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No difference in patellar position between mobile-bearing and fixed-bearing total knee arthroplasty for medial osteoarthritis: a prospective randomized study

Abstract

Purpose

Total knee arthroplasty (TKA) is the treatment of choice for severe osteoarthritis of the knee. Many studies have been performed comparing mobile- and fixed-bearing designs; however, there are insufficient data regarding the patellar position in either system. This study aimed to compare the resultant patellar position with a mobile- versus a fixed-bearing TKA and the influence of both designs on clinical outcomes.

Materials and methods

In this prospective randomized study, between 2007 and 2009, 160 TKA patients were assessed; 79 received a mobile-bearing and 81 received a fixed-bearing implant, for medial compartment osteoarthritis. A posteriorly stabilized, HLS Noetos knee prosthesis (Tornier, Saint-Ismier, France) was used in all cases. The only difference between the groups was whether the tibial component incorporated a fixed or mobile bearing. The patella was resurfaced in all cases. The International Knee Society Score (KSS) and the patellar tilt and translation were compared post-operatively. Patellar translation and patellar tilt analyses were subdivided into two subgroups (< 5 mm vs > 5 mm and < 5° vs > 5°).

Results

The KSS was not statistically different between the groups at a mean follow-up of 7.4 years (range 5–11 years). Patellar translation and patellar tilt were not statistically different between the groups. When considering the patellar translation subgroup analysis, a significantly increased risk of patellar translation, greater than 5 mm, was found in the mobile-bearing group compared to fixed-bearing group (OR = 2.3; p = 0.048) without generating any meaningful difference in clinical outcomes.

Conclusion

The theoretical advantages of mobile-bearing implants compared to fixed-bearing implants were not demonstrated in this randomized study, at mid-term follow-up. In daily practice, the choice between mobile-bearing and fixed-bearing designs should be based on the experience and clinical judgment of the surgeon.

Level of evidence

Prospective randomized study, level I.

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References

  1. Abdel MP, Tibbo ME, Stuart MJ, Trousdale RT, Hanssen AD, Pagnano MW (2018) A randomized controlled trial of fixed- versus mobile-bearing total knee arthroplasty. Bone Joint J 100(B):925–929

    PubMed  Google Scholar 

  2. Aglietti P, Baldini A, Buzzi R, Lup D, De Luca L (2005) Comparison of mobile-bearing and fixed-bearing total knee arthroplasty: a prospective randomized study. J Arthroplasty 20:145–153

    PubMed  Google Scholar 

  3. Arbuthnot JE, McNicholas MJ, McGurty DW, Rowley DI (2004) Total knee replacement and patellofemoral pain. Surgeon 2:230–233

    CAS  PubMed  Google Scholar 

  4. Barrack RL, Wolfe MW, Waldman DA, Milicic M, Bertot AJ, Myers L (1997) Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study. J Bone Joint Surg Am 79:1121–1131

    CAS  PubMed  Google Scholar 

  5. Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop 392:46–55

    Google Scholar 

  6. Beard DJ, Pandit H, Price AJ, Butler-Manuel PA, Dodd CAF, Murray DW, Goodfellow JW (2007) Introduction of a new mobile-bearing total knee prosthesis: minimum three year follow-up of an RCT comparing it with a fixed-bearing device. Knee 14:448–451

    CAS  PubMed  Google Scholar 

  7. Becher C, Heyse TJ, Kron N, Ostermeier S, Hurschler C, Schofer MD, Fuchs-Winkelmann S, Tibesku CO (2009) Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro. Knee Surg Sports Traumatol Arthrosc 17:1159–1165

    PubMed  Google Scholar 

  8. Bhan S, Malhotra R, Kiran EK, Shukla S, Bijjawara M (2005) 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 87:2290–2296

    CAS  PubMed  Google Scholar 

  9. Biau D, Mullins MM, Judet T, Piriou P (2006) Mobile versus fixed-bearing total knee arthroplasty: mid-term comparative clinical results of 216 prostheses. Knee Surg Sports Traumatol Arthrosc 14:927–933

    CAS  PubMed  Google Scholar 

  10. Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242

    CAS  PubMed  Google Scholar 

  11. Bo Z, Liao L, Zhao J, Wei Q, Ding X, Yang B (2014) Mobile bearing or fixed bearing? A meta-analysis of outcomes comparing mobile bearing and fixed bearing bilateral total knee replacements. Knee 21:374–381

    PubMed  Google Scholar 

  12. Breugem SJM, Sierevelt IN, Schafroth MU, Blankevoort L, Schaap GR, van Dijk CN (2008) Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop 466:1959–1965

    PubMed  Google Scholar 

  13. Breugem SJM, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN (2014) No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc 22:509–516

    PubMed  Google Scholar 

  14. Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, Wang F (2018) Different factors conduct anterior knee pain following primary total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 33:1962–1971

    PubMed  Google Scholar 

  15. Erak S, Rajgopal V, Macdonald SJ, McCalden RW, Bourne RB (2009) Ten-year results of an inset biconvex patella prosthesis in primary knee arthroplasty. Clin Orthop 467:1781–1792

    PubMed  Google Scholar 

  16. Feczko PZ, Jutten LM, van Steyn MJ, Deckers P, Emans PJ, Arts JJ (2017) Comparison of fixed and mobile-bearing total knee arthroplasty in terms of patellofemoral pain and function: a prospective, randomised, controlled trial. BMC Musculoskelet Disord 18:279

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Gomes LS, Bechtold JE, Gustilo RB (1988) Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop 236:72–81

    Google Scholar 

  18. Harrington MA, Hopkinson WJ, Hsu P, Manion L (2009) Fixed- vs mobile-bearing total knee arthroplasty: does it make a difference? A prospective randomized study. J Arthroplasty 24:24–27

    PubMed  Google Scholar 

  19. Hasegawa M, Sudo A, Uchida A (2009) Staged bilateral mobile-bearing and fixed-bearing total knee arthroplasty in the same patients: a prospective comparison of a posterior-stabilized prosthesis. Knee Surg Sports Traumatol Arthrosc 17:237–243

    PubMed  Google Scholar 

  20. Jacobs W, Anderson P, Limbeek J, Wymenga A (2004) Mobile bearing vs fixed bearing prostheses for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev CD003130

  21. Kim YH, Kook HK, Kim JS (2001) Comparison of fixed-bearing and mobile-bearing total knee arthroplasties. Clin Orthop 392:101–115

    Google Scholar 

  22. Kim Y-H, Kim D-Y, Kim J-S (2007) Simultaneous mobile- and fixed-bearing total knee replacement in the same patients. A prospective comparison of mid-term outcomes using a similar design of prosthesis. J Bone Joint Surg Br 89:904–910

    PubMed  Google Scholar 

  23. Kim Y-H, Yoon S-H, Kim J-S (2007) The long-term results of simultaneous fixed-bearing and mobile-bearing total knee replacements performed in the same patient. J Bone Joint Surg Br 89:1317–1323

    PubMed  Google Scholar 

  24. Kim Y-H, Park J-W, Kim J-S (2017) Comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties—a prospective randomized study. J Arthroplasty 33:130–135

    CAS  PubMed  Google Scholar 

  25. Lädermann A, Lübbeke A, Stern R, Riand N, Fritschy D (2008) Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomised, clinical and radiological study with mid-term results at 7 years. Knee 15:206–210

    PubMed  Google Scholar 

  26. Li Y-L, Wu Q, Ning G-Z, Feng S-Q, Wu Q-L, Li Y, Hao Y (2014) No difference in clinical outcome between fixed- and mobile-bearing TKA: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 22:565–575

    PubMed  Google Scholar 

  27. Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes Group (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83:1856–1864

    Google Scholar 

  28. Lum ZC, Shieh AK, Dorr LD (2018) Why total knees fail—a modern perspective review. World J Orthop 9:60–64

    PubMed  PubMed Central  Google Scholar 

  29. Moskal JT, Capps SG (2014) Rotating-platform TKA no different from fixed-bearing TKA regarding survivorship or performance: a meta-analysis. Clin Orthop 472:2185–2193

    PubMed  Google Scholar 

  30. Oh KJ, Pandher DS, Lee SH, Sung Joon SD, Lee ST (2009) Meta-analysis comparing outcomes of fixed-bearing and mobile-bearing prostheses in total knee arthroplasty. J Arthroplasty 24:873–884

    PubMed  Google Scholar 

  31. Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD, Jacofsky DJ (2004) Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary total knee arthroplasties. Clin Orthop 428:221–227

    Google Scholar 

  32. Poirier N, Graf P, Dubrana F (2015) Mobile-bearing versus fixed-bearing total knee implants. Results of a series of 100 randomised cases after 9 years follow-up. Orthop Traumatol Surg Res 101:S187–S192

    CAS  PubMed  Google Scholar 

  33. Popovic N, Lemaire R (2003) Anterior knee pain with a posterior-stabilized mobile-bearing knee prosthesis: the effect of femoral component design. J Arthroplasty 18:396–400

    CAS  PubMed  Google Scholar 

  34. Price AJ, Rees JL, Beard D, Juszczak E, Carter S, White S, de Steiger R, Dodd CAF, Gibbons M, McLardy-Smith P, Goodfellow JW, Murray DW (2003) A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis. A multicentre single-blind randomised controlled trial. J Bone Joint Surg Br 85:62–67

    CAS  PubMed  Google Scholar 

  35. Shemshaki H, Dehghani M, Eshaghi MA, Esfahani MF (2012) Fixed versus mobile weight-bearing prosthesis in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:2519–2527

    PubMed  Google Scholar 

  36. Skwara A, Tibesku CO, Ostermeier S, Stukenborg-Colsman C, Fuchs-Winkelmann S (2009) Differences in patellofemoral contact stresses between mobile-bearing and fixed-bearing total knee arthroplasties: a dynamic in vitro measurement. Arch Orthop Trauma Surg 129:901–907

    PubMed  Google Scholar 

  37. Smith H, Jan M, Mahomed NN, Davey JR, Gandhi R (2011) Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty 26:1205–1213

    PubMed  Google Scholar 

  38. Sneppen O, Gudmundsson GH, Bünger C (1985) Patellofemoral function in total condylar knee arthroplasty. Int Orthop 9:65–68

    CAS  PubMed  Google Scholar 

  39. Tayot O, Aït Si Selmi T, Neyret P (2001) Results at 11.5 years of a series of 376 posterior stabilized HLS1 total knee replacements. Survivorship analysis, and risk factors for failure. Knee 8:195–205

    CAS  PubMed  Google Scholar 

  40. 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

    PubMed  Google Scholar 

  41. 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

    PubMed  Google Scholar 

  42. van Jonbergen H-PW, Reuver JM, Mutsaerts EL, Poolman RW (2014) Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 22:478–499

    PubMed  Google Scholar 

  43. van Jonbergen HPW, Scholtes VAB, Poolman RW (2014) A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing: a concise follow-up at a mean of 3.7 years. Bone Joint J 96(B):473–478

    PubMed  Google Scholar 

  44. Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 85:212–217

    CAS  PubMed  Google Scholar 

  45. Wen Y, Liu D, Huang Y, Li B (2011) A meta-analysis of the fixed-bearing and mobile-bearing prostheses in total knee arthroplasty. Arch Orthop Trauma Surg 131:1341–1350

    PubMed  Google Scholar 

  46. Whiteside LA, Nakamura T (2003) Effect of femoral component design on unresurfaced patellas in knee arthroplasty. Clin Orthop 410:189–198

    Google Scholar 

  47. Wood DJ, Smith AJ, Collopy D, White B, Brankov B, Bulsara MK (2002) Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am 84:187–193

    PubMed  Google Scholar 

  48. 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

    PubMed  Google Scholar 

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Funding

No funding was received for this study.

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Correspondence to Elliot Sappey-Marinier.

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Ethical approval was obtained from the Institutional Review Board of Hospices Civils de Lyon and Lyon 1 university. (study ID numbers 2005.407/36).

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Sappey-Marinier, E., de Abreu, F.G.A., O’Loughlin, P. et al. No difference in patellar position between mobile-bearing and fixed-bearing total knee arthroplasty for medial osteoarthritis: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 28, 1542–1550 (2020). https://doi.org/10.1007/s00167-019-05565-5

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  • DOI: https://doi.org/10.1007/s00167-019-05565-5

Keywords

  • Total knee arthroplasty
  • Total knee replacement
  • Mobile bearing
  • Fixed bearing
  • Patellar position