Comparison of ultra-congruent mobile- and fixed-bearing navigation-assisted total knee arthroplasty with minimum 5-year follow-up



The purpose of this study was to compare the midterm outcomes between fixed and mobile ultra-congruent (UC) bearings in total knee arthroplasty (TKA).


This is a retrospective matched-pairs case–control study of patients who underwent primary navigation-assisted TKA with a minimum 5-year follow-up. A total of 182 cases involved the fixed UC bearing system as Group 1 and 101 cases involved mobile UC bearing system group as Group 2. After 1:1 matching, 73 knees in each group were enrolled. Clinical and radiographic outcomes were evaluated.


The overall survival was 143 of 146 cases (97.9 %) at final follow-up, and 72 of 73 cases (96.3 %) in Group 1 and 71 of 73 cases (95.8 %) in Group 2 at final follow-up based on an endpoint of revision surgery. The reasons of revision TKA were periprosthetic fracture in Group 1, infection and bearing dislocation in Group 2. There was no statistical difference in Hospital for Special Surgery (HSS) scores, Knee Society Scores (KSS), WOMAC index score evaluations between groups.


This study demonstrated that the fixed-bearing UC prosthesis could provide satisfactory performance compared with that of the mobile-bearing UC prosthesis with minimum 5-year follow-up. The fixed-bearing UC prosthesis could be considered in navigation-assisted TKA with theoretical advantages of UC design.

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  1. 1.

    Bailey O, Ferguson K, Crawfurd E, James P, May PA, Brown S, Blyth M, Leach WJ (2015) No clinical difference between fixed- and mobile-bearing cruciate-retaining total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 23:1653–1659

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89:261–269

    PubMed  Google Scholar 

  3. 3.

    Bistolfi A, Lee GC, Deledda D, Rosso F, Berchialla P, Crova M, Massazza G (2014) NexGen LPS mobile bearing total knee arthroplasty: 10-year results. Knee Surg Sports Traumatol Arthrosc 22:1786–1792

    Article  PubMed  Google Scholar 

  4. 4.

    Blunn GW, Joshi AB, Minns RJ, Lidgren L, Lilley P, Ryd L, Engelbrecht E, Walker PS (1997) Wear in retrieved condylar knee arthroplasties. A comparison of wear in different designs of 280 retrieved condylar knee prostheses. J Arthroplasty 12:281–290

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Carothers JT, Kim RH, Dennis DA, Southworth C (2011) Mobile-bearing total knee arthroplasty: a meta-analysis. J Arthroplasty 26:537–542

    Article  PubMed  Google Scholar 

  6. 6.

    Chavoix JB (2013) Functionality and safety of an ultra-congruent rotating platform knee prosthesis at 5.6 years: more than 5-year follow-up of the e.motion UC-TKA. Open Orthop J 7:152–157

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Cheng T, Pan XY, Mao X, Zhang GY, Zhang XL (2012) Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up. Knee 19:237–245

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Cheng T, Zhang G, Zhang X (2011) Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res 171:590–600

    Article  PubMed  Google Scholar 

  9. 9.

    Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 20:1307–1322

    Article  PubMed  Google Scholar 

  10. 10.

    Cho SD, Youm YS, Park KB (2011) Three- to six-year follow-up results after high-flexion total knee arthroplasty: can we allow passive deep knee bending? Knee Surg Sports Traumatol Arthrosc 19:899–903

    Article  PubMed  Google Scholar 

  11. 11.

    Dennis DA, Komistek RD (2006) Mobile-bearing total knee arthroplasty: design factors in minimizing wear. Clin Orthop Relat Res 452:70–77

    Article  PubMed  Google Scholar 

  12. 12.

    Dennis DA, Komistek RD, Mahfouz MR, Outten JT, Sharma A (2005) Mobile-bearing total knee arthroplasty: do the polyethylene bearings rotate? Clin Orthop Relat Res 440:88–95

    Article  PubMed  Google Scholar 

  13. 13.

    Engh GA, Zimmerman RL, Parks NL, Engh CA (2009) Analysis of wear in retrieved mobile and fixed bearing knee inserts. J Arthroplasty 24:28–32

    Article  PubMed  Google Scholar 

  14. 14.

    Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Google Scholar 

  15. 15.

    Geiger F, Mau H, Kruger M, Thomsen M (2008) Comparison of a new mobile-bearing total knee prosthesis with a fixed-bearing prosthesis: a matched pair analysis. Arch Orthop Trauma Surg 128:285–291

    Article  PubMed  Google Scholar 

  16. 16.

    Goebel D, Schultz W (2012) The Columbus Knee System: 4-year results of a new deep flexion design compared to the NexGen full flex implant. Arthritis 2012:213817

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Grupp TM, Kaddick C, Schwiesau J, Maas A, Stulberg SD (2009) Fixed and mobile bearing total knee arthroplasty—influence on wear generation, corresponding wear areas, knee kinematics and particle composition. Clin Biomech (Bristol, Avon) 24:210–217

    CAS  Article  Google Scholar 

  18. 18.

    Hakki S, Saleh KJ, Potty AG, Bilotta V, Oliveira D (2013) Columbus navigated TKA system: clinical and radiological results at a minimum of 5 years with survivorship analysis. Orthopedics 36:e308–e318

    Article  PubMed  Google Scholar 

  19. 19.

    Han HS, Kang SB, Yoon KS (2007) High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br 89:1457–1461

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Hilding MB, Lanshammar H, Ryd L (1996) Knee joint loading and tibial component loosening. RSA and gait analysis in 45 osteoarthritic patients before and after TKA. J Bone Joint Surg Br 78:66–73

    CAS  PubMed  Google Scholar 

  21. 21.

    Hofmann AA, Tkach TK, Evanich CJ, Camargo MP (2000) Posterior stabilization in total knee arthroplasty with use of an ultracongruent polyethylene insert. J Arthroplasty 15:576–583

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Iosifidis M, Iliopoulos E, Neofytou D, Sakorafas N, Andreou D, Alvanos D, Kyriakidis A (2014) The Rotaglide mobile-bearing total knee arthroplasty: no difference between cemented and hybrid implantation. Knee Surg Sports Traumatol Arthrosc 22:1843–1848

    Article  PubMed  Google Scholar 

  23. 23.

    Ko YB, Jang EC, Park SM, Kim SH, Kwak YH, Lee HJ (2015) No difference in clinical and radiologic outcomes after total knee arthroplasty with a new ultra-congruent mobile bearing system and rotating platform mobile bearing systems after minimum 5-year follow-up. J Arthroplasty 30:379–383

    Article  PubMed  Google Scholar 

  24. 24.

    Kwak JY, Jeong JH, Lee SH, Jung HJ, Jung YB (2012) Comparison of the clinical outcomes after total knee arthroplasty with the LCS rotating platform mobile bearing knee system and the PFC Sigma RP-F mobile bearing knee system. Clin Orthop Surg 4:256–262

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Laskin RS, Maruyama Y, Villaneuva M, Bourne R (2000) Deep-dish congruent tibial component use in total knee arthroplasty: a randomized prospective study. Clin Orthop Relat Res 380:36–44

    Article  Google Scholar 

  26. 26.

    Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19:2027–2032

    Article  PubMed  Google Scholar 

  27. 27.

    Marques CJ, Daniel S, Sufi-Siavach A, Lampe F (2015) No differences in clinical outcomes between fixed- and mobile-bearing computer-assisted total knee arthroplasties and no correlations between navigation data and clinical scores. Knee Surg Sports Traumatol Arthrosc 23:1660–1668

    Article  PubMed  Google Scholar 

  28. 28.

    Massin P, Boyer P, Sabourin M (2012) Less femorotibial rotation and AP translation in deep-dished total knee arthroplasty. An intraoperative kinematic study using navigation. Knee Surg Sports Traumatol Arthrosc 20:1714–1719

    Article  PubMed  Google Scholar 

  29. 29.

    Meftah M, Ranawat AS, Ranawat CS (2012) Ten-year follow-up of a rotating-platform, posterior-stabilized total knee arthroplasty. J Bone Joint Surg Am 94:426–432

    Article  PubMed  Google Scholar 

  30. 30.

    Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64

    Google Scholar 

  31. 31.

    Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171

    Article  Google Scholar 

  32. 32.

    Peters CL, Mulkey P, Erickson J, Anderson MB, Pelt CE (2014) Comparison of total knee arthroplasty with highly congruent anterior-stabilized bearings versus a cruciate-retaining design. Clin Orthop Relat Res 472:175–180

    Article  PubMed  Google Scholar 

  33. 33.

    Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 85-a:1278–1285

    Article  PubMed  Google Scholar 

  34. 34.

    Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835

    CAS  PubMed  Google Scholar 

  35. 35.

    Vanlommel J, Luyckx JP, Labey L, Innocenti B, De Corte R, Bellemans J (2011) Cementing the tibial component in total knee arthroplasty: which technique is the best? J Arthroplasty 26:492–496

    Article  PubMed  Google Scholar 

  36. 36.

    Wajsfisz A, Biau D, Boisrenoult P, Beaufils P (2010) Comparative study of intraoperative knee flexion with three different TKR designs. Orthop Traumatol Surg Res 96:242–248

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Yau WP, Chiu KY, Tang WM, Ng TP (2005) Residual posterior femoral condyle osteophyte affects the flexion range after total knee replacement. Int Orthop 29:375–379

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Youm YS, Cho SD, Lee SH, Cho HY (2014) Total knee arthroplasty using a posterior cruciate ligament sacrificing medial pivot knee: minimum 5-year follow-up results. Knee Surg Relat Res 26:135–140

    Article  PubMed  PubMed Central  Google Scholar 

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This research was supported by the Aesculap AG, Tuttlingen, Germany.

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Correspondence to Han-Jun Lee.

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Kim, S.H., Lim, J., Ko, Y. et al. Comparison of ultra-congruent mobile- and fixed-bearing navigation-assisted total knee arthroplasty with minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 24, 3466–3473 (2016).

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  • Total knee arthroplasty
  • Ultra-congruent bearing
  • Navigation system
  • Mobile bearing
  • Fixed bearing