Reduced patellofemoral and walking pain with mobile-bearing vs. fixed-bearing total knee replacements: a mid-term prospective analytic study

Objective: Total knee replacement (TKR) is the standard treatment for advanced stage knee osteoarthritis. The introduction of the mobile-bearing (MB) design has given rise to a series of theoretical advantages compared to fixed-bearing (FB) implants, although current literature does not reveal significant differences between the designs. The aim of this study was to estimate the clinical results of 2 cemented total knee prosthetic designs: an MB and an FB design.Methods: A series of patients with similar clinical and radiographic characteristics were treated consecutively with 100 FB followed by 94 MB implants. Patients were evaluated radiographically and clinically.Results: Statistically significant differences were found in terms of pain at 5 years in favor of MB prostheses (p=0.006). The "pain on ascending/descending stairs" category on the KSS score showed improvement at 5 years for the MB design (p=0.003). MB implants showed better results in terms of ability to ascend/descend stairs at five years (p=0.002). With regards to the patients' ability to walk, there were differences at 1 year (p=0.020) and at 5 years (p=0.021) in favor of MB implants.Conclusion: At a mean follow-up of 5 years, significant differences were observed in the MB prosthesis in terms of postoperative pain, ability to ascend/descend stairs, and patellofemoral pain

___

Aglietti P, Baldini A, Buzzi R, Lup D, De Luca L. Com- parison of mobile-bearing and fixed-bearing total knee ar- throplasty: a prospective randomized study. J Arthroplasty 2005;20:145-53.

Baldini A, Scuderi GR, Aglietti P, Chalnick D, Insall JN. Flexion-extension gap changes during total knee arthro- plasty: effect of posterior cruciate ligament and posterior osteophytes removal. J Knee Surg 2004;17:69-72.

Beard DJ, Pandit H, Price AJ, Butler-Manuel PA, Dodd CA, Murray DW, et al. Introduction of a new mobile-bear- ing total knee prosthesis: minimum three year follow-up of an RCT comparing it with a fixed-bearing device. Knee 2007;14:448-51.

Bhan S, Malhotra R, Kiran EK, Shukla S, Bijjawara M. A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years. J Bone Joint Surg Am 2005;87:2290-6.

Biau D, Mullins MM, Judet T, Piriou P. Mobile versus fixed-bearing total knee arthroplasty: mid-term compara- tive clinical results of 216 prostheses. Knee Surg Sports Traumatol Arthrosc 2006;14:927-33.

Bistolfi A, Massazza G, Lee GC, Deledda D, Berchialla P, Crova M. Comparison of fixed and mobile-bearing total knee arthroplasty at a mean follow-up of 116 months. J Bone Joint Surg Am 2013;95:83.

Bolanos AA, Colizza WA, McCann PD, Gotlin RS, Wootten ME, Kahn BA, et al. A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties. J Arthroplasty 1998;13:906-15.

Buechel FF, Pappas MJ. Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee pros- theses using meniscal bearings. Clin Orthop Relat Res 1990;260:162-9.

Buechel FF. Mobile-bearing knee arthroplasty: rotation is our salvation J Arthroplasty 2004;19(4 Suppl 1):27-30.

Colizza WA, Insall JN, Scuderi GR. The posterior sta- bilized total knee prosthesis. Assessment of polyethylene damage and osteolysis after a ten-year-minimum follow- up. J Bone Joint Surg Am 1995;77:1713-20.

Diduch DR, Insall JN, Scott WN, Scuderi GR, Font- Rodriguez D. Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am 1997;79:575-82.

Firestone TP, Teeny SM, Krackow KA, Hungerford DS. The clinical and roentgenographic results of cementless porous-coated patellar fixation. Clin Orthop Relat Res 1991;273:184-9.

Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res 1997;345:79-86.

Hansson U, Toksvig-Larsen S, Jorn LP, Ryd L. Mobile vs. fixed meniscal bearing in total knee replacement: a ran- domised radiostereometric study. Knee 2005;12:414,8.

Incavo SJ, Beynnon BD, Johnson CC, Churchill DL. Knee kinematics in genesis total knee arthroplasty. A compari- son of different tibial designs with and without posterior cruciate substitution in cadaveric specimens. Am J Knee Surg 1997;10:209-15.

Wohlrab D, Ditl J, Herrschelmann R, Schietsch U, Hein W, Hube R. Does the NexGen LPS flex mobile knee pros- thesis offer advantages compared to the NexGen LPS?--a comparison of clinical and radiological results. [Article in German] Z Orthop Ihre Grenzgeb 2005;143:567-72. [Abstract]

Fontanesi G, Rotini R, Pignedoli P, Giancecchi F. Reten- tion of the posterior cruciate ligament in total knee arthro- plasty. Ital J Orthop Traumatol 1991;17:65-71.

Lädermann A, Lübbeke A, Stern R, Riand N, Fritschy D. Fixed-bearing versus mobile-bearing total knee arthroplas- ty: a prospective randomised, clinical and radiological study with mid-term results at 7 years. Knee 2008;15:206-10.

Silvestre Muñoz A, Almeida Herrero F, Lopez Lozano R, Argüelles Linares F. Comparison of mobile- and fixed- bearing cemented total knee arthroplasty. Acta Orthop Belg 2008;74:801-8.

Li N, Tan Y, Deng Y, Chen L. Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta- analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2014;22:556-64.

Kim YH, Kim DY, Kim JS. Simultaneous mobile- and fixed-bearing total knee replacement in the same pa- tients. A prospective comparison of mid-term outcomes using a similar design of prosthesis. J Bone Joint Surg Br 2007;89:904-10.

Oh KJ, Pandher DS, Lee SH, Sung Joon SD Jr, Lee ST. Meta-analysis comparing outcomes of fixed-bearing and mobile-bearing prostheses in total knee arthroplasty. J Ar- throplasty 2009;24:873-84.

Wylde V, Learmonth I, Potter A, Bettinson K, Lingard E. Patient-reported outcomes after fixed- versus mobile- bearing total knee replacement: a multi-centre randomised controlled trial using the Kinemax total knee replacement. J Bone Joint Surg Br 2008;90:1172-9.

Wohlrab D, Hube R, Zeh A, Hein W. Clinical and radio- logical results of high flex total knee arthroplasty: a 5 year follow-up. Arch Orthop Trauma Surg 2009;129:21-4.

Gioe TJ, Glynn J, Sembrano J, Suthers K, Santos ER, Singh J. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs. A prospective randomized trial. J Bone Joint Surg Am 2009;91:2104-12.

Kim YH, Kim JS, Choe JW, Kim HJ. Long-term compari- son of fixed-bearing and mobile-bearing total knee replace- ments in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am 2012;94:866-73.

Watanabe T, Tomita T, Fujii M, Hashimoto J, Sugamoto K, Yoshikawa H. Comparison between mobile-bearing and fixed-bearing knees in bilateral total knee replacements. Int Orthop 2005;29:179-81.

Gómez-Barrena E, Nuñez A, Martinez-Moreno E, Valls J, Munuera L. Neural and muscular electric activity in the cat's knee. Changes when the anterior cruciate ligament is transected. Acta Orthop Scand 1997;68:149-55.

Kaper BP, Smith PN, Bourne RB, Rorabeck CH, Robert- son D. Medium-term results of a mobile bearing total knee replacement. Clin Orthop Relat Res 1999;367:201-9.

Rand JA. The patellofemoral joint in total knee arthroplas- ty. J Bone Joint Surg Am 1994;76:612-20.

Stern SH, Insall JN. Posterior stabilized prosthesis. Re- sults after follow-up of nine to twelve years. J Bone Joint Surg Am 1992;74:980-6.

Harwin SF, Kester MA, Malkani AL, Manley MT. Excel- lent fixation achieved with cementless posteriorly stabi- lized total knee arthroplasty. J Arthroplasty 2013;28:7-13.

Lonner JH, Jasko JG, Bezwada HP, Nazarian DG, Booth RE Jr. Incidence of patellar clunk with a modern posteri- or-stabilized knee design. Am J Orthop (Belle Mead NJ) 2007;36:550-3.

Chen F, Mont MA, Bachner RS. Management of ipsilat- eral supracondylar femur fractures following total knee ar- throplasty. J Arthroplasty 1994;9:521-6.

Grace JN, Sim FH. Fracture of the patella after total knee arthroplasty. Clin Orthop Relat Res 1988;230:168-75.

Chmell MJ, Moran MC, Scott RD. Periarticular Fractures After Total Knee Arthroplasty: Principles of Management. J Am Acad Orthop Surg 1996;4:109-116.

Stern SH, Insall JN. Total knee arthroplasty in obese pa- tients. J Bone Joint Surg Am 1990;72:1400-4.

Woolson ST, Northrop GD. Mobile- vs. fixed-bearing to- tal knee arthroplasty: a clinical and radiologic study. J Ar- throplasty 2004;19:135-40.

Mont MA, Dellon AL, Chen F, Hungerford MW, Krack- ow KA, Hungerford DS. The operative treatment of pero- neal nerve palsy. J Bone Joint Surg Am 1996;78:863-9.