Elliot Sappey-Marinier1, Felipe Galvão A de Abreu2,3, Padhraig O'Loughlin4, Romain Gaillard2, Philippe Neyret5, Sebastien Lustig2,6, Elvire Servien2,7. 1. 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. esappey@gmail.com. 2. 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. 3. Orthopaedic Department, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. 4. Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland. 5. Clinique Genolier, 3 route du muids, 1272, Genolier, Switzerland. 6. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France. 7. LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France.
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 amobile-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.
RCT Entities:
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.
Entities:
Keywords:
Fixed bearing; Mobile bearing; Patellar position; Total knee arthroplasty; Total knee replacement
Authors: Mark W Pagnano; Robert T Trousdale; Michael J Stuart; Arlen D Hanssen; David J Jacofsky Journal: Clin Orthop Relat Res Date: 2004-11 Impact factor: 4.176
Authors: David J Wood; Anne J Smith; Dermot Collopy; Bruce White; Boris Brankov; Max K Bulsara Journal: J Bone Joint Surg Am Date: 2002-02 Impact factor: 5.284
Authors: Sani Erak; Vaishnav Rajgopal; Steven J Macdonald; Richard W McCalden; Robert B Bourne Journal: Clin Orthop Relat Res Date: 2009-04-04 Impact factor: 4.176
Authors: David H Dejour; Jacobus H Müller; Mo Saffarini; Michel Timoteo; Pierre Chambat; Gerard Deschamps; Michel P Bonnin Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-03-04 Impact factor: 4.342