N Poirier1, P Graf2, F Dubrana3. 1. 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. Electronic address: nicolas.poirier@chu-brest.fr. 2. Clinique Pasteur-Lanroze, 32, rue Auguste-Kervern, 29200 Brest, France. 3. 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.
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.
RCT Entities:
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.