS The mean range of motion was 122.0°. The mean femoral component rotation for the tibial tray was 5.0°. No paradoxical anterior movement of the nearest point was confirmed between the femoral component and the tibial tray in the early flexion ranges. Initial contact of the post-cam was confirmed at a knee flexion angle of 33.8°. Subsequently, the wide contact of the post-cam was maintained until flexion reached 120° in all knees, but disengagement of the post-cam was observed in two knees when flexion was ≥130°. CONCLUSIONS The results of this study demonstrated that the prosthesis design generally works in vivo as intended by its design concept. The present kinematic data may provide useful information for improvement of high-flex type prostheses.
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Arami A, Miehlbradt J, Aminian K. Accurate internal-external rotation measurement in total knee prostheses: A magnetic solution. J Biomech 2012; 45:2023-7. [PMID: 22698831 DOI: 10.1016/j.jbiomech.2012.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/04/2012] [Accepted: 05/13/2012] [Indexed: 11/28/2022]
Abstract
In this work we tackled the problem of accurate measurement of internal-external (IE) rotations in the prosthetic knee. We presented a magnetic measurement system to be implanted in the knee prostheses in order to measure IE without soft tissue artifacts. The measurement system consisted of a permanent magnet attached under the tibial plate of the prosthesis and a combination of magnetic sensors in the polyethylene insert. Two different sensor configurations were designed, and five different angle estimators for measurement of IE angles were defined and tested based on several static and dynamic measurements toward a stereophotogrammetry motion capture system. Also a noise analysis was done to see which estimators are less sensitive to measurement noise. One-sensor configuration provided lower power budget with dynamic RMS error of 0.49° and a noise range of ±0.53°. Two-sensor configuration doubles the power consumption but provided slightly lower dynamic RMS error (0.37°) and a noise range of ±0.42°, and offers the possibility of having redundancy in case of damaged sensor.
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Affiliation(s)
- Arash Arami
- Ecole Polytechnique Fédérale de Lausanne, Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland.
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38
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Thelu CE, Pasquier G, Maynou C, Migaud H. Poor results of the Optetrak™ cemented posterior stabilized knee prosthesis after a mean 25-month follow-up: analysis of 110 prostheses. Orthop Traumatol Surg Res 2012; 98:413-20. [PMID: 22613936 DOI: 10.1016/j.otsr.2012.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 02/20/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The introduction of a new knee arthroplasty model, even if it differs from a validated implant by only a few details, should be followed by rigorous assessment. The Optetrak™ cemented posterior stabilized knee prosthesis evolved from the Insall prosthesis with a smaller tibial keel associated with a higher tibial cam and increased femorotibial congruency as well as a more posterior-stabilized trochlea. HYPOTHESIS We hypothesized that this implant with only minor modifications to the Insall prosthesis would provide as favorable results as the Insall prosthesis. MATERIALS AND METHODS A continuous series of 110 prostheses (106 patients) implanted between 2005 and 2007 was retrospectively analyzed with a mean follow-up of 25 months (range, 12-42 months) by an independent observer. The follow-up was based on the IKS score and the radiological assessment was conducted by three senior surgeons. RESULTS The mean IKS score was 83.7 (range, 13-100) points at the last follow-up, the mean function score was 82.6 (range, 30-100 points), and mean flexion was 120° (range, 80-140°). Seventeen patients (15%) were disappointed or dissatisfied, 25 knees (22%) were painful, requiring regular painkillers. The prostheses had a satisfactory mechanical axis, with a mean HKA angle of 177.4 ± 4°, but 25 prostheses (22%) presented rims evolving toward tibial implant loosening, and 24 (21%) developed signs of patellofemoral conflict. With follow-up less than 5 years, nine cases were revised for tibial loosening, three for patellofemoral instability, and one for patellofemoral pain. The cases of tibial loosening were particular because they occurred at the cement-tibial-implant interface. The cumulated survival rate at 36 months was 80.97 ± 9.1% and 76.74 ± 12% at 45 months. DISCUSSION This tibial implant with a small keel does not resist the stresses applied by posterior stabilization, with notably a higher level of stress than the Insall prosthesis from which it was derived. In cases of centering defect, the design of the trochlea can lead to impingement between the edges of the patella and the prominent edges of the prosthetic trochlea. We have suspended implantation of this prosthesis and continue to monitor the progression of patients having received these implants. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- C-E Thelu
- Faculté de médecine, Lille Nord-de-France University, 59045 Lille cedex, France
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Jolles BM, Grzesiak A, Eudier A, Dejnabadi H, Voracek C, Pichonnaz C, Aminian K, Martin E. A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five-year follow-up. ACTA ACUST UNITED AC 2012; 94:648-55. [DOI: 10.1302/0301-620x.94b5.27598] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study compared the outcome of total knee replacement (TKR) in adult patients with fixed- and mobile-bearing prostheses during the first post-operative year and at five years’ follow-up, using gait parameters as a new objective measure. This double-blind randomised controlled clinical trial included 55 patients with mobile-bearing (n = 26) and fixed-bearing (n = 29) prostheses of the same design, evaluated pre-operatively and post-operatively at six weeks, three months, six months, one year and five years. Each participant undertook two walking trials of 30 m and completed the EuroQol questionnaire, Western Ontario and McMaster Universities osteoarthritis index, Knee Society score, and visual analogue scales for pain and stiffness. Gait analysis was performed using five miniature angular rate sensors mounted on the trunk (sacrum), each thigh and calf. The study population was divided into two groups according to age (≤ 70 years versus > 70 years). Improvements in most gait parameters at five years’ follow-up were greater for fixed-bearing TKRs in older patients (> 70 years), and greater for mobile-bearing TKRs in younger patients (≤ 70 years). These findings should be confirmed by an extended age controlled study, as the ideal choice of prosthesis might depend on the age of the patient at the time of surgery.
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Affiliation(s)
- B. M. Jolles
- CHUV and University of Lausanne – Site
Hôpital Orthopédique, 4 Avenue Pierre Decker, CH-1011
Lausanne, Switzerland
| | - A. Grzesiak
- CHUV and University of Lausanne – Site
Hôpital Orthopédique, 4 Avenue Pierre Decker, CH-1011
Lausanne, Switzerland
| | - A. Eudier
- CHUV and University of Lausanne – Site
Hôpital Orthopédique, 4 Avenue Pierre Decker, CH-1011
Lausanne, Switzerland
| | - H. Dejnabadi
- École Polytechnique Fédérale de Lausanne
– CBT - LMAM, CH-1015 Lausanne, Switzerland
| | - C. Voracek
- CHUV and University of Lausanne – Site
Hôpital Orthopédique, 4 Avenue Pierre Decker, CH-1011
Lausanne, Switzerland
| | - C. Pichonnaz
- CHUV and University of Lausanne – Site
Hôpital Orthopédique, 4 Avenue Pierre Decker, CH-1011
Lausanne, Switzerland
| | - K. Aminian
- École Polytechnique Fédérale de Lausanne
– CBT - LMAM, CH-1015 Lausanne, Switzerland
| | - E. Martin
- CHUV and University of Lausanne – Department
of Geriatrics and Geriatric Rehabilitation, Hôpital
de Sylvana, CH-1011 Lausanne, Switzerland
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Argenson JNA, Parratte S, Ashour A, Saintmard B, Aubaniac JM. The outcome of rotating-platform total knee arthroplasty with cement at a minimum of ten years of follow-up. J Bone Joint Surg Am 2012; 94:638-44. [PMID: 22488620 DOI: 10.2106/jbjs.k.00263] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Durable, long-term results have been reported for patients managed with first-generation mobile-bearing total knee arthroplasty. Second-generation mobile-bearing total knee arthroplasty has been introduced to enhance instrumentation, to increase flexion, and to improve functional outcome, but, to our knowledge, no long-term results are available. METHODS From May 1999 to June 2000, 116 consecutive rotating-platform total knee arthroplasties were performed by the two senior authors in 112 patients with use of the LPS-Flex Mobile cemented prosthesis, which was implanted with a measured resection technique. The patella was resurfaced in every knee. The average age of the patients at the time of surgery was sixty-nine years (range, thirty-seven to eighty-five years), and seventy-seven patients (eighty knees) were women. The predominant diagnosis was osteoarthritis. The clinical and radiographic evaluation was performed with use of the Knee Society rating system. The level of activity and patient-reported functional outcome were evaluated with use of the University of California at Los Angeles (UCLA) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), respectively. RESULTS The average duration of follow-up was 10.6 years (range, ten to 11.8 years). Three patients were lost to follow-up, and five patients died of causes unrelated to knee arthroplasty. Two knees were revised, one because of infection and one because of failure of the medial collateral ligament. Kaplan-Meier survivorship analysis showed an implant survival rate of 98.3% at ten years. For the 104 patients (108 knees) who were evaluated at a minimum of ten years, the average Knee Society knee and function scores improved from 34 to 94 points and from 55 to 88 points, respectively, at the time of the latest follow-up. There was no periprosthetic osteolysis and no evidence of implant loosening on follow-up radiographs. The average knee flexion was 117° preoperatively and 128° at the time of the latest follow-up evaluation. At the time of the latest follow-up, the KOOS quality-of-life score was significantly better for patients with >125° of flexion (p = 0.00034). CONCLUSIONS This study demonstrated durable clinical and radiographic results at a minimum of ten years after total knee replacement with a second-generation, cemented, rotating-platform, posterior-stabilized total knee prosthesis. According to the functional outcome results obtained in this study, we believe that this design is a valuable option for active patients undergoing total knee arthroplasty.
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Affiliation(s)
- Jean-Noel A Argenson
- Service de Chirurgie Orthopédique, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France. jean-noel.argenson@ap-hm
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41
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Kalisvaart MM, Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD. Randomized clinical trial of rotating-platform and fixed-bearing total knee arthroplasty: no clinically detectable differences at five years. J Bone Joint Surg Am 2012; 94:481-9. [PMID: 22437996 DOI: 10.2106/jbjs.k.00315] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For some surgeons, rotating-platform total knee designs are an intellectually appealing option to use for total knee arthroplasty because of the contention that they can self-align and accommodate small mismatches in the rotational position of the tibial and femoral components. We carried out a randomized clinical trial to determine if a posterior-stabilized, rotating-platform knee design provided better maximum knee flexion, better function, or better durability at five years of follow-up when compared with a fixed-bearing design. METHODS This randomized clinical trial of 240 primary total knee arthroplasties involved a single type of distal femoral implant (posterior-stabilized) and three different types of tibial implant (all-polyethylene fixed-bearing, modular-metal-backed fixed-bearing, and rotating-platform). The three tibial implant groups were balanced dynamically with a computerized randomization process that accounted for patient age, sex, and body mass index; surgeon; and implant type. Patients returned for examination and radiographs at three months, one year, two years, and five years postoperatively. RESULTS Knee range of motion was not significantly different among the all-polyethylene, modular-metal-backed, and rotating-platform tibial component groups at two years (mean, 111°, 111°, and 110°, respectively) or five years (mean, 110°, 109°, and 109°, respectively). Function, as measured with Knee Society scores, was not significantly different among the all-polyethylene, modular-metal-backed, and rotating-platform groups at two years (mean, 90, 91, and 91 points, respectively) or five years (mean, 88, 89, and 88 points, respectively). Stair-climbing scores were not significantly different among the three groups at two years (mean, 39, 40, and 39 points, respectively) or five years (mean, 37, 40, and 36 points, respectively). There were four revisions: one in the all-polyethylene group (patellar fracture), two in the modular-metal-backed group (aseptic loosening), and one in the rotating-platform group (deep infection). CONCLUSIONS In this randomized clinical trial, the rotating-platform total knee design was reliable and durable but did not provide better maximum knee flexion, better function, or better durability at five years postoperatively when compared with a posterior-stabilized, fixed-bearing design incorporating either an all-polyethylene or a modular-metal-backed tibial component.
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Affiliation(s)
- Michael M Kalisvaart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
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Mahoney OM, Kinsey TL, D’Errico TJ, Shen J. The John Insall Award: no functional advantage of a mobile bearing posterior stabilized TKA. Clin Orthop Relat Res 2012; 470:33-44. [PMID: 22006197 PMCID: PMC3238000 DOI: 10.1007/s11999-011-2114-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mobile bearing (MB) total knee design has been advocated as a means to enhance the functional characteristics and decrease the wear rates of condylar total knee arthroplasty (TKA). However, it is unclear if these designs achieve these goals. QUESTIONS/PURPOSES We asked whether function of patients or survivorship would be greater or complications would be lesser in groups of patients with MB compared with fixed bearing (FB) TKA. We also sought to describe retrieval findings. METHODS We randomized 507 primary TKAs in 416 eligible patients to receive MB (n = 252) or FB (n = 255) devices from November 2001 to August 2007 (Investigational Device Exemption G000180, ClinicalTrials.gov registration number NCT00946075). Patients were blinded to treatment allocation. WOMAC Index, SF-12 Health Survey, knee range of motion, and Knee Society scores were collected and compared preoperatively and at 6, 12, and 24 months postoperatively. We recorded device failures and complications until October 2009. Kaplan-Meier survivorship was compared using the log rank test. Twelve retrieved MB devices underwent pathologic analysis. The minimum postoperative time was 2.2 years (mean, 5.9 years; range, 2.2-7.9 years). RESULTS We found no differences in mean clinical assessment scores or mean score changes from baseline at any postoperative interval through 2 postoperative years. Nineteen of the 252 MB and 13 of the 255 FB knees had undergone revision of any component. Estimated survival at 6 postoperative years was similar for the two devices: 90.1% (95% confidence interval [CI], 84.1-93.9) for MB and 94.2% (95% CI, 90.1-96.6) for FB. Two MB and no FB tibial components were revised for loosening. There was one case of MB insert dislocation. Retrieved MB devices demonstrated no unexpected wear or mechanical device failures. CONCLUSION We found no evidence of functional advantage of the MB design. Survivorship was similar, although the study is limited by short duration of followup.
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Affiliation(s)
- Ormonde M. Mahoney
- Athens Orthopedic Clinic, PA, 1765 Old West Broad Street, Building 2, Suite 200, Athens, GA 30606 USA ,Department of Kinesiology, University of Georgia, Athens, GA USA
| | - Tracy L. Kinsey
- Athens Orthopedic Clinic, PA, 1765 Old West Broad Street, Building 2, Suite 200, Athens, GA 30606 USA ,Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
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Spencer SJ, Baird K, Young D, Tait GR. The Rotaglide mobile bearing knee arthroplasty A 10- to 13-year review from an independent centre. Knee 2012; 19:20-3. [PMID: 21216600 DOI: 10.1016/j.knee.2010.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 02/02/2023]
Abstract
The Rotaglide knee arthroplasty has a highly congruent mobile meniscal bearing allowing both rotation and antero-posterior translation. We reviewed 137 consecutive primary arthroplasties in 120 patients at mean 11.1 years (10-12.9) following surgery. No cases were lost to follow-up. Hospital for Special Surgery (HSS) and American Knee Society (AKSS) scores were recorded at a review clinic. Radiographs were assessed using the Knee Society's roentgenographic evaluation system. Forty-two patients had died, leaving 78 patients (87 knees) available for review. Sixty-four patients (70 knees) were assessed at a clinic and in 14 (17 knees) clinical outcomes were obtained via telephone and their most recent radiographs were assessed. There were three cases of aseptic loosening and one deep infection requiring revision surgery. Two meniscal bearings were replaced with thicker inserts, one following bearing fracture and one following bearing dislocation. Survival at 11 years for aseptic loosening was 97.6% (95% CI 94.3 to 1.0) and survival using re-operation for any cause was 95.3% (95% CI 90.8 to 99.8). The Rotaglide mobile-bearing total knee replacement demonstrates good survivorship and outcome scores at 11 years following surgery.
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Affiliation(s)
- Simon J Spencer
- Department of Orthopaedic Surgery, Crosshouse Hospital, Kilmarnock, UK.
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44
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Long-term comparison of mobile-bearing vs fixed-bearing total knee arthroplasty. J Arthroplasty 2011; 26:1219-23. [PMID: 21397453 DOI: 10.1016/j.arth.2011.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 01/23/2011] [Indexed: 02/01/2023] Open
Abstract
Few published reports have been published regarding a comparison of the long-term outcomes between mobile- (MB) and fixed-bearing component designs for knee arthroplasty. The minimum 10-year clinical and radiologic follow-up of an unselected consecutive series of 89 patients (107 knees) who were randomized to have one of these different designs for primary arthroplasty was done. Twenty-six patients (30 knees) who had a fixed-bearing design and 24 patients (33 knees) who had an MB prosthesis were available for follow-up. Two MB knees were revised for aseptic loosening of a tibial component in one and femoral component fracture in the other. In patients who did not have revision surgery, there were no differences between the groups with respect to mean Knee Society scores, knee flexion, or pain scores.
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45
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Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty 2011; 26:1205-13. [PMID: 21295940 DOI: 10.1016/j.arth.2010.12.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/17/2010] [Indexed: 02/01/2023] Open
Abstract
Mobile bearing (MB) knee replacements were designed with the goal of increased conformity and decreased bearing wear. We conducted a meta-analysis and systematic review of randomized controlled trials comparing outcomes of MB and fixed bearing (FB) total knee arthroplasty (TKA). We identified 14 studies reporting our primary outcome of Knee Society Scores (KSS). We also pooled data for post-operative range of motion (ROM) and Hospital for Special Surgery scores (HSS). The standard difference in mean outcome scores for KSS and HSS demonstrated no difference between groups (P = .902, and P = .426 respectively). Similarly, the pooled data for ROM showed no difference between groups (P = .265). The results of this study found no significant differences between clinical outcomes of MB and FB TKA.
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García-Crespo R, Marco F, Moro LE, Ariza G, Luque R, López-Durán L. Midterm results of Optetrak posterior-stabilized total knee system after 7 to 12 years in a university hospital. J Arthroplasty 2011; 26:1326-31. [PMID: 21752582 DOI: 10.1016/j.arth.2010.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 09/26/2010] [Accepted: 11/11/2010] [Indexed: 02/01/2023] Open
Abstract
A clinical study has been carried out on 434 posterior-stabilized knee prostheses (Optetrak; Exactech, Gainesville, Fla) implanted between 1995 and 2000 in a university general hospital by 23 surgeons. At a mean follow-up of 8.8 years, 297 knees in 249 patients were available for review. Average patient age at surgery was 71.8 years. Average body mass index was 28.8 kg/m(2). Mean flexion range was 108° .The average knee score (Hospital for Special Surgery) increased from 48 points preoperatively to 86 points (60-97 points) at the final review. Of the patients, 81% had an excellent or good result, 14.9% had a fair result, and 4.1% had a poor result. Using the Kaplan-Meier method, we obtained a 91.3% predicted implant survival at 12 years including septic and aseptic revision in the best-case scenario.
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Wen Y, Liu D, Huang Y, Li B. A meta-analysis of the fixed-bearing and mobile-bearing prostheses in total knee arthroplasty. Arch Orthop Trauma Surg 2011; 131:1341-50. [PMID: 21655969 DOI: 10.1007/s00402-011-1328-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We asked whether the mobile-bearing knee prostheses could offer clinical and radiographic advantages over the fixed-bearing knee prostheses. MATERIALS AND METHODS We conducted a systematic review and meta-analysis to evaluate the validity of this theory. We searched PubMed, EMBASE, Ovid and the Cochrane Central Register of Controlled Trials from January 1979 to June 2010 for randomized controlled studies comparing the effect of fixed- and mobile-bearing prostheses in TKA. We assessed the methodological quality of the studies and abstracted the relevant data independently. RESULTS 15 studies involving 1,950 knees were identified in this analysis. No statistically significant difference was present in terms of KSS, patient preference, radiolucent line around implant and prosthesis-related complications as compared to the fixed- and mobile-bearing knee design. CONCLUSIONS Theoretically, mobile-bearing implant design could improve clinical and radiographic outcomes as being compared to fixed-bearing implant design, but the anticipated effectiveness has not been implemented in the current clinical practice at mid-term follow up.
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Affiliation(s)
- Yu Wen
- Basic Medical College, China Medical University, Shenyang, Liaoning, China
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Lampe F, Sufi-Siavach A, Bohlen KE, Hille E, Dries SPM. 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. Open Orthop J 2011; 5:201-8. [PMID: 21687563 PMCID: PMC3115600 DOI: 10.2174/1874325001105010201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/01/2011] [Accepted: 04/11/2011] [Indexed: 01/14/2023] Open
Abstract
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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Affiliation(s)
- Frank Lampe
- Schön Klinik Hamburg-Eilbek, Dehnhaide 120, DE 22081 Hamburg, Germany
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Affatato S, Spinelli M, Lopomo N, Grupp TM, Marcacci M, Toni A. Can the method of fixation influence the wear behaviour of ZrN coated unicompartmental mobile knee prostheses? Clin Biomech (Bristol, Avon) 2011; 26:152-8. [PMID: 20934240 DOI: 10.1016/j.clinbiomech.2010.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Modern unicompartmental knee prostheses represent a valid alternative to total knee replacement. It is known that variations in clinical alignment lead to altered biomechanics and abnormal wear. The aim of this study was to assess the influence, on wear behaviour, of two different cementing interfaces of the femoral components tested on a knee joint wear simulator. METHODS The wear tests were run in a knee wear simulator at a frequency of 1.1 Hz for 3 million cycles in accordance with ISO 14243-3. Twelve commercial mobile GUR 1020 UHMWPE meniscus specimens articulated in between 12 cobalt-chromium-molybdenum alloy femoral and tibial components covered by a multi-layer of chromium nitride and a final layer of zirconium nitride ceramic coating to prevent ion release from the substrate. Two wear tests were performed: in the first test, each femoral component was cemented into a custom made metallic-block shaped to perfectly host it. In the second test, synthetic composite femurs received the femoral components on the basis of guidelines used in current surgery. FINDINGS The two cementing interfaces showed a significantly different wear behaviour, quantified as mean weight loss (P<0.001). Scanning electron microscope examinations of new and tested metallic components showed macro- and micro-pores of few microns on both configurations. INTERPRETATION The wear pattern observed at 3 million cycles showed differences between the two methods of fixation for the meniscus femoral components.
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Affiliation(s)
- S Affatato
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Mobile-bearing prosthesis did not improve mid-term clinical results of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18:1311-6. [PMID: 20407753 DOI: 10.1007/s00167-010-1143-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 04/06/2010] [Indexed: 02/06/2023]
Abstract
A prospective study was performed to compare the clinical and radiological results of mobile- and fixed-bearing total knee arthroplasty with specific attention to rotational alignment and range of motion. Sixty-one knees were assigned to total knee arthroplasty with either the NexGen LPS Flex fixed-bearing or with the NexGen LPS Flex mobile-bearing prosthesis. Postoperatively, knees were compared with regard to range of motion, clinical score, and radiographic findings. Rotational alignment of the femoral and tibial components was evaluated by computed tomography. The median follow-up period was 5.9 years (range 2.1-8.8 years). Median postoperative Knee Society scores were 99 points (68-100) for the fixed-bearing group and 100 points (66-100) for the mobile-bearing group (n.s.). The median postoperative flexion angles of 120° (90°-150°) for the fixed-bearing group and 125° (90°-145°) for the mobile-bearing group were not significantly different from each other (n.s.). No knee required revision surgery due to wear of polyethylene or loosening of the component in either group. Computed tomography showed that 11 knees had rotational mismatches of more than 10° between the femoral and tibial components, but no significant difference was found in the postoperative extension and flexion angles or in the clinical score between the two treatment groups. Using the identical design for both fixed- and mobile-bearing prostheses, this prospective, randomized study did not show any clinical advantages of the mobile-bearing knee. Analysis of rotational alignment by CT scan did not reveal a particular advantage of the self-aligning mechanism of mobile-bearing implants.
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