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.

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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.