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Less wear in deep-dished mobile compared to fixed bearing total knee arthroplasty of the same design at 5-year follow-up: a randomised controlled model-based Roentgen stereophotogrammetric analysis trial

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this prospective randomised controlled study was to compare wear characteristics and functional outcome between deep-dished mobile bearing (MB) and fixed bearing (FB) cemented total knee arthroplasty (TKA). We hypothesised that deep-dished MB reduces polyethylene wear and improves patient-reported outcome measures.

Methods

A total of 50 patients were randomised to receive a MB or FB tibia component of the same cemented TKA design. Patients were evaluated over a 5-year follow-up period. Medial and lateral wear were assessed using model-based Roentgen Stereophotogrammetric Analysis (RSA) and compared with the direct postoperative minimal joint space measurement. Functional outcome was assessed by the clinician-derived KSS and OKS, WOMAC, LEAS, and FJS-12. All data were derived using a general linear mixed model.

Results

At 5-year follow-up, decreased wear in the MB compared to the FB group was observed on the lateral side (0.07 ± 0.17 mm, p = 0.026), but not on the medial side (0.31 ± 0.055 mm, p = 0.665). Functional outcomes improved with a statistical significant effect over time, with no significant differences between groups (all p > 0.17).

Conclusion

This model-based RSA study with 5-year follow-up showed that cemented deep-dished MB reduced lateral polyethylene wear as compared to FB in a single TKA system, whilst clinical outcomes were comparable. Longer follow-up is needed to establish clinical implications of these altered wear patterns and determine type of wear.

Level of evidence

Level 1 randomised controlled trial.

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Funding

For this study, no funding has been received.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

    S. Kalaai, J. Most, B. van Dun, P. B. J. Tilman, B. Boonen & M. G. M. Schotanus

  2. Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands

    S. Kalaai

  3. School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands

    J. Most, B. Boonen & M. G. M. Schotanus

  4. Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands

    B. L. Kaptein

  5. Department of Orthopaedic Surgery and Traumatology, Imelda Hospital, Bonheiden, Belgium

    B. van Dun

Authors
  1. S. Kalaai
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  2. J. Most
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  4. B. L. Kaptein
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  7. M. G. M. Schotanus
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Contributions

SK conceived, designed, coordinated the study, collected and analysed the data and drafted the manuscript. BVD, JM and BB critically reviewed the manuscript. PT participated in the design of the study and critically reviewed the manuscript. BK performed the data analysis. MS participated in the design of the study, co-ordinated the study and critically reviewed the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to S. Kalaai.

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The authors certify that they have no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licencing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript.

Ethical approval

Ethical approval by the local ethical committee was obtained for this study.

Informed consent

Informed consent was obtained for each patient of this study.

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Kalaai, S., Most, J., van Dun, B. et al. Less wear in deep-dished mobile compared to fixed bearing total knee arthroplasty of the same design at 5-year follow-up: a randomised controlled model-based Roentgen stereophotogrammetric analysis trial. Knee Surg Sports Traumatol Arthrosc 31, 5137–5144 (2023). https://doi.org/10.1007/s00167-023-07584-9

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  • DOI: https://doi.org/10.1007/s00167-023-07584-9

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