Higher Axial Tibiofemoral Rotation and Functional Outcomes with Mobile-Bearing Compared with Fixed-Bearing Total Knee Arthroplasty at 1- but Not at 2-Year Follow-Up—A Randomized Clinical Trial

Abstract

The objective of this study was to determine in vivo knee kinematics and clinical outcomes of patients who underwent fixed- and mobile-bearing total knee arthroplasty (TKA) at 1- and 2-year follow-up. This prospective double-blinded randomized controlled trial was performed from November 2011 to December 2012. A total of 64 patients were randomized to fixed- and mobile-bearing TKA groups (32 patients in each group). All patients were evaluated with the following: three-dimensional in vivo knee kinematics analysis during gait, stepping up and stepping down stair steps, and getting up from and sitting on a chair; and knee range of motion and patient-reported outcome measures (Knee Outcome Survey Activities of Daily Living Scale [KOS-ADLS] and pain visual analog scale [VAS]) at 1- and 2-year follow-up. Descriptive statistics (means, standard deviations, and percentages) were calculated for all variables. The Kolmogorov–Smirnov test was used to test if variables were normally distributed. A Student's t-test was used to compare continuous variables between patients in the two groups. The chi-square test was used to compare the groups with respect to categorical variables. The α level for statistical significance was set at p < 0.05. The mean axial tibiofemoral rotation in patients who underwent mobile-bearing TKA was significantly higher during gait (13.3 vs. 10.7), stepping up (12.8 vs. 10) stair steps, and getting up (16.1 vs. 12.1) from a chair compared with fixed-bearing TKA patients at 1-year follow-up (p < 0.05). KOS-ADLS function score was significantly higher in the mobile-bearing compared with the fixed-bearing TKA group (32 vs. 27.7) at 1-year follow-up (p < 0.05). No significant difference in kinematics and clinical outcomes between fixed- and mobile-bearing TKA groups was observed at 2-year follow-up (p > 0.05). Based on the results of this study, mobile-bearing TKA allowed a higher degree of rotation when walking, stepping up stair steps, and standing up from a chair, and had higher functional outcomes compared with fixed-bearing TKA at 1-year follow-up. However, no difference in in vivo kinematics or in clinical outcomes was observed between fixed- and mobile-bearing prostheses at 2-year follow-up.

Keywords

knee - arthroplasty - fixed-bearing prosthesis - mobile-bearing prosthesis - in vivo kinematics

• References

• 1 Aujla RS, Esler CN. Total knee arthroplasty for osteoarthritis in patients less than fifty-five years of age: a systematic review. J Arthroplasty 2017; 32 (08) 2598-2603
• 2 Walker PS, Sathasivam S. The design of guide surfaces for fixed-bearing and mobile-bearing knee replacements. J Biomech 1999; 32 (01) 27-34
• 3 D'Lima DD, Trice M, Urquhart AG, Colwell Jr CW. Tibiofemoral conformity and kinematics of rotating-bearing knee prostheses. Clin Orthop Relat Res 2001; (386) 235-242
• 4 Robinson EJ, Mulliken BD, Bourne RB, Rorabeck CH, Alvarez C. Catastrophic osteolysis in total knee replacement. A report of 17 cases. Clin Orthop Relat Res 1995; (321) 98-105
• 5 Stiehl JB, Dennis DA, Komistek RD, Crane HS. In vivo determination of condylar lift-off and screw-home in a mobile-bearing total knee arthroplasty. J Arthroplasty 1999; 14 (03) 293-299
• 6 Jones RE, Skedros JG, Chan AJ, Beauchamp DH, Harkins PC. Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis. J Arthroplasty 2001; 16 (03) 279-287
• 7 Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA 1994; 271 (17) 1349-1357
• 8 Delport HP, Banks SA, De Schepper J, Bellemans J. A kinematic comparison of fixed- and mobile-bearing knee replacements. J Bone Joint Surg Br 2006; 88 (08) 1016-1021
• 9 Rees JL, Beard DJ, Price AJ. , et al. Real in vivo kinematic differences between mobile-bearing and fixed-bearing total knee arthroplasties. Clin Orthop Relat Res 2005; (432) 204-209
• 10 Watanabe T, Tomita T, Fujii M, Hashimoto J, Sugamoto K, Yoshikawa H. Comparison between mobile-bearing and fixed-bearing knees in bilateral total knee replacements. Int Orthop 2005; 29 (03) 179-181
• 11 Nester C. The relationship between transverse plane leg rotation and transverse plane motion at the knee and hip during normal walking. Gait Posture 2000; 12 (03) 251-256
• 12 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; (Suppl. 277) 277-272
• 13 Huang CH, Liau JJ, Cheng CK. Fixed or mobile-bearing total knee arthroplasty. J Orthop Surg Res 2007; 2: 1
• 14 Ranawat CS, Komistek RD, Rodriguez JA, Dennis DA, Anderle M. In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses. Clin Orthop Relat Res 2004; (418) 184-190
• 15 Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 2003; (416) 37-57
• 16 Gonçalves RS, Cabri J, Pinheiro JP. Cross-cultural adaptation and validation of the Portuguese version of the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS). Clin Rheumatol 2008; 27 (11) 1445-1449
• 17 Breivik H. Fifty years on the Visual Analogue Scale (VAS) for pain-intensity is still good for acute pain. But multidimensional assessment is needed for chronic pain. Scand J Pain 2016; 11: 150-152
• 18 Shi K, Hayashida K, Umeda N, Yamamoto K, Kawai H. Kinematic comparison between mobile-bearing and fixed-bearing inserts in NexGen legacy posterior stabilized flex total knee arthroplasty. J Arthroplasty 2008; 23 (02) 164-169
• 19 Liu F, Ohdera T, Miyamoto H, Wasielewski RC, Komistek RD, Mahfouz MR. In vivo kinematic determination of total knee arthroplasty from squatting to standing. Knee 2009; 16 (02) 116-120
• 20 Shi X, Shen B, Yang J, Kang P, Zhou Z, Pei F. In vivo kinematics comparison of fixed- and mobile-bearing total knee arthroplasty during deep knee bending motion. Knee Surg Sports Traumatol Arthrosc 2014; 22 (07) 1612-1618
• 21 Wolterbeek N, Nelissen RG, Valstar ER. No differences in in vivo kinematics between six different types of knee prostheses. Knee Surg Sports Traumatol Arthrosc 2012; 20 (03) 559-564
• 22 Abdel MP, Tibbo ME, Stuart MJ, Trousdale RT, Hanssen AD, Pagnano MW. A randomized controlled trial of fixed- versus mobile-bearing total knee arthroplasty. Bone Joint J 2018; 100-B [phone]
• 23 Van Hamersveld KT, Marang-Van De Mheen PJ, Van Der Heide HJL, Van Der Linden-Van Der Zwaag HMJ, Valstar ER, Nelissen RGHH. Migration and clinical outcome of mobile-bearing versus fixed-bearing single-radius total knee arthroplasty. Acta Orthop 2018; 89 (02) 190-196
• 24 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 (01) 279
• 25 Hofstede SN, Nouta KA, Jacobs W. , et al. 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; (02) CD003130