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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(05): s00451814104
DOI: 10.1055/s-0045-1814104
Original Article

Mobile-Bearing versus Fixed-Bearing Total Knee Arthroplasty: A Comparative Analysis of Long-Term Clinical and Implant Survival Outcomes

Artroplastia total do joelho com plataforma móvel versus plataforma fixa: Uma análise comparativa dos desfechos clínicos de longo prazo e de sobrevida do implante

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Abstract

Objective

The present study compared clinical outcomes, implant survival, and axial mobility between mobile-bearing (MB) and fixed-bearing (FB) prostheses in patients with medial knee osteoarthritis.

Methods

A retrospective cohort study of 1,289 patients who underwent primary cemented total knee arthroplasty (TKA) from 2003 to 2022 was conducted. Mobile-bearing prostheses were used in 820 patients (mean follow-up: 8.1 years), and FB in 469 patients (mean follow-up: 15.2 years). Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Kujala scores. Range of motion and axial tibial rotation were clinically evaluated. Statistical tests included analysis of variance, t-tests, and Fisher's F-test (significance p < 0.05).

Results

Both groups showed significant functional improvement (p < 0.001). At the final follow-up, no significant differences were found between MB and FB in the IKDC or Kujala scores. Implant survival was 96.3% (MB) versus 95.7% (FB) (p = 0.67). Axial tibial rotation was significantly higher in MB (23.1 ± 4.5°) than in FB (19.4 ± 4.2°) (p = 0.003). No bearing dislocations occurred.

Conclusion

Mobile-bearing and FB designs offer durable functional benefits. Although MB provided greater axial mobility, it did not result in superior functional outcomes or implant longevity. Prosthesis selection should be tailored to individual patient needs, surgeon preference, and cost. Further prospective studies are needed to define the clinical relevance of enhanced kinematics.

Resumo

Objetivo

Este estudo comparou os desfechos clínicos, a sobrevida do implante e a mobilidade axial entre próteses de plataforma móvel (PM) e de plataforma fixa (PF) em pacientes com osteoartrite medial do joelho.

Métodos

Foi realizado um estudo de coorte retrospectivo de 1.289 pacientes submetidos à artroplastia total cimentada primária do joelho (ATJ) entre 2003 e 2022. As próteses PM foram utilizadas em 820 pacientes (seguimento médio de 8,1 anos) e as PF em 469 pacientes (seguimento médio de 15,2 anos). Os desfechos funcionais foram avaliados com os escores International Knee Documentation Committe (IKDC) e Kujala. A amplitude de movimento e a rotação axial da tíbia foram avaliadas clinicamente. Os testes estatísticos incluíram análise de variância, testes t e F de Fisher (significância de p < 0,05).

Resultados

Ambos os grupos apresentaram melhora funcional significativa (p < 0,001). No seguimento final, não foram encontradas diferenças significativas entre PM e PF nos escores IKDC ou Kujala. A sobrevida do implante foi de 96,3% (PM) versus 95,7% (PF) (p = 0,67). A rotação tibial axial foi significativamente maior em PM (23,1 ± 4,5°) do que em PF (19,4 ± 4,2°) (p = 0,003). Não ocorreram deslocamentos da plataforma.

Conclusão

Os modelos PM e PF oferecem benefícios funcionais duráveis. Embora a PM tenha proporcionado maior mobilidade axial, ela não resultou em desfechos funcionais superiores ou longevidade do implante. A seleção da prótese deve ser adaptada às necessidades individuais do paciente, à preferência do cirurgião e ao custo. Mais estudos prospectivos são necessários para definir a relevância clínica da cinemática aprimorada.

Keywords

arthroplasty, replacement, knee - knee joint - knee prosthesis - prosthesis design

Palavras-chave

articulação do joelho - artroplastia do joelho - desenho de prótese - prótese do joelho

Data Availability

Data will be available upon request to the corresponding author.


Authors' Contributions

Each author contributed individually and significantly to the development of this article: PARG: validation, visualization, writing – original draft, writing – review and editing; PDRM: validation, visualization, writing – original draft, research; CPPC: conceptualization, research, methodology, validation, visualization, writing – original draft, writing – revision and editing; FEU: conceptualization, data curation, formal analysis, research, methodology, validation, visualization, writing – original draft, writing – revision and editing; DARM: validation, visualization, writing – original draft, research; AXBC: validation, visualization, writing – original draft, research.


Financial Support

The authors declare that they did not receive financial support from agencies in the public, private, or nonprofit sectors to conduct the present study.


Work developed at Clínica Arthros, Quito, Ecuador.




Publication History

Received: 20 June 2025

Accepted: 30 September 2025

Article published online:
22 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Pablo Agustín Ramos Guarderas, Pablo David Ramos Murillo, Carlos Patricio Peñaherrera Carrillo, Francisco Endara Urresta, Daniel Alejandro Ramos Murillo, Alejandro Xavier Barros Castro. Mobile-Bearing versus Fixed-Bearing Total Knee Arthroplasty: A Comparative Analysis of Long-Term Clinical and Implant Survival Outcomes. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451814104.
DOI: 10.1055/s-0045-1814104