Skip to main content
SpringerLink
Log in

Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Only few long-term data on ligament-balanced cruciate-retaining total knee arthroplasty (CR TKA) are currently available. Either a mobile- or fixed-bearing insert can be chosen, which showed good mid-term outcome and few complications and revisions. This multi-centre retrospective cross-sectional cohort study investigated the 12-year results of primary TKA using a balancing gap technique and compared survival and clinical outcome between fixed and mobile inserts.

Methods

In this retrospective cross-sectional cohort study, 557 cases of three clinics (2 Swiss, 1 Dutch) operated between 1998 and 2003 with the first series of a TKA implanted with a balanced gap technique (433 (77.7%) fixed, 124 (22.3%) mobile (anterior–posterior gliding (7–9 mm) and rotational (15°) degrees of freedom) inserts) were included for survival analysis (Kaplan–Meier, by insert type). At the 12-year follow-up (FU) examination of 189 cases, range of motion, knee society score (KSS), numeric rating scale (NRS) for pain and satisfaction were determined and radiographs were evaluated by median tests, by insert type.

Results

Of 521 cases available for analysis, 28 (5.4%; 11 fixed, 17 mobile bearing) were revised. Mean cumulative survival after 12.4 years was 97.0% (95% CI 94.7–98.4) for fixed bearings and 85.4% (95% CI 77.5–90.7) after 12.2 years for mobile bearings, p < 0.0001. Patients’ mean age at 11.0 years FU (n = 189) was 78.0 (range 54.5–97.3) years. Mean total KSS was 157.8 (24–200) points, and mean passive flexion was 114° (45–150); no clinical score differed significantly between fixed and mobile bearings.

Conclusion

This study showed a superior survival for fixed bearing compared with mobile bearing in a CR TKA using a ligament-balanced technique after more than 12 years. Clinical outcomes are excellent to good after long-term follow-up, and similar for fixed and mobile bearing.

Level of evidence

Therapeutic studies—retrospective cohort study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  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

    Article  CAS  PubMed  Google Scholar 

  2. Bauze AJ, Falworth MS, Oakeshott RD (2009) Early results of total knee arthroplasty with a low contact stress anteroposterior glide. J Orthop Surg 17:174–178

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Christen B, Heesterbeek P, Wymenga A, Wehrli U (2007) Posterior cruciate ligament balancing in total knee replacement: the quantitative relationship between tightness of the flexion gap and tibial translation. J Bone Joint Surg Br 89:1046–1050

    Article  CAS  PubMed  Google Scholar 

  5. Heesterbeek P, Keijsers N, Jacobs W, Verdonschot N, Wymenga A (2010) Posterior cruciate ligament recruitment affects antero-posterior translation during flexion gap distraction in total knee replacement. An intraoperative study involving 50 patients. Acta Orthop 81:471–477

    Article  PubMed  PubMed Central  Google Scholar 

  6. Heesterbeek PJC, Haffner N, Wymenga AB, Stifter J, Ritschl P (2015) Patient-related factors influence stiffness of the soft tissue complex during intraoperative gap balancing in cruciate-retaining total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc. doi:10.1007/s00167-015-3694-5

    Google Scholar 

  7. Hofstede SN, Nouta KA, Jacobs W, van Hooff ML, Wymenga AB, Pijls BG, Nelissen RGHH, Marang-van de Mheen PJ (2015) 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 2:CD003130

    Google Scholar 

  8. van Houten AH, Heesterbeek PJC, Wymenga AB (2016) Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2656–2662

    Article  PubMed  Google Scholar 

  9. Jacobs WCH, Christen B, Wymenga AB, Schuster A, van der Schaaf DB, ten Ham A, Wehrli U (2012) Functional performance of mobile versus fixed bearing total knee prostheses: a randomised controlled trial. Knee Surg Sport Traumatol Arthrosc 20:1450–1455

    Article  CAS  Google Scholar 

  10. de Jong RJ, Heesterbeek PJC, Wymenga AB (2010) A new measurement technique for the tibiofemoral contact point in normal knees and knees with TKR. Knee Surg Sports Traumatol Arthrosc 18:388–393

    Article  PubMed  Google Scholar 

  11. Kim Y-H, Park J-W, Kim J-S, Kulkarni SS, Kim Y-H (2014) Long-term clinical outcomes and survivorship of press-fit condylar sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients. J Bone Joint Surg Am 96:e168-1–e168-7

    Google Scholar 

  12. Li N, Tan Y, Deng Y, Chen L (2014) Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sport Traumatol Arthrosc 22:556–564

    Article  Google Scholar 

  13. 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 

  14. Namba RS, Inacio MCS, Paxton EW, Ake CF, Wang C, Gross TP, Marinac-Dabic D, Sedrakyan A (2012) Risk of revision for fixed versus mobile-bearing primary total knee replacements. J Bone Joint Surg Am 94:1929–1935

    Article  PubMed  Google Scholar 

  15. Paradowski PT, Bergman S, Sundén-Lundius A, Lohmander LS, Roos EM (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord. doi:10.1186/1471-2474-7-38

    PubMed  PubMed Central  Google Scholar 

  16. Rowe PJ, Myles CM, Walker C, Nutton R (2000) Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture 12:143–155

    Article  CAS  PubMed  Google Scholar 

  17. Schuster A, von Roll A, Pfluger D, Wyss T (2011) Anteroposterior stability after posterior cruciate-retaining total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc 19:1113–1120

    Article  CAS  Google Scholar 

  18. Van Der Voort P, Pijls BG, Nouta KA, Valstar ER, Jacobs WCH, Nelissen RGHH (2013) A systematic review and meta-regression of mobile-bearing versus fixed-bearing total knee replacement in 41 studies. Bone Joint J 95-B:1209–1216

    Article  PubMed  Google Scholar 

  19. Wyatt MC, Frampton C, Horne JG, Devane P (2013) 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 2:129–131

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wyss T, Schuster AJ, Christen B, Wehrli U (2008) Tension controlled ligament balanced total knee arthroplasty: 5-year results of a soft tissue orientated surgical technique. Arch Orthop Trauma Surg 128:129–135

    Article  PubMed  Google Scholar 

  21. Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX (2013) 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 95-B:1057–1063

    Article  CAS  PubMed  Google Scholar 

Download references

Authors’ contributions

PH participated in the design of the study, performed the statistical analysis and drafted the manuscript. AvH and JK carried out the follow-up of the patients and helped to draft the manuscript. HE, BC, AW, and AS conceived of the study and participated in its design and coordination. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Sint Maartenskliniek, Nijmegen, The Netherlands

    P. J. C. Heesterbeek, A. H. van Houten & A. B. Wymenga

  2. Orthopädische Klinik orthosiloah Bern-Gümligen, Bern, Switzerland

    J. S. Klenk & A. J. Schuster

  3. Regionalspital Emmental AG, Burgdorf, Switzerland

    H. Eijer

  4. Orthopädische Klinik Bern, Bern, Switzerland

    B. Christen

Authors
  1. P. J. C. Heesterbeek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. H. van Houten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. S. Klenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Eijer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Christen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. B. Wymenga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. J. Schuster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. J. C. Heesterbeek.

Ethics declarations

Conflict of interest

The institutions of the authors received a research grant from Mathys Ltd for performing the study. Mathys Ltd had no role in the conduct, analysis and presentation of the results.

Funding

This study was partly funded by Mathys Ltd (Institutional research grant).

Ethical approval

All procedures performed in our study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Heesterbeek, P.J.C., van Houten, A.H., Klenk, J.S. et al. Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26, 1524–1531 (2018). https://doi.org/10.1007/s00167-017-4542-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4542-6

Keywords

Search

Navigation