Download PDF
J Knee Surg 2022; 35(02): 135-144
DOI: 10.1055/s-0040-1713356
Original Article

Mobile Bearing versus Fixed Bearing for Total Knee Arthroplasty: Meta-analysis of Randomized Controlled Trials at Minimum 10-Year Follow-up

Pu Chen
1   Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
,
Liuwei Huang
2   Department of Nephrology, NanFang Hospital, Sourthern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
,
Dong Zhang
1   Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
,
Xiaozhe Zhang
1   Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
,
Yufeng Ma
1   Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
,
Qingfu Wang
1   Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
› Author Affiliations Funding This work was supported by the National Natural Science Foundation of China (General Program) (No.81373662) and Capacity building project of Chinese and western medicine clinical collaboration on major difficult disease in 2019.
› Further Information
    Permissions and Reprints

Abstract

This meta-analysis aimed to compare the clinical and radiographic outcomes between mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing total knee arthroplasty (FB-TKA) at a minimum 10-year follow-up. PubMed, EMBASE, and Cochrane databases were searched. All included articles were evaluated by two trained reviewers according to the guidelines of the Cochrane Collaboration Handbook for potential risk, and the Consolidated Standards on Reporting Trials (CONSORT) checklist and scoring system was also used to assess the methodological quality of each study. The extracted data included function scores, range of motion (ROM) of the knee, incidence of adverse events or revision, survivorship analysis, and radiographic outcomes. Seven randomized controlled trials (RCTs) were included in this meta-analysis, and all RCTs had a follow-up period longer than 10 years. This meta-analysis shows no significant difference between the two groups with respect to the Keen Society Score (KSS; p = 0.38), KSS function score (p = 0.30), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC; p = 0.59), ROM (p = 0.71), radiolucent line (p = 0.45), femoral and tibial component positions in the coronal plane (p = 0.55 and 0.35, respectively), revision incidence (p = 0.77), and survivorship rates (p = 0.39). Meanwhile, it showed a slight difference between the two groups in the tibial component position in the sagittal plane (p = 0.003). According to this meta-analysis, the current best available evidence suggests no significant difference between the MB-TKA and FB-TKA groups with respect to the clinical outcomes, radiographic outcomes, revision, and survivorship at a minimum 10-year follow-up. This is a Level II, meta-analysis study.

Keywords

mobile bearing - fixed bearing - total knee arthroplasty - randomized controlled trials - meta-analysis

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


Authors' Contributions

Study design: P.C., L.H., Q.W.; article search: P.C., Y.M.; date extraction: P.C., L.H.; table-form making: D.Z., X.Z.; article writing: P.C., L.H.; final decision: Q.W.




Publication History

Received: 26 April 2019

Accepted: 02 May 2020

Article published online:
26 June 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol 2014; 28 (01) 5-15
    CrossrefPubMedGoogle Scholar
  • 2 Jevsevar DS, Brown GA, Jones DL. et al; American Academy of Orthopaedic Surgeons. The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J Bone Joint Surg Am 2013; 95 (20) 1885-1886
    CrossrefPubMedGoogle Scholar
  • 3 Kim YH, Park JW, Kim JS. Comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties-a prospective randomized study. J Arthroplasty 2018; 33 (01) 130-135
    CrossrefPubMedGoogle Scholar
  • 4 Maniar RN, Singhi T, Maniar PR, Kumar V. Ten- to 13-year results of mobile bearing posterior-stabilized rotating-platform knee implants, reported by nondesigner surgeon. J Arthroplasty 2017; 32 (03) 830-835
    CrossrefPubMedGoogle Scholar
  • 5 Ulivi M, Orlandini L, Meroni V, Consonni O, Sansone V. Survivorship at minimum 10-year follow-up of a rotating-platform, mobile-bearing, posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (06) 1669-1675
    CrossrefPubMedGoogle Scholar
  • 6 Mouttet A, Louis ML, Sourdet V. The EUROP total knee prosthesis: a ten-year follow-up study of a posterior cruciate-retaining design. Orthop Traumatol Surg Res 2011; 97 (06) 639-647
    CrossrefPubMedGoogle Scholar
  • 7 Dixon MC, Brown RR, Parsch D, Scott RD. Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years. J Bone Joint Surg Am 2005; 87 (03) 598-603
    CrossrefPubMedGoogle Scholar
  • 8 Powell AJ, Crua E, Chong BC. et al. A randomized prospective study comparing mobile-bearing against fixed-bearing PFC Sigma cruciate-retaining total knee arthroplasties with ten-year minimum follow-up. Bone Joint J 2018; 100-B (10) 1336-1344
    CrossrefPubMedGoogle Scholar
  • 9 Bhan S, Malhotra R, Kiran EK, Shukla S, Bijjawara M. A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years. J Bone Joint Surg Am 2005; 87 (10) 2290-2296
    PubMedGoogle Scholar
  • 10 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
    CrossrefPubMedGoogle Scholar
  • 11 Amaro JT, Novaretti JV, Astur DC. et al. 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. J Knee Surg 2020; 33 (05) 474-480
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Dennis DA, Komistek RD. Mobile-bearing total knee arthroplasty: design factors in minimizing wear. Clin Orthop Relat Res 2006; 452 (452) 70-77
    CrossrefPubMedGoogle Scholar
  • 13 Vertullo CJ, Easley ME, Scott WN, Insall JN. Mobile bearings in primary knee arthroplasty. J Am Acad Orthop Surg 2001; 9 (06) 355-364
    CrossrefPubMedGoogle Scholar
  • 14 Kim YH, Park JW, Kim JS. The long-term results of simultaneous high-flexion mobile-bearing and fixed-bearing total knee arthroplasties performed in the same patients. J Arthroplasty 2019; 34 (03) 501-507
    CrossrefPubMedGoogle Scholar
  • 15 Kim YH, Kim JS, Choe JW, Kim HJ. Long-term comparison of fixed-bearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am 2012; 94 (10) 866-873
    CrossrefPubMedGoogle Scholar
  • 16 Woolson ST, Epstein NJ, Huddleston JI. Long-term comparison of mobile-bearing vs fixed-bearing total knee arthroplasty. J Arthroplasty 2011; 26 (08) 1219-1223
    CrossrefPubMedGoogle Scholar
  • 17 Radetzki F, Wienke A, Mendel T, Gutteck N, Delank KS, Wohlrab D. High flex total knee arthroplasty--a prospective, randomized study with results after 10 years. Acta Orthop Belg 2013; 79 (05) 536-540
    PubMedGoogle Scholar
  • 18 Pijls BG, Valstar ER, Kaptein BL, Nelissen RG. Differences in long-term fixation between mobile-bearing and fixed-bearing knee prostheses at ten to 12 years' follow-up: a single-blinded randomised controlled radiostereometric trial. J Bone Joint Surg Br 2012; 94 (10) 1366-1371
    CrossrefPubMedGoogle Scholar
  • 19 Wyatt MC, Frampton C, Horne JG, Devane P. Mobile- versus fixed-bearing modern total knee replacements- which is the more patella-friendly design?: The 11-year New Zealand Joint Registry study. Bone Joint Res 2013; 2 (07) 129-131
    CrossrefPubMedGoogle Scholar
  • 20 Choi NY, In Y, Bae JH, Do JH, Chung SJ, Koh IJ. Are midterm patient-reported outcome measures between rotating-platform mobile-bearing prosthesis and medial-pivot prosthesis different? A minimum of 5-year follow-up study. J Arthroplasty 2017; 32 (03) 824-829
    CrossrefPubMedGoogle Scholar
  • 21 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
    CrossrefPubMedGoogle Scholar
  • 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: a follow-up at a mean of ten years. Bone Joint J 2018; 100-B (07) 925-929
    CrossrefPubMedGoogle Scholar
  • 23 Nieuwenhuijse MJ, van der Voort P, Kaptein BL, van der Linden-van der Zwaag HM, Valstar ER, Nelissen RG. Fixation of high-flexion total knee prostheses: five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study. J Bone Joint Surg Am 2013; 95 (19) e1411-e11
    CrossrefPubMedGoogle Scholar
  • 24 Kalisvaart MM, Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD. Randomized clinical trial of rotating-platform and fixed-bearing total knee arthroplasty: no clinically detectable differences at five years. J Bone Joint Surg Am 2012; 94 (06) 481-489
    CrossrefPubMedGoogle Scholar
  • 25 Heesterbeek PJC, van Houten AH, Klenk JS. et al. Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (05) 1524-1531
    CrossrefPubMedGoogle Scholar
  • 26 Moskal JT, Capps SG. Rotating-platform TKA no different from fixed-bearing TKA regarding survivorship or performance: a meta-analysis. Clin Orthop Relat Res 2014; 472 (07) 2185-2193
    CrossrefPubMedGoogle Scholar
  • 27 Fransen BL, van Duijvenbode DC, Hoozemans MJM, Burger BJ. No differences between fixed- and mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1757-1777
    CrossrefPubMedGoogle Scholar
  • 28 Li YL, Wu Q, Ning GZ. et al. No difference in clinical outcome between fixed- and mobile-bearing TKA: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (03) 565-575
    CrossrefPubMedGoogle Scholar
  • 29 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
    PubMedGoogle Scholar
  • 30 Bo ZD, Liao L, Zhao JM, Wei QJ, Ding XF, Yang B. Mobile bearing or fixed bearing? A meta-analysis of outcomes comparing mobile bearing and fixed bearing bilateral total knee replacements. Knee 2014; 21 (02) 374-381
    CrossrefPubMedGoogle Scholar
  • 31 Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX. Is there reduced polyethylene wear and longer survival when using a mobile-bearing design in total knee replacement? A meta-analysis of randomised and non-randomised controlled trials. Bone Joint J 2013; 95-B (08) 1057-1063
    CrossrefPubMedGoogle Scholar
  • 32 Cheng M, Chen D, Guo Y, Zhu C, Zhang X. Comparison of fixed- and mobile-bearing total knee arthroplasty with a mean five-year follow-up: A meta-analysis. Exp Ther Med 2013; 6 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 33 van der Voort P, Pijls BG, Nouta KA, Valstar ER, Jacobs WC, Nelissen RG. A systematic review and meta-regression of mobile-bearing versus fixed-bearing total knee replacement in 41 studies. Bone Joint J 2013; 95-B (09) 1209-1216
    CrossrefPubMedGoogle Scholar
  • 34 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    CrossrefPubMedGoogle Scholar
  • 35 Chen P, Huang L, Ma Y. et al. Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. J Orthop Surg Res 2019; 14 (01) 385
    CrossrefPubMedGoogle Scholar
  • 36 Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. CONSORT Group. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008; 148 (04) 295-309
    CrossrefPubMedGoogle Scholar
  • 37 Smith H, Jan M, Mahomed NN, Davey JR, Gandhi R. Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty 2011; 26 (08) 1205-1213
    CrossrefPubMedGoogle Scholar
  • 38 Wen Y, Liu D, Huang Y, Li B. A meta-analysis of the fixed-bearing and mobile-bearing prostheses in total knee arthroplasty. Arch Orthop Trauma Surg 2011; 131 (10) 1341-1350
    CrossrefPubMedGoogle Scholar