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Borsinger TM, Quinlan ND, Van Citters DW, Pellegrini VD. Distinctive Polyethylene Damage in Rotating-Platform Total Knee Arthroplasty: A Comparative Retrieval Study in Patients Revised With Clinical Instability. J Arthroplasty 2025:S0883-5403(25)00172-X. [PMID: 39978652 DOI: 10.1016/j.arth.2025.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 02/11/2025] [Accepted: 02/13/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Biomechanical studies suggest mobile-bearing rotating-platform total knee arthroplasty (TKA-RP) has limited tolerance of asymmetric flexion gaps, and improper balancing may result in polyethylene insert instability. We sought to identify a distinctive pattern of polyethylene insert damage associated with clinical failure of TKA-RP. METHODS There were nine patients who had an index TKA-RP and underwent a revision for symptomatic flexion instability (clinical cohort) from 2013 to 2019. There were 30 TKA-RPs (registry cohort) that were randomly selected from an all-cause revision retrieval database with archived clinical and demographic data. Based on prior biomechanical testing, we hypothesized a distinctive pattern of polyethylene damage would occur on the postero-lateral articular surface with dynamic instability. Polyethylene inserts were inspected by three experienced reviewers using the modified Hood method and categorized according to clinical instability and damage pattern. Each registry implant was dichotomized with damage either consistent or not, with that observed in the clinical cohort. RESULTS Of the nine, seven clinical cohort inserts exhibited a consistent pattern of polyethylene damage on the postero-lateral articular surface, ranging from localized loss of machine lines on the insert margin to gross deformation of the articular surface lip with loss of peripheral wall contour. In five of these seven knees, both components were secure at revision. Of the 30 registry cohort patients, nine reported mechanical symptoms of clinical instability. There were eight inserts that exhibited a polyethylene damage pattern similar to that observed in the "clinical cohort"; only two knees had both components secure at revision. CONCLUSIONS The majority (15 of 18) of retrieved TKA-RP inserts associated with clinical instability exhibited a distinctive pattern of postero-lateral articular surface polyethylene damage, suggesting posterior condyle subluxation over the peripheral insert wall as predicted by cadaveric testing. Concomitant aseptic loosening did not preclude this hallmark damage pattern. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tracy M Borsinger
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Orthopaedic Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Nicole D Quinlan
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina; Raleigh Orthopaedic Clinic, Raleigh, North Carolina
| | | | - Vincent D Pellegrini
- Department of Orthopaedic Surgery, University of Virginia Medical Center, Charlottesville, Virginia; Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
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Phillips M, Davis C, Civinini R, Ebied A, Carbo L, Mahapatra A, Ong M, Ekhtiari S. Is There a Difference Between Posterior-Stabilized, Cruciate-Retaining, or Medial-Pivot Implants Used During Primary Total Knee Arthroplasty? J Arthroplasty 2025; 40:S75-S78. [PMID: 39510389 DOI: 10.1016/j.arth.2024.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/24/2024] [Accepted: 10/28/2024] [Indexed: 11/15/2024] Open
Affiliation(s)
- Mark Phillips
- Department of Surgery, McMaster University, Hamilton, Canada
| | - Charles Davis
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | - Lisandro Carbo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Micheal Ong
- The Chinese University of Hong Kong, Hong Kong
| | - Seper Ekhtiari
- Department of Surgery, McMaster University, Hamilton, Canada; Juravinski Hospital, Hamilton, Canada
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Van Meirhaeghe JP, Harris IA, Cuthbert A, Lorimer M, McAuliffe M, Adie S, Molnar R. The influence of implant factors on patient outcomes in primary total knee arthroplasty. J Orthop 2024; 58:154-160. [PMID: 39157416 PMCID: PMC11326491 DOI: 10.1016/j.jor.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024] Open
Abstract
Background The influence of implant factors on patient-reported outcome measures (PROMS) after total knee arthroplasty (TKA) has previously been studied but findings are often inconsistent, restricted in scope and biased by confounding factors. This study aims to determine the association between implant-related factors and early post-operative PROMs after TKA. Methods Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program, the study included 9487 primary TKA procedures performed in 43 hospitals from July 31, 2018 to December 31, 2020. Data included baseline demographic data, surgical details and PROMs collected pre- and 6 months post-operatively. Seven prosthesis characteristics were incorporated in the multivariable model, with proportional odds ordinal regression analysis used to assess their effects on post-operative Oxford knee score (OKS) and joint pain. Adjustments were made for pre-operative OKS and joint pain, as well as potential patient confounders. Results At six months, fixed bearing implants showed higher odds of better OKS compared to mobile bearing implants (odds ratio [OR] = 1.20, 95 % confidence interval [CI] 1.06-1.37. p < 0.004). Similar findings were found with the use of image derived instrumentation (IDI) (OR = 1.27, 95 % CI 1.11-1.46, p < 0.001), robotic assisted vs. non-navigated knees (OR = 1.21, 95 % CI 1.06-1.38, p < 0.005) and no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.032). For lower pain scores at six months, the use of highly crosslinked polyethylene (OR = 1.12, 95 % CI 1.02-1.22, p < 0.015), cemented femoral components (OR = 1.11, 95 % CI 1.01-1.22, p < 0.024), IDI (OR = 1.20, 95 % CI 1.05-1.37, p < 0.009) or no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.034) were associated. Conclusion Utilizing a fixed bearing or robotic assistance correlated with improved OKS scores, whereas highly crosslinked polyethylene or cemented femoral components were associated with improved pain scores. At six months, the use of IDI compared to non-navigated TKA, and patellar resurfacing showed both improved OKS and pain scores.
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Affiliation(s)
- Jan Peter Van Meirhaeghe
- Sydney Orthopaedic Trauma and Reconstructive Surgery (SOTRS), Sydney, Australia
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Ian A. Harris
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Alana Cuthbert
- South Australian Health & Medical Research Institute (SAHMRI), Australia
| | - Michelle Lorimer
- South Australian Health & Medical Research Institute (SAHMRI), Australia
| | - Michael McAuliffe
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Australia
- Queensland University of Technology (QUT - Gardens Point), Australia
| | - Sam Adie
- St. George and Sutherland Hospitals, Sydney, Australia
- St. George and Sutherland Clinical School, UNSW, Australia
| | - Robert Molnar
- St. George and Sutherland Hospitals, Sydney, Australia
- St. George and Sutherland Clinical School, UNSW, Australia
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Kim S, Yang J, Moon S, Choi S. Will Mobile-Bearing Total Knee Arthroplasty Be Lost to History? A Comparative Study of Long-Term Follow-Up. Life (Basel) 2024; 14:1344. [PMID: 39459644 PMCID: PMC11509738 DOI: 10.3390/life14101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 10/09/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
Mobile-bearing (MB) total knee arthroplasty (TKA) implants were introduced as an alternative to fixed-bearing (FB) implants because of their theoretical advantages related to femorotibial rotational mismatch. The purpose of this study is to compare the clinical and radiologic outcomes of MB and FB TKA after approximately 13 years of follow-up. We compared the results of 88 patients with a mean age of 66 years who had received a rotating platform MB implant or a FB implant. The mean follow-up was 13.6 years. The patients were assessed clinically (VAS, ROM, KSS, WOMAC scores) and radiographically before and 13 years after operation. There were no statistically significant differences between the FB and MB groups in terms of clinical outcomes and radiological outcomes (p > 0.05 for all). Although the incidence of complications was higher in the MB group, the findings were not statistically significant compared to the FB group (p > 0.05 for all). Although there were no significant differences in the clinical and radiologic outcomes between the FB and MB groups, the possible higher risk of osteolysis or aseptic loosening in the MB group could be an important clinical implication when selecting the TKA implant.
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Affiliation(s)
- Sangrim Kim
- Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju 63241, Republic of Korea
| | - Joseph Yang
- Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju 63241, Republic of Korea
| | - Seokhwan Moon
- Harrow School, 5 High Street, Harrow on the Hill, Middlesex, London HA1 3HP, UK
| | - Sungwook Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju 63241, Republic of Korea
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Feng H, Feng ML, Cheng JB, Zhang X, Tao HC. Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty. World J Orthop 2024; 15:180-191. [PMID: 38464355 PMCID: PMC10921178 DOI: 10.5312/wjo.v15.i2.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a mature procedure recommended for correcting knee osteoarthritis deformity, relieving pain, and restoring normal biomechanics. Although TKA is a successful and cost-effective procedure, patient dissatisfaction is as high as 50%. Knee pain after TKA is a significant cause of patient dissatisfaction; the most common location for residual pain is the anterior region. Between 4% and 40% of patients have anterior knee pain (AKP). AIM To investigate the effect of various TKA procedures on postoperative AKP. METHODS We searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022. Randomized controlled trials with one intervention in the experimental group and no corresponding intervention (or other interventions) in the control group were collected. Two researchers independently read the title and abstract of the studies, preliminarily screened the articles, and read the full text in detail according to the selection criteria. Conflicts were resolved by consultation with a third researcher. And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software. RESULTS There were 25 randomized controlled trials; 13 were comparative studies with or without patellar resurfacing. The meta-analysis showed no significant difference between the experimental and control groups (P = 0.61). Six studies were comparative studies of circumpatellar denervation vs non-denervation, divided into three subgroups for meta-analysis. The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups (P = 0.31, P = 0.50). One subgroup meta-analysis showed a significant difference between the experimental and control groups (P = 0.001). Two studies compared fixed-bearing TKA and mobile-bearing TKA; the results meta-analysis showed no significant difference between the experimental and control groups (P = 0.630). Two studies compared lateral retinacular release vs non-release; the meta-analysis showed a significant difference between the experimental and control groups (P = 0.002); two other studies compared other factors. CONCLUSION Patellar resurfacing, mobile-bearing TKA, and fixed-bearing TKA do not reduce the incidence of AKP. Lateral retinacular release can reduce AKP; however, whether circumpatellar denervation can reduce AKP is controversial.
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Affiliation(s)
- Hui Feng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ming-Li Feng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing-Bo Cheng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiang Zhang
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hai-Cheng Tao
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Ruckenstuhl P, Revelant F, Hauer G, Bernhardt GA, Leitner L, Gruber G, Leithner A, Sadoghi P. No difference in clinical outcome, pain, and range of motion between fixed and mobile bearing Attune total knee arthroplasty: a prospective single-center trial. BMC Musculoskelet Disord 2022; 23:413. [PMID: 35501786 PMCID: PMC9063062 DOI: 10.1186/s12891-022-05382-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/25/2022] [Indexed: 12/11/2022] Open
Abstract
Background Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits. Methods The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up. Results The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups (p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° (p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings (p = 0.012). Conclusion According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05382-x.
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Affiliation(s)
- Paul Ruckenstuhl
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Fabio Revelant
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Georg Hauer
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Gerald Gruber
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
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Yang D, Zhou Y, Shao H, Deng W. Different Deformity Origins and Morphological Features in Subtypes of Valgus Knees: A Radiological Classification System. Orthop Surg 2022; 14:96-103. [PMID: 34870368 PMCID: PMC8755874 DOI: 10.1111/os.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the deformity origins and distribution among valgus knees to individualize their morphological features. METHODS Radiographic images of 105 valgus knees were analyzed. Long-film radiographs and computed tomography were collected for every knee. A malalignment test was performed on standing long-film radiographs. The hip-knee-ankle angle (HKA), the anatomical lateral distal femoral angle (aLDFA), and the anatomical medial proximal tibial angle (aMPTA) were measured on long-film radiographs. The distal condylar angle and posterior condylar angle on distal femur were further measured on computed tomography scans. The tibial bone varus angle was measured on long-film radiographs as well. All the valgus knees were sorted into different subtypes according to the origins of bony deformity, and the prevalence of each subtype was reported. Finally, to examine the inter-observer reproducibility of this classification system, two observers measured the deformities and did the classification for all the 105 knees independently and then the intraclass correlation coefficient (ICC) was calculated. RESULTS Among the 105 knees, 48 knees (45.7%) had apparent deformity from the tibial plateau, and 62 knees (59.0%) had apparent deformity from the supracondylar region of the femur. Eighteen knees (17.1%) had distal condylar angle >7°, among which 11 knees had posterior condylar angle >3° simultaneously. Valgus knees had five subtypes of bone deformity origins-the supracondylar part of the femur, the distal aspect of the lateral femoral condyle, both distal and posterior aspects of the lateral femoral condyle, the tibial plateau, or the metaphyseal segment of the tibia. A valgus knee could be labeled as only one subtype, or a combination of two or more subtypes. Labeling 105 knees with origin of the most severe deformity, the prevalence of each subtype was 40.0%, 5.7%, 9.5%, 28.6%, and 16.2%, respectively. The intra-observer and inter-observer ICC of this classification system was 0.992 and 0.976, respectively. CONCLUSIONS Valgus knees can be classified into different subtypes according to deformity origins. This radiological classification system has satisfactory reproducibility. It helps surgeons better individualize morphological features of valgus knees.
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Affiliation(s)
- Dejin Yang
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
| | - Yixin Zhou
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
| | - Hongyi Shao
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
| | - Wang Deng
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
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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: 19] [Impact Index Per Article: 6.3] [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: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [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: 22] [Impact Index Per Article: 5.5] [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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Thiengwittayaporn S, Tangtrakul P, Hongku N, Tunyasuwanakul R. Patellar Denervation Reduces Postoperative Anterior Knee Pain After Patellar Resurfacing Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2021; 36:1295-1301. [PMID: 33214014 DOI: 10.1016/j.arth.2020.10.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/17/2020] [Accepted: 10/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The benefit of patellar denervation (PD) in patellar resurfacing total knee arthroplasty (TKA) is still debatable. This prospective, randomized controlled trial investigated whether circumferential PD should be performed in patellar resurfacing TKA. METHODS A total of 241 patients who underwent unilateral TKA were randomized into PD or non-PD groups. Incidence, intensity, and presentation time of anterior knee pain (AKP) and clinical outcomes were evaluated at 3, 6, 9, 12, 18, and 24 months postoperatively. RESULTS The incidence of AKP was significantly lower in the PD group (6.4% vs 16.2%, P = .032). The intensity of AKP and patient satisfaction scores were significantly better in the PD group at 3 months but not after 3 months. The presentation time of AKP mostly occurs at 3 months after surgery. The Knee Society score, range of motion, Oxford score, patellar score, activity of daily living score, and visual analog scale of overall knee pain were not significantly different between the two groups during the follow-up period. CONCLUSION Given that PD can improve AKP and patient satisfaction at an early period postoperatively without jeopardizing clinical outcomes at no additional cost, this inexpensive procedure readily available in nearly every operation room is strongly recommended during primary TKA with patellar resurfacing.
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Affiliation(s)
- Satit Thiengwittayaporn
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Pitch Tangtrakul
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Natthapong Hongku
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Revit Tunyasuwanakul
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
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12
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Nacca DC, Amaro JT, Miyahira MKC, Novaretti JV, Astur DC, Cohen M. Comparative Study of the Function and Quality of Life of Patients Submitted to Total Knee Arthroplasty with Fixed and Mobile Tibial Platforms. Rev Bras Ortop 2020; 56:53-60. [PMID: 33627900 PMCID: PMC7895627 DOI: 10.1055/s-0040-1709989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/27/2020] [Indexed: 11/12/2022] Open
Abstract
Objective
To compare the function and quality of life of patients undergoing total knee arthroplasty (TKA) with fixed tibial platform and mobile tibial platform.
Methods
We evaluated 240 patients with knee osteoarthritis, randomized into two groups - Group A consisted of 120 patients who underwent TKA with fixed tibial platform, and the B group, consisting of 120 patients who underwent mobile platform arthroplasty. Patients were accessed according to the function and quality of life by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Short Form Health Survey (SF-36), and pain scores by visual analog scale (VAS) of pain, preoperatively and at 6 months, 1 year, 2 years, 4 years and 8 years of surgery.
Results
Regarding the various domains of the SF-36, we observed that the average behavior of functional capacity scores, physical aspects, pain and emotional aspects in the patient groups were statistically different during follow-up. The other domains of quality of life showed no mean differences. Regarding the pain assessed by VAS and WOMAC pain scores, we can see that it showed a mean change in follow-up in both patient groups. However, at 2 years of follow-up, they were statistically worse in group A, equaling group B in the other moments.
Conclusion
After 2 years of follow-up, we observed that pain scores and VAS were lower in the fixed platform group. However, these differences did not remain in the mid-term, suggesting that the mobile tibial platform arthroplasty has a short-term advantage, and may help in the rehabilitation process.
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Affiliation(s)
- Daiane Cavenaghi Nacca
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Joicemar Tarouco Amaro
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - João Victor Novaretti
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Diego Costa Astur
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Moisés Cohen
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Castellarin G, Cimino V. A simple technique to perform total knee replacement without violating the femoral canal: early clinical results on a cohort of 303 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1377-1382. [PMID: 32519070 DOI: 10.1007/s00590-020-02711-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is becoming increasingly common to find patients candidate for total knee replacement with inaccessible femoral canal due to long femoral hip stems, osteo-synthetic hardware or diaphyseal mal-unions. To treat those patients avoiding complex and expensive procedures, we developed an innovative surgical technique based on a novel device called extra-medullary alignment system. We initially employed this technique in 18 cases with inaccessible femoral canal. Early results were so encouraging that we adopted this technique also for our standard cases. MATERIALS AND METHODS We report here our findings with a first series of 303 consecutive patients performed employing this technique. All patients received a cemented cruciate-retaining mobile-bearing total knee. Patients were followed for a minimum of 2 years and evaluated employing the Knee Society Score and the Oxford questionnaire. We also recorded the surgical time and any complication occurred intra-operatively and postoperatively. Patients' X-rays were as well evaluated. RESULTS No patient was lost to follow-up. Patients group average Knee Society and Oxford scores improved, respectively, from 45 and 16 pre-op to 92 and 45 at 2-year follow-up. Those results were compared and found aligned to those reported by similar historic control groups. Prosthetic implant alignment and surgical time demonstrated to be similar the one obtained using endo-medullary-referenced instruments. In this series, we did not observe any meaningful complication. CONCLUSIONS The extra-medullary alignment system seems to be a simple and reliable technique enabling to perform total knee replacement in a truly minimal invasive manner avoiding femoral canal violation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gianluca Castellarin
- Department of Orthopaedic Surgery II, Suzzara Hospital, Via G. Cantore 14, 46029, Suzzara, Mantua, Italy.
| | - Vincenzo Cimino
- Department of Orthopaedic Surgery II, Suzzara Hospital, Via G. Cantore 14, 46029, Suzzara, Mantua, Italy
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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: 1.4] [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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Nakamura S, Shima K, Kuriyama S, Nishitani K, Ito H, Matsuda S. Tibial Tubercle-Trochlear Groove Distance Influences Patellar Tilt After Total Knee Arthroplasty. J Arthroplasty 2019; 34:3080-3087. [PMID: 31451393 DOI: 10.1016/j.arth.2019.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tibial tubercle-trochlear groove (TT-TG) distance is associated with a greater risk of recurrent patellar dislocation in young, active patients. However, the effect of TT-TG distance after total knee arthroplasty (TKA) has not been investigated. The purpose is to analyze the effect of TT-TG distance and component rotation on patellar tilt and patellar shift after TKA. METHODS After TKA, axial computed tomography scans and axial radiograph were taken in 115 consecutive knees. TT-TG distance was measured between the most anterior point of the tibial tuberosity and the deepest point of the femoral component relative to a line connecting the anterior condyles. Femoral and tibial component rotation was measured relative to the femoral and tibial rotational axis, respectively. Pearson correlation coefficients were calculated. RESULTS TT-TG distance had a significant correlation with patellar tilt in extension (R = 0.220, P = .018), patellar tilt in flexion (R = 0.438, P < .001), and patellar shift (R = 0.330, P < .001). Tibial component rotation had a significant correlation with patellar tilt in flexion (R = -0.251, P = .007) and patellar shift (R = -0.360, P < .001). Femoral component rotation had no significant correlations. Tibial component rotation had a significant correlation with TT-TG distance (R = -0.573, P < .001), whereas femoral component rotation had no correlation (P = .192). CONCLUSION TT-TG distance had a significant correlation with patellar tilt and patellar shift. Surgeons need to understand the factors affecting TT-TG distance and to pay attention to avoiding excessive TT-TG distance after TKA.
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Affiliation(s)
- Shinichiro Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Shima
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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16
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Bigoni M, Zanchi N, Turati M, Pirovano G, Zatti G, Munegato D. Short-term differences in anterior knee pain and clinical outcomes between rotating and fixed platform posterior stabilized total knee arthroplasty with a new femoral component design. World J Orthop 2019; 10:128-136. [PMID: 30918796 PMCID: PMC6428999 DOI: 10.5312/wjo.v10.i3.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare rotating versus fixed-bearing Press-Fit Condylar (PFC) Sigma posterior stabilized (PS) total knee arthroplasty (TKA) with the new “J curve” femoral design in terms of clinical outcomes and anterior knee pain.
METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed (FP group, 20 cases) or rotating platform (RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, pre-operative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Performance Score, Short Form (SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery (HSS) patellar score.
RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective (FP: 22.36; RP: 28.75; P < 0.05), HSS Patella score total (FP: 73.68; RP: 86.50; P < 0.05), and KOOS symptoms (FP: 73.49; RP: 86.44; P < 0.05).
CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.
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Affiliation(s)
- Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Nicolò Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, Grenoble-Alpes University, Grenoble 38043, France
| | - Gabriele Pirovano
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
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17
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Kim YH, Park JW, Kim JS. The Long-Term Results of Simultaneous High-Flexion Mobile-Bearing and Fixed-Bearing Total Knee Arthroplasties Performed in the Same Patients. J Arthroplasty 2019; 34:501-507. [PMID: 30503307 DOI: 10.1016/j.arth.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our study determined the long-term clinical, radiographic, and computed tomography scanning results of high-flexion mobile-bearing and fixed-bearing total knee arthroplasties (TKAs) in the same younger patients. In addition, the survivorship and complication rates of both groups were evaluated. METHODS Bilateral simultaneous sequential TKAs were performed in 164 patients (328 knees). There were 142 women and 22 men with a mean age of 63 ± 9 years (range 41-65), who received a high-flexion mobile-bearing prosthesis in one knee and a high-flexion fixed-bearing prosthesis in the other. The mean follow-up was 16.9 years (range 15-18). RESULTS At the latest follow-up, the mean Knee Society knee scores (94 ± 8 vs 95 ± 9 points, P = .7), Western Ontario and McMaster Universities Osteoarthritis Index (20 ± 11 vs 20 ± 11 points, P = 1.0), range of knee motion (125° ± 10° vs 127° ± 9°, P = .8), and University of California, Los Angeles activity scores (7.8 vs 7.8 points, P = 1.0) were below the level of clinical significance between the 2 groups. Survival rate of high-flexion mobile-bearing TKA was 98.2% and that of high-flexion fixed-bearing TKA was 97% at 16 years. No osteolysis was identified in either group. CONCLUSION After a minimum duration of follow-up of 13 years, we found no significant difference between these 2 groups with regard to functional outcome, knee motion, prevalence of osteolysis, or survivorship. This study does not clearly direct the surgeon toward either arm of treatment. Longer term follow-up is needed to prove the superiority of one type of implant over the other one.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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18
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Migliorini F, Eschweiler J, Tingart M, Rath B. Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: a meta-analysis of clinical trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:937-946. [PMID: 30649620 DOI: 10.1007/s00590-019-02370-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/04/2019] [Indexed: 01/28/2023]
Abstract
AIM A meta-analysis comparing the outcomes of patients undergoing cruciate retaining (CR) versus posterior stabilized (PS) in primary total knee arthroplasty was performed. The outcomes of interest were the Knee Society Rating System, clinical (KSCS) and functional (KSFS) subscales, joint range of motion (ROM), surgical duration and further complications (anterior knee pain, instability and revision rate). MATERIALS AND METHODS The search was conducted in July 2018, accessing the following databases: Cochrane Systematic Reviews, Scopus, PubMed, EMBASE, CINAHL, AMED and Google Scholar. We included only clinical trials level of evidence I and II. During the statistical analysis, we excluded all the studies that affect negatively the I2 test, in order to achieve more reliable results. For the methodological quality assessment we referred to the PEDro score. The risk of publication's bias was evaluated by the funnel plots across all the comparisons. RESULTS The PEDro score reported a good methodological quality assessment. The funnel plot detected a very low risk of publication's bias. We included in this study 36 articles, counting a total of 4052 patients and 4884 procedures. The mean follow-up term for both groups was 3.39 years. The ROM resulted in an overall estimate effect of 2.18° in favor of the PS group. The overall WOMAC showed a result in favor of the PS group. The overall estimate effect of the KSCS was 0.02% higher in the CR group. The KSFS showed an overall estimate effect of 2.09% in favor of the PS group. Concerning the surgical duration, the estimate effect resulted in 6.87 min shorter in the CR group. No differences were reported across the two groups regarding anterior knee pain, knee joint instability or revision rate. CONCLUSION Both the prosthetic implants provided to be a safety and feasible solution to treat end-stage knee joint degeneration. The PS implants reported improvements in the knee range of motion and a prolongation of the surgical time. No clinically relevant dissimilarities concerning the analyzed scores were evidenced. No statistically significant relevant differences in complications were detected.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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19
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Antinolfi P, Manfreda F, Placella G, Teodori J, Cerulli G, Caraffa A. The Challenge of Managing the "Third-Space" in Total Knee Arthroplasty: Review of Current Concepts. JOINTS 2018; 6:204-210. [PMID: 30582109 PMCID: PMC6301849 DOI: 10.1055/s-0038-1675845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/07/2018] [Indexed: 12/17/2022]
Abstract
Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis and it has proven to be durable and effective. Anterior knee pain (AKP) is still one of the most frequent complications after TKA, but sometimes no recognized macroscopic causes can be found. The correct treatment of patella is considered the key for a proper management of AKP. The inclusion of patellar resurfacing during TKA has been described as a potential method for the reduction of AKP. After surgeons started to resurface the patella, new complications emerged, such as component failure, instability, fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed as a good alternative to resurfacing but whether or not to resurface the patella is still a controversial topic in the literature. Therefore, patellofemoral joint is a complex critical aspect in TKA and choosing between the several options of treatment of patella could not be sufficient. In this review, evidence-based studies do not succeed in resolving this difficult argument. The accurate management of the so-called “third space” should include an accurate assessment of cartilage layers, balance of soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial components. In fact, the selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA.
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Affiliation(s)
- Pierluigi Antinolfi
- Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Manfreda
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Giacomo Placella
- Service of Orthopedics and Traumatology, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Julien Teodori
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Giuliano Cerulli
- I.R.T.A.L. Istituto di Ricerca Traslazionale Apparato Locomotore, Nicola's Foundation, Arezzo, Italy
| | - Auro Caraffa
- Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy.,Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
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20
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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: 0.6] [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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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: 3.6] [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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Napier RJ, O’Neill C, O’Brien S, Doran E, Mockford B, Boldt J, Beverland DE. A prospective evaluation of a largely cementless total knee arthroplasty cohort without patellar resurfacing: 10-year outcomes and survivorship. BMC Musculoskelet Disord 2018; 19:205. [PMID: 29945574 PMCID: PMC6020353 DOI: 10.1186/s12891-018-2128-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/10/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The theoretical benefits of a mobile bearing design in Total Knee Arthroplasty (TKA) include increased articular surface conformity with a reduction in both polyethylene wear and implant interface shear. However, to date these theoretical advantages have not been translated into published evidence of superior survivorship. This paper presents the results of a prospective, non-comparative study evaluating the performance of the mobile bearing Low Contact Stress LCS Complete Rotating Platform TKA in a largely cementless cohort without patellar resurfacing. METHODS 237 consecutive patients (240 knees) undergoing primary TKA were prospectively recruited. All received the LCS Complete Rotating Platform TKA (DePuy International, Leeds, UK). Clinical and radiographic assessments were performed at 3, 12, 60 and 120 months post-operatively. Radiographic evaluation was performed by an independent external surgeon. RESULTS The mean age was 70.3 years. 77.5% of cases were cementless. Radiographic assessment suggested excellent femoral component fixation. 22 tibial radiolucent lines (RLLs) > 1 mm were observed in 12 knees. No RLLs were progressive. There have been two revisions; one for late infection and one for aseptic loosening. No patients underwent secondary patellar resurfacing. The cumulative implant survivorship, using component revision for any reason as the endpoint, was 98.9% (95% CI, 95.6 to 99.7%) at 10 years. CONCLUSIONS The excellent survivorship at a minimum 10-year follow-up supports the use of uncemented porous coated fixation without patellar resurfacing with the non-posterior stabilized LCS Complete Rotating Platform TKA.
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Affiliation(s)
- Richard J. Napier
- Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB Northern Ireland
| | - Christopher O’Neill
- Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB Northern Ireland
| | - Seamus O’Brien
- Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB Northern Ireland
| | - Emer Doran
- Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB Northern Ireland
| | - Brian Mockford
- Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB Northern Ireland
| | - Jens Boldt
- Akutklinik Siloah, Worbstrasse 324, CH 3073 Guemligen, Switzerland
| | - David E. Beverland
- Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB Northern Ireland
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Spinout/Dislocation in Mobile-Bearing Total Knee Arthroplasty: A Report of 26 Cases. J Arthroplasty 2018; 33:537-543. [PMID: 29056307 DOI: 10.1016/j.arth.2017.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Excellent medium-term to long-term results for function and survivorship have been shown with mobile-bearing (MB) total knee arthroplasty (TKA). One of the key arguments against its use is the risk of "spinout" or dislocation of the MB. The aim of this study is to discuss the etiology, prevention, incidence, management, and outcome of spinout. METHODS Between October 1993 and February 2016, 8373 consecutive primary MB TKAs were performed irrespective of preoperative deformity. Before 2001, soft-tissue knee balancing was achieved by release of collateral ligaments and all spinouts were treated by open reduction. Thereafter, soft-tissue balancing was achieved without ligament release and with the use of a higher conformity MB and all spinouts were reduced closed, giving 2 comparative cohorts. RESULTS Twenty-six spinouts occurred in 8373 (0.31%) patients. In the first cohort up until May 2001, there were 14 spinouts of 2379 (0.58%) cases. There were 12 in cohort 2, in those patients having surgery after May 2001, thus giving an incidence of 12 of 5994 (0.2%), which was significantly lower than in cohort 1 (P < .01). Spinout was associated with the valgus knee (P < .01) and most (73%) occurred within the first 6 months. There was 1 arthrodesis in cohort 1 and 1 both-component revision in cohort 2. CONCLUSION The etiology of spinout is flexion gap instability. It can normally be reduced closed with recurrence being uncommon. Focus on soft-tissue balance necessary with an MB TKA can reduce the incidence of revision for instability as compared to a fixed-bearing TKA. Therefore, the risk of spinout should not be used as an argument against the MB TKA.
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Comparison of fixed-bearing and mobile-bearing total knee arthroplasty after high tibial osteotomy. INTERNATIONAL ORTHOPAEDICS 2017; 42:317-322. [PMID: 28667383 DOI: 10.1007/s00264-017-3540-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There is no information comparing the results of fixed-bearing total knee replacement and mobile-bearing total knee replacement in the same patients previously treated by high tibial osteotomy. The purpose was therefore to compare fixed-bearing and mobile-bearing total knee replacements in patients treated with previous high tibial osteotomy. METHODS We compared the results of 57 patients with osteoarthritis who had received a fixed-bearing prosthesis after high tibial osteotomy with the results of 41 matched patients who had received a rotating platform after high tibial osteotomy. The match was made for length of follow-up period. The mean follow-up was 17 years (range, 15-20 years). The patients were assessed clinically and radiographically. RESULTS The pre-operative knee scores had no statistically significant differences between the two groups. So was the case with the intra-operative releases, blood loss, thromboembolic complications and infection rates in either group. There was significant improvement in both groups of knees, and no significant difference was observed between the groups (i.e., fixed-bearing and mobile-bearing knees) for the mean Knee Society knee clinical score (95 and 92 points, respectively), or the Knee Society knee functional score (82 and 83 points, respectively) at the latest follow-up. However, the mean post-operative knee motion was higher for the fixed-bearing group (117° versus 110°). In the fixed-bearing group, one knee was revised because of periprosthetic fracture. In the rotating platform mobile-bearing group, one knee was revised because of aseptic loosening of the tibial component. The Kaplan-Meier survivorship for revision at ten years of follow-up was 95.2% for the fixed bearing prosthesis and 91.1% for the rotating platform mobile-bearing prosthesis. CONCLUSIONS Although we did manage to detect significant differences mainly in clinical and radiographic results between the two groups, we found no superiority or inferiority of the mobile-bearing total knee prosthesis over the fixed-bearing total knee prosthesis for patients previously operated by high tibial osteotomy.
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Feczko PZ, Jutten LM, van Steyn MJ, Deckers P, Emans PJ, Arts JJ. Comparison of fixed and mobile-bearing total knee arthroplasty in terms of patellofemoral pain and function: a prospective, randomised, controlled trial. BMC Musculoskelet Disord 2017; 18:279. [PMID: 28662692 PMCID: PMC5493003 DOI: 10.1186/s12891-017-1635-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 06/19/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite growing evidence in the literature, there is still a lack of consensus regarding the use of the mobile-bearing (MB) design total knee arthroplasty (TKA). METHODS In a prospective, comparative, randomised, single centre trial, 106 patients with end-stage osteoarthritis of the knee were randomised to either an MB or fixed-bearing (FB) group to receive posterior stabilised (PS)-TKA using a standard medial parapatellar approach and patellar resurfacing with follow-up (FU) for 5 years. The primary outcome was anterior knee pain (AKP) during the chair rise test and the stair climb test 5 years after surgery. The secondary outcome was the ability to rise from a chair and to climb stairs, range of motion (ROM), Knee Society Score (KSS), RAND-36 scores and radiological analysis of the patellar tilt. RESULTS No statistically significant difference was found between the two groups at 5 years FU in terms of median AKP during the chair rise test and the stair climb test (p = 0.5 and p = 0.8, respectively). There was no significant difference in any of the other secondary outcome parameters between the groups at 5 years FU. CONCLUSION A mobile-bearing TKA does not decrease AKP compared to fixed bearings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02892838 . LEVEL OF EVIDENCE II.
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Affiliation(s)
- P Z Feczko
- Department of Orthopaedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - L M Jutten
- Department of Orthopaedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - M J van Steyn
- Reynaert Private Hospital, Maastricht, the Netherlands
| | - P Deckers
- Department of Orthopaedic Surgery, Zuyderland Hospital, Heerlen, the Netherlands
| | - P J Emans
- Department of Orthopaedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - J J Arts
- Department of Orthopaedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
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26
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Superior-inferior position of patellar component affects patellofemoral kinematics and contact forces in computer simulation. Clin Biomech (Bristol, Avon) 2017; 45:19-24. [PMID: 28437676 DOI: 10.1016/j.clinbiomech.2017.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior knee pain has been reported as a major postoperative complication after total knee arthroplasty, which may lead to patient dissatisfaction. Rotational alignment and the medial-lateral position correlate with patellar maltracking, which can cause knee pain postoperatively. However, the superior-inferior position of the patellar component has not been investigated. The purpose of the current study was to investigate the effects of the patellar superior-inferior position on patellofemoral kinematics and kinetics. METHODS Superior, central, and inferior models with a dome patellar component were constructed. In the superior and inferior models, the position of the patellar component translated superiorly and inferiorly, respectively, by 3mm, relative to the center model. Kinematics of the patellar component, quadriceps force, and patellofemoral contact force were calculated using a computer simulation during a squatting activity in a weight-bearing deep knee bend. FINDINGS In the inferior model, the flexion angle, relative to the tibial component, was the greatest among all models. The inferior model showed an 18.0%, 36.5%, and 22.7% increase in the maximum quadriceps force, the maximum medial patellofemoral force, and the maximum lateral patellofemoral force, respectively, compared with the superior model. INTERPRETATION Superior-inferior positions affected patellofemoral kinematic and kinetics. Surgeons should avoid the inferior position of the patellar component, because the inferior positioned model showed greater quadriceps and patellofemoral force, resulting in a potential risk for anterior knee pain and component loosening.
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27
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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: 23] [Impact Index Per Article: 2.9] [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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28
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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: 0.5] [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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van Houten AH, Heesterbeek PJC, Wymenga AB. Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2656-62. [PMID: 26704792 DOI: 10.1007/s00167-015-3930-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Incidence of anterior knee pain after total knee arthroplasty (TKA) is reported to be between 4 and 49 %. The incidence of AKP at long-term follow-up and possible determinants after cruciate cruciate-retaining TKA were investigated. METHODS A 10-year follow-up of a cohort of 55 patients (63 TKAs), who received the balanSys™ cruciate-retaining total knee system (Mathys Ltd, Bettlach, Switzerland) between 1999 and 2002, was performed. Patients had undergone the balanced gap technique, with either a fixed bearing or an AP-glide bearing. Standardised diagnostic questions regarding AKP were collected and categorised into two groups: those with and without AKP. The lateral patellar tilt, patellar displacement measurement and modified Insall-Salvati ratio were used for patella position evaluation on skyline radiographs. The Knee Society Score (KSS), the Knee Osteoarthritis Outcome Score (KOOS) and Numerical Rating Scales (NRS) for pain and satisfaction were obtained at follow-up. RESULTS Sixteen patients in the study population experienced AKP. Incidence of AKP (fixed bearing 13/44; AP-glide bearing baring 3/17) was not dependent on type of insert (n.s.). There were no statistical differences in patella position and tibiofemoral contact point between the AKP group and the no AKP group (n.s.). KSS, KOOS, NRS-pain and NRS-satisfaction were significantly lower for the patients with AKP (all p < 0.05). CONCLUSION Twenty-six percentage of the patients experienced AKP 10 years after balanced gap TKA. Postoperative patella positioning was not found to be a determinant for anterior knee pain after TKA. However, patellar displacement does not seem completely favourable. Moreover, type of bearing was not found a determinant for AKP at long-term follow-up. LEVEL OF EVIDENCE Lower quality prospective cohort study (<80 % follow-up, patients enrolled at different time points in disease), Level II.
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Affiliation(s)
- Albert H van Houten
- Sint Maartenskliniek Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands.
| | | | - Ate B Wymenga
- Sint Maartenskliniek Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
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Artz NJ, Hassaballa MA, Robinson JR, Newman JH, Porteous AJ, Murray JRD. Patient Reported Kneeling Ability in Fixed and Mobile Bearing Knee Arthroplasty. J Arthroplasty 2015; 30:2159-63. [PMID: 26362784 DOI: 10.1016/j.arth.2015.06.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 06/10/2015] [Accepted: 06/25/2015] [Indexed: 02/01/2023] Open
Abstract
Kneeling is an important function of the knee joint required for many daily activities. Bearing type is thought to influence functional outcome following UKA and TKA. Self-reported kneeling ability was recorded in 471 UKA and 206 TKA patients with fixed or mobile bearing implants. Kneeling ability was recorded from the Oxford Knee Score question 7. The self-reported ability to kneel was similar in patients with fixed and mobile bearing UKA implants following surgery. In TKA, greater proportions of patients were able to kneel in the fixed compared to the mobile bearing groups up to two years after surgery indicating that self-reported kneeling ability is enhanced in fixed compared to mobile bearing TKA.
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Affiliation(s)
- Neil J Artz
- School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, United Kingdom
| | - Mo A Hassaballa
- Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - James R Robinson
- Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - John H Newman
- Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Andrew J Porteous
- Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - James R D Murray
- Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
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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: 0.9] [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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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: 2.3] [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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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: 1.9] [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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Verra WC, van den Boom LGH, Jacobs WCH, Schoones JW, Wymenga AB, Nelissen RGHH. Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty. Acta Orthop 2015; 86:195-201. [PMID: 25323799 PMCID: PMC4404770 DOI: 10.3109/17453674.2014.973329] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE To retain or to sacrifice the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) remains a matter of discussion. In this systematic review, we wanted to find differences in functional and clinical outcome between the 2 methods. METHODS We conducted a systematic review and meta-analysis including all randomized controlled trials (RCTs) and quasi-RCTs that have compared PCL retention with PCL sacrifice in TKA with a minimum of 1-year follow-up. Primary outcome was range of motion. Secondary outcomes were knee pain and clinical scoring systems that were preferably validated. Quality of evidence was graded using the GRADE approach. All outcomes available for data pooling were used for meta-analysis. RESULTS 20 studies involving 1,877 patients and 2,347 knees were included. In meta-analysis, the postoperative flexion angle had a mean difference of 2 degrees (95% CI: 0.23-4.0; p = 0.03) and the KSS functional score was 2.4 points higher in favor of PCL sacrifice (95% CI: 0.41-4.3; p = 0.02). There were no statistically significant differences regarding other measured clinical outcomes such as WOMAC, KSS pain, clinical and overall score, HSS score, SF-12, radiolucencies, femoro-tibial angle, and tibial slope. The quality of the studies varied considerably. Risk of bias in most studies was unclear; 5 were judged to have a low risk of bias and 5 to have a high risk of bias. INTERPRETATION We found no clinically relevant differences between retention and sacrifice of the PCL in TKA, in terms of functional and clinical outcomes. The quality of the studies ranged from moderate to low. Based on the current evidence, no recommendation can be made as to whether to retain or to sacrifice the PCL.
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Affiliation(s)
- Wiebe C Verra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden
| | | | - Wilco C H Jacobs
- Department of Neurosurgery, Leiden University Medical Center, Leiden
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden
| | - Ate B Wymenga
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden
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Hofstede SN, Nouta KA, Jacobs W, van Hooff ML, Wymenga AB, Pijls BG, Nelissen RGHH, Marang-van de Mheen PJ. Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 2015; 2015:CD003130. [PMID: 25650566 PMCID: PMC10960232 DOI: 10.1002/14651858.cd003130.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear whether there are differences in benefits and harms between mobile and fixed prostheses for total knee arthroplasty (TKA). The previous Cochrane review published in 2004 included two articles. Many more trials have been performed since then; therefore an update is needed. OBJECTIVES To assess the benefits and harms of mobile bearing compared with fixed bearing cruciate retaining total knee arthroplasty for functional and clinical outcomes in patients with osteoarthritis (OA) or rheumatoid arthritis (RA). SEARCH METHODS We searched The Cochrane Library, PubMed, EMBASE, CINAHL and Web of Science up to 27 February 2014, and the trial registers ClinicalTrials.gov, Multiregister, Current Controlled Trials and the World Health Organization (WHO) International Clinical Trials Registry Platform for data from unpublished trials, up to 11 February 2014. We also screened the reference lists of selected articles. SELECTION CRITERIA We selected randomised controlled trials comparing mobile bearing with fixed bearing prostheses in cruciate retaining TKA among patients with osteoarthritis or rheumatoid arthritis, using functional or clinical outcome measures and follow-up of at least six months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS We found 19 studies with 1641 participants (1616 with OA (98.5%) and 25 with RA (1.5%)) and 2247 knees. Seventeen new studies were included in this update.Quality of the evidence ranged from moderate (knee pain) to low (other outcomes). Most studies had unclear risk of bias for allocation concealment, blinding of participants and personnel, blinding of outcome assessment and selective reporting, and high risk of bias for incomplete outcome data and other bias. Knee painWe calculated the standardised mean difference (SMD) for pain, using the Knee Society Score (KSS) and visual analogue scale (VAS) in 11 studies (58%) and 1531 knees (68%). No statistically significant differences between groups were reported (SMD 0.09, 95% confidence interval (CI) -0.03 to 0.22, P value 0.15). This represents an absolute risk difference of 2.4% points higher (95% CI 0.8% lower to 5.9% higher) on the KSS pain scale and a relative percent change of 0.22% (95% CI 0.07% lower to 0.53% higher). The results were homogeneous. Clinical and functional scores The KSS clinical score did not differ statistically significantly between groups (14 studies (74%) and 1845 knees (82%)) with a mean difference (MD) of -1.06 points (95% CI -2.87 to 0.74, P value 0.25) and heterogeneous results. KSS function was reported in 14 studies (74%) with 1845 knees (82%) as an MD of -0.10 point (95% CI -1.93 to 1.73, P value 0.91) and homogeneous results. In two studies (11%), the KSS total score was favourable for mobile bearing (159 vs 132 for fixed bearing), with MD of -26.52 points (95% CI -45.03 to -8.01, P value 0.005), but with a wide 95% confidence interval indicating uncertainty about the estimate.Other reported scoring systems did not show statistically significant differences: Hospital for Special Surgery (HSS) score (seven studies (37%) in 1021 knees (45%)) with an MD of -1.36 (95% CI -4.18 to 1.46, P value 0.35); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (two studies (11%), 167 knees (7%)) with an MD of -4.46 (95% CI -16.26 to 7.34, P value 0.46); and Oxford total (five studies (26%), 647 knees (29%) with an MD of -0.25 (95% CI -1.41 to 0.91, P value 0.67). Health-related quality of lifeThree studies (16%) with 498 knees (22%) reported on health-related quality of life, and no statistically significant differences were noted between the mobile bearing and fixed bearing groups. The Short Form (SF)-12 Physical Component Summary had an MD of -1.96 (95% CI -4.55 to 0.63, P value 0.14) and heterogeneous results. Revision surgeryTwenty seven revisions (1.3%) were performed in 17 studies (89%) with 2065 knees (92%). In all, 13 knees were revised in the fixed bearing group and 14 knees in the mobile bearing group. No statistically significant differences were found (risk difference 0.00, 95% CI -0.01 to 0.01, P value 0.58), and homogeneous results were reported. MortalityIn seven out of 19 studies, 13 participants (37%) died. Two of these participants had undergone bilateral surgery, and for seven participants, it was unclear which prosthesis they had received; therefore they were excluded from the analyses. Thus our analysis included four out of 191 participants (2.1%) who had died: one in the fixed bearing group and three in the mobile bearing group. No statistically significant differences were found. The risk difference was -0.02 (95% CI -0.06 to 0.03, P value 0.49) and results were homogeneous. Reoperation ratesThirty reoperations were performed in 17 studies (89%) with 2065 knees (92%): 18 knees in the fixed bearing group (of the 1031 knees) and 12 knees in the mobile group (of the 1034 knees). No statistically significant differences were found. The risk difference was -0.01 (95% CI -0.01 to 0.01, P value 0.99) with homogeneous results. Other serious adverse eventsSixteen studies (84%) reported nine other serious adverse events in 1735 knees (77%): four in the fixed bearing group (of the 862 knees) and five in the mobile bearing group (of the 873 knees). No statistically significant differences were found (risk difference 0.00, 95% CI -0.01 to 0.01, P value 0.88), and results were homogeneous. AUTHORS' CONCLUSIONS Moderate- to low-quality evidence suggests that mobile bearing prostheses may have similar effects on knee pain, clinical and functional scores, health-related quality of life, revision surgery, mortality, reoperation rate and other serious adverse events compared with fixed bearing prostheses in posterior cruciate retaining TKA. Therefore we cannot draw firm conclusions. Most (98.5%) participants had OA, so the findings primarily reflect results reported in participants with OA. Future studies should report in greater detail outcomes such as those presented in this systematic review, with sufficient follow-up time to allow gathering of high-quality evidence and to inform clinical practice. Large registry-based studies may have added value, but they are subject to treatment-by-indication bias. Therefore, this systematic review of RCTs can be viewed as the best available evidence.
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Key Words
- humans
- knee prosthesis
- arthritis, rheumatoid
- arthritis, rheumatoid/surgery
- arthroplasty, replacement, knee
- arthroplasty, replacement, knee/adverse effects
- arthroplasty, replacement, knee/instrumentation
- arthroplasty, replacement, knee/mortality
- bias
- health status
- knee joint
- osteoarthritis, knee
- osteoarthritis, knee/surgery
- prosthesis design
- prosthesis design/methods
- quality of life
- randomized controlled trials as topic
- range of motion, articular
- reoperation
- reoperation/statistics & numerical data
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Affiliation(s)
- Stefanie N Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, Postzone J10-s, room J10-88, P.O. Box 9600, Leiden, Netherlands, 2300 RC.
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Vermesan D, Trocan I, Prejbeanu R, Poenaru DV, Haragus H, Gratian D, Marrelli M, Inchingolo F, Caprio M, Cagiano R, Tatullo M. Reduced operating time but not blood loss with cruciate retaining total knee arthroplasty. J Clin Med Res 2014; 7:171-5. [PMID: 25584102 PMCID: PMC4285063 DOI: 10.14740/jocmr2048w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/11/2022] Open
Abstract
Background There is no consensus regarding the use of retaining or replacing cruciate implants for patients with limited deformity who undergo a total knee replacement. Scope of this paper is to evaluate whether a cruciate sparing total knee replacement could have a reduced operating time compared to a posterior stabilized implant. Methods For this purpose, we performed a randomized study on 50 subjects. All procedures were performed by a single surgeon in the same conditions to minimize bias and only knees with a less than 20 varus deviation and/or maximum 15° fixed flexion contracture were included. Results Surgery time was significantly shorter with the cruciate retaining implant (P = 0.0037). The mean duration for the Vanguard implant was 68.9 (14.7) and for the NexGen II Legacy was 80.2 (11.3). A higher range of motion, but no significant Knee Society Scores at 6 months follow-up, was used as controls. Conclusions In conclusion, both implants had the potential to assure great outcomes. However, if a decision has to be made, choosing a cruciate retaining procedure could significantly reduce the surgical time. When performed under tourniquet, this gain does not lead to reduced blood loss.
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Affiliation(s)
- Dinu Vermesan
- Department of Orthopedics and Trauma, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Ilie Trocan
- Department of Orthopedics and Trauma, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Radu Prejbeanu
- Department of Orthopedics and Trauma, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Dan V Poenaru
- Department of Orthopedics and Trauma, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Horia Haragus
- Department of Orthopedics and Trauma, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | | | - Massimo Marrelli
- Calabrodental Clinic, Maxillofacial Unit, Crotone, Italy ; Marrelli Hospital, Orthopedics and Traumatology Unit, Crotone, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, Medical Faculty, University of Bari "Aldo Moro", Italy
| | - Monica Caprio
- Department of Biomedical Sciences and Human Oncology, Medical Faculty, University of Bari "Aldo Moro", Italy
| | - Raffaele Cagiano
- Department of Biomedical Sciences and Human Oncology, Medical Faculty, University of Bari "Aldo Moro", Italy ; These authors contributed equally to this research paper
| | - Marco Tatullo
- Calabrodental Clinic, Maxillofacial Unit, Crotone, Italy ; Tecnologica Research Institute, Biomedical Section, Crotone, Italy ; These authors contributed equally to this research paper
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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: 2.6] [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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Dynamic finite element analysis of mobile bearing type knee prosthesis under deep flexional motion. ScientificWorldJournal 2014; 2014:586921. [PMID: 25133247 PMCID: PMC4124825 DOI: 10.1155/2014/586921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/22/2014] [Indexed: 11/17/2022] Open
Abstract
The primary objective of this study is to distinguish between mobile bearing and fixed bearing posterior stabilized knee prostheses in the mechanics performance using the finite element simulation. Quantifying the relative mechanics attributes and survivorship between the mobile bearing and the fixed bearing prosthesis remains in investigation among researchers. In the present study, 3-dimensional computational model of a clinically used mobile bearing PS type knee prosthesis was utilized to develop a finite element and dynamic simulation model. Combination of displacement and force driven knee motion was adapted to simulate a flexion motion from 0° to 135° with neutral, 10°, and 20° internal tibial rotation to represent deep knee bending. Introduction of the secondary moving articulation in the mobile bearing knee prosthesis has been found to maintain relatively low shear stress during deep knee motion with tibial rotation.
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The Rotaglide+ total knee replacement: a comparison of mobile versus fixed bearings. Knee Surg Sports Traumatol Arthrosc 2014; 22:1626-31. [PMID: 23269476 DOI: 10.1007/s00167-012-2351-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Mobile-bearing knee replacements were introduced as an alternative to their fixed-bearing counterparts. Movement of the polyethylene insert relative to the tibial tray has been shown to decrease contact stresses, wear and polyethylene-induced osteolysis. The aim of this study is to compare outcomes between mobile and fixed-bearing surfaces of the Rotaglide+ total knee prosthesis. METHODS A prospective, partially randomised twin cohort study of 149 Rotaglide+ total knee arthroplasties performed in one unit between September 2000 and January 2005, was carried out. The patients were allocated to a mobile or fixed bearing. The patients were assessed using a pain visual analogue score (VAS), the American Knee Surgeons Score (AKSS) the range of movement, the Oxford Knee Score (OKS) and walking time. Seventy-five patients had mobile-bearing surfaces, and 74 had fixed bearings. RESULTS At 5-year follow-up, there was no significant difference between the fixed- and mobile-bearing implants with respect to range of movement [104.7(SD 17.0) vs. 103.6(SD 15.7) degrees]; AKSS [146.6(SD 23.9) vs. 144.1(SD 32.4)]; VAS [3.3(SD 1.2) vs. 3.4(SD 1.3)]; OKS [30.8(SD 9.7) vs. 29.6(SD 10.9)], respectively. CONCLUSION This study is the first of its kind to outline the medium-term (≥5 years) outcomes in Rotaglide+ total knee replacements. Its findings reinforce previous research which has shown no discernible difference in clinical outcomes between the 2 groups.
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Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22:478-99. [PMID: 23160846 DOI: 10.1007/s00167-012-2294-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 10/25/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Anterior knee pain (AKP) following total knee replacement (TKR) is both prevalent and clinically relevant. The purpose of this study was to systematically review the peer-reviewed literature, and to identify and assess the different modifiable and non-modifiable determinants that may be associated with the development of AKP in patients following primary TKR. METHODS A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Google Scholar) was performed in January 2012. The quality of the studies was assessed using the GRADE approach. RESULTS A total of 54 articles met the inclusion criteria. Variables that have been researched with regard to the prevalence of AKP include patient and knee-specific characteristics, prosthetic design, operative technique, treatment of the patella, and time of assessment. A weak correlation with AKP was found for specific retained presurgery gait patterns. A weak recommendation can be given for the use of femoral components with a posterior centre of rotation, resection of Hoffa's fat pad, patellar rim electrocautery, and preventing combined component internal rotation. The correlation between postsurgical AKP and the degree of patellar cartilage wear, tibial component bearing strategies, and patellar resurfacing is inconclusive. Due to substantial heterogeneity of the included studies, no meta-analysis was performed. CONCLUSIONS No single variable is likely to explain the differences in the reported rates of AKP, although variables leading to abnormal patellofemoral joint loading appear to be of special significance. LEVEL OF EVIDENCE III.
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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: 2.8] [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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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. [PMID: 23117166 DOI: 10.1007/s00167-012-2275-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 10/22/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the outcomes between posterior cruciate-retaining and posterior stabilized total knee arthroplasty (TKA) in order to evaluate which approach is superior. METHODS Randomized controlled trials (RCTs) comparing posterior cruciate-retaining with posterior stabilized TKA were reviewed which were published up to August 2011. Methodological quality of each included RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale. The relevant data were analysed using Review Manager 5.1. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of the evidence. RESULTS Eight RCTs involving 888 patients with 963 knee joints met predetermined inclusion criteria. The postoperative range of motion (ROM) and flexion angle were 11.07° and 2.88° higher for patients with a posterior stabilized TKA than those with a posterior cruciate-retaining TKA, respectively [weighted mean difference (WMD), -11.07; 95% confidence interval (CI), -18.06 to -4.08; p < 0.01 and WMD, -2.88; 95% CI, -5.63 to -0.12; p = 0.04]. No statistical differences were observed between the two designs for knee society pain score, extension angle, 2- and 5-year knee society score, 2- and 5-year knee society function score and complications after primary TKA. CONCLUSION Posterior cruciate-retaining and posterior stabilized TKA have similar clinical outcomes with regard to knee function, postoperative knee pain and the other complications. Prosthesis survivorship for both posterior cruciate-retaining and posterior stabilized TKA is satisfactory, and there are no differences between them at short- and middle-term follow-up. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ning Li
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China
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Breugem SJM, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN. No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc 2014; 22:509-16. [PMID: 23124601 DOI: 10.1007/s00167-012-2281-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 10/23/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE The presence of anterior knee pain remains one of the major complaints following total knee arthroplasty (TKA). Since the introduction of the mobile TKA, many studies have been performed and only a few show a slight advantage for the mobile. In our short-term follow-up study, we found less anterior knee pain in the posterior stabilized mobile knees compared to the posterior stabilized knees. The concept of self-alignment and the results from our short-term study led us to form the hypothesis that the posterior stabilized mobile knee leads to a lower incidence of anterior knee pain compared to the posterior stabilized fixed knee. This study was designed to see whether this difference remains after 7.9 years in the follow-up. A secondary line of enquiry was to see whether one was superior to the other regarding pain, function, quality of life and survival. METHODS This current report is a 6-10-year (median 7.9 years) follow-up study of the remaining 69 patients with a cemented three-component TKA for osteoarthritis in a prospective, randomized, double-blinded clinical trial. RESULTS In the posterior stabilized group, five of the 40 knees (13%) versus five of the 29 posterior stabilized mobile group (17%) experienced anterior knee pain. No differences were observed with regard to ROM, VAS, Oxford 12-item knee questionnaire, SF-36, HSS patella, Kujala or the AKSS score. Patients with anterior knee pain reported more pain, lower levels of the AKSS, HSS patella and the Kujala scores than the patients without anterior knee pain. CONCLUSION In the current clinical practice, the appearance of anterior knee pain persists as a problem; simply changing to a mobile bearing does not seem to be the solution. The posterior stabilized mobile total knee did not sustain the advantage of less anterior knee pain, compared with the posterior stabilized fixed total knee arthroplasty. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Affiliation(s)
- Stefan J M Breugem
- Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands,
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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: 1.9] [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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Jenny JY, Miehlke R, Saragaglia D, Geyer R, Mercier N, Schoenahl JY, Thiel B. Single-radius, multidirectional total knee replacement. Knee Surg Sports Traumatol Arthrosc 2013; 21:2764-9. [PMID: 22926672 DOI: 10.1007/s00167-012-2178-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 08/17/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study was designed to evaluate the mid-term (5- to 8-year) survival rate of a new total knee replacement (TKR) with a single-radius femoral component and a multidirectional, highly congruent tibial component, in comparison with an historical group (TKR with multi-radius design and fixed bearing). METHODS Four hundred and thirty patients were included, of which 369 patients (86 %) completed the 5-year follow-up with Knee Society Score evaluation and radiograph examination (study group = 387, control group = 83). RESULTS There was a significant improvement for all analysed items between pre-operative status and late follow-up. Mean knee score was 93 ± 9 points in the study group and 88 ± 16 points in the control group (p < 0.001). Mean flexion angle was not different (118 ± 11 vs. 114 ± 13 degrees). Mean functional score was 87 ± 16 points in the study group and 71 ± 24 points in the control group (p < 0.001). Survival rate at 5-year follow-up was 98.8 % (vs. 98.0 %) for mechanical revisions only, and 96.4 % (vs. 98.1 %) for all revisions. CONCLUSIONS The new TKR allowed obtaining significantly better results than the fixed-bearing TKR. These results are in line with the best series published in the current literature, but there was no evidence of any superiority of this TKR against already published standards.
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Affiliation(s)
- Jean-Yves Jenny
- Center for Orthopedic and Hand Surgery, University Hospital Strasbourg, 10 avenue Baumann, 67400, Illkirch, France,
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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: 3.8] [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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Verra WC, van den Boom LGH, Jacobs W, Clement DJ, Wymenga AAB, Nelissen RGHH. Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 2013; 2013:CD004803. [PMID: 24114343 PMCID: PMC6599815 DOI: 10.1002/14651858.cd004803.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The functional and clinical basis on which to choose whether or not to retain the posterior cruciate ligament during total knee arthroplasty surgery remained unclear after a Cochrane systematic review and meta-analysis in 2005, which contained eight clinical trials. Several new trials have been conducted since then. Hence, an update of the review was performed. OBJECTIVES Our aim was to assess the benefits and harms of retention compared to sacrifice of the posterior cruciate ligament in total knee arthroplasty in patients with osteoarthritis of the knee. SEARCH METHODS An extensive search was conducted in CENTRAL, MEDLINE (PubMed), EMBASE, Web of Science, CINAHL, Academic Search Premier, Current Contents Connect and Science Direct. All databases were searched, without any limitations, up to 6 December 2012. References of the articles were checked and citation tracking was performed. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing retention with sacrifice of the posterior cruciate ligament in primary total knee arthroplasty in patients with osteoarthritis of the knee. DATA COLLECTION AND ANALYSIS Data were collected with a pre-developed form. Risk of bias was assessed independently by two authors (WV, LB). The level of evidence was graded using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies, when possible. Subgroup analyses were performed for posterior cruciate ligament retention versus sacrifice using the same total knee arthroplasty design, and for studies using a posterior cruciate ligament retaining or posterior stabilised design, and when sufficient studies were available subgroup analyses were performed for the same brand. MAIN RESULTS Seventeen randomised controlled trials (with 1810 patients and 2206 knees) were found, described in 18 articles. Ten of these were new studies compared to the previous Cochrane Review. One study from the original Cochrane review was excluded. Most new studies compared a posterior cruciate ligament retaining design with a posterior stabilised design, in which the posterior cruciate ligament is sacrificed (a posterior stabilised design has an insert with a central post which can engage on a femoral cam during flexion).The quality of evidence (graded with the GRADE approach) and the risk of bias were highly variable, ranging from moderate to low quality evidence and with unclear or low risk of bias for most domains, respectively.The performance outcome 'range of motion' was 2.4 ° higher in favour of posterior cruciate ligament sacrifice (118.3 ° versus 115.9 °; 95% confidence interval (CI) of the difference 0.13 to 4.67; P = 0.04), however the results were heterogeneous. On the item 'knee pain' as experienced by patients, meta-analysis could be performed on the Knee Society knee pain score; this score was 48.3 in both groups, yielding no difference between the groups. Implant survival rate could not be meta-analysed adequately since randomised controlled trials lack the longer term follow-up in order to evaluate implant survival. A total of four revisions in the cruciate-retention and four revisions in the cruciate-sacrifice group were found. The well-validated Western Ontario and McMaster Universities osteoarthritis index (WOMAC) total score was not statistically significantly different between the groups (16.6 points for cruciate-retention versus 15.0 points for cruciate-sacrifice). One study reported a patient satisfaction grade (7.7 points for cruciate-retention versus 7.9 points for cruciate-sacrifice on a scale from 0 to 10, 10 being completely satisfied) which did not differ statistically significantly. Complications were distributed equally between both groups. Only one study reported several re-operations other than revision surgery; that is patella luxations, surgical manipulation because of impaired flexion.The mean functional Knee Society Score was 2.3 points higher (81.2 versus 79.0 points; 95% CI of the difference 0.37 to 4.26; P = 0.02) in the posterior cruciate ligament sacrificing group. Results from the outcome Knee Society functional score were homogeneous. All other outcome measures (extension angle, knee pain, adverse effects, clinical questionnaire scores, Knee Society clinical scores, radiological rollback, radiolucencies, femorotibial angle and tibial slope) showed no statistically significant differences between the groups. In the subgroup analyses that allowed pooling of the results of the different studies, no homogeneous statistically significant differences were identified. AUTHORS' CONCLUSIONS The methodological quality and the quality of reporting of the studies were highly variable. With respect to range of motion, pain, clinical, and radiological outcomes, no clinically relevant differences were found between total knee arthroplasty with retention or sacrifice of the posterior cruciate ligament. Two statistically significant differences were found; range of motion was 2.4 ° higher in the posterior cruciate ligament sacrificing group, however results were heterogeneous; and the mean functional Knee Society Score was 2.3 points higher in the posterior cruciate ligament sacrificing group. These differences are clinically not relevant.
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Affiliation(s)
- Wiebe C Verra
- Leiden University Medical CenterDepartment of OrthopedicsAlbinusdreef 2LeidenNetherlands2333 ZA
| | - Lennard GH van den Boom
- University Medical Center GroningenDepartment of OrthopedicsHanzeplein 1GroningenNetherlands9713 GZ
| | - Wilco Jacobs
- Leiden University Medical CenterDepartment of NeurosurgeryPO Box 9600LeidenNetherlands2300 RC
| | - Darren J Clement
- School of Medicine, University Hospital of North StraffordshireMedical Research UnitThornburrow DriveHartshillUK
| | - Ate AB Wymenga
- Sint MaartenskliniekDepartment of OrthopedicsPO Box 9011NijmegenNetherlands6500 GM
| | - Rob GHH Nelissen
- Leiden University Medical CenterDepartment of OrthopedicsAlbinusdreef 2LeidenNetherlands2333 ZA
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Châtain F, Gaillard TH, Denjean S, Tayot O. Outcomes of 447 SCORE® highly congruent mobile-bearing total knee arthroplasties after 5-10 years follow-up. Orthop Traumatol Surg Res 2013; 99:681-6. [PMID: 23988419 DOI: 10.1016/j.otsr.2013.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The goal of mobile-bearing total knee arthroplasties (TKA) with an anatomical trochlea is to reduce polyethylene wear, the risk of loosening, and patellofemoral complications. Rotating mobile-bearing SCORE(®) TKA was designed according to these principles with standard instrumentation for component placement and a specific computer navigation system, Amplivision(®). HYPOTHESIS We hypothesized that the results of SCORE(®) TKA would be satisfactory and better using computer navigation with or without patellar resurfacing and that there would be no specific patellofemoral complications associated with this trochlear design. MATERIALS AND METHODS Four hundred and forty-seven SCORE(®) TKA were performed. Outcome assessment was based on the IKS score, and component survival calculated by Kaplan-Meier analysis. RESULTS Mean follow-up was 6.6 years (maximum 10.6 years). Six percent of patients were lost to follow-up. Ninety-eight percent of the patients were satisfied or very satisfied. The IKS knee score was 89 points and the function score was 86. The mechanical axis was 180° (174-186), and it was significantly improved if the initial deformity was severe and TKA was computer navigated. There were nine revisions (one for fracture, two for pain, two for stiffness, four for infection). DISCUSSION This study confirmed our hypothesis: the results of SCORE(®) TKA were very satisfying after at least 5 years of follow-up because there was no mechanical loosening, no bearing dislocation and no patellofemoral complications with or without patellar resurfacing. Results were identical whether patellar resurfacing was performed or not. Although clinical results were not better for computer- navigated TKA, radiological results were. At 98 months of follow-up, component survival in relation to the risk of aseptic loosening or patellofemoral complications was 100%. LEVEL OF EVIDENCE Level IV continuous retrospective study.
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Affiliation(s)
- F Châtain
- Clinique des Alpes, 31, rue A.-Dumas, 38100 Grenoble, France; Clinique Belledonne, avenue G.-Péri, 38240 Saint-Martin d'Hères, France.
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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: 1.5] [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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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: 1.4] [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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