Abstract
Background
Periprosthetic osteolysis is an increasingly prevalent complication of TKA. To reduce the polyethylene wear and periprosthetic osteolysis, particularly in young patients, the design of the contemporary fixed-bearing TKAs has been modified and mobile-bearing TKAs have been introduced.
Questions/purposes
We asked whether the prevalence of osteolysis would be less in well-functioning mobile-bearing TKAs than in well-functioning contemporary fixed-bearing TKAs in young patients.
Patients and Methods
We compared 488 patients (894 knees) who received fixed-bearing knee prostheses with 445 patients (816 knees) who received mobile-bearing knee prostheses. There were 187 men and 301 women (mean age, 58.6 years; range, 33-65 years) in the fixed-bearing group and 167 men and 278 women (mean age, 55.7 years; range, 33-65 years) in the mobile-bearing group. The mean followup was 12.6 years (range, 10–17 years) in the fixed-bearing group and 12.9 years (range, 10–17 years) in the mobile-bearing group.
Results
The incidence of osteolysis was 1.6% (14 of 894 knees) in the fixed-bearing group and 2.2% (18 of 816 knees) in the mobile-bearing group at the final review. The mean postoperative Knee Society knee and function scores were 92.9 points and 83.5 points, respectively, in the fixed-bearing group and 90.7 points and 83.8 points, respectively, in the mobile-bearing group. The revision rates were 3.7% (33 of 894 knees) in the fixed-bearing group and 2.7% (22 of 816 knees) in the mobile-bearing group.
Conclusions
We found the incidence of osteolysis, rate of revision, and implant survivorship were similar between fixed-bearing and mobile-bearing TKAs in younger patients.
Level of Evidence
Level III, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Arora J, Ogden AC. Osteolysis in a surface-cemented, primary, modular Freeman-Samuelson total knee replacement. J Bone Joint Surg Br. 2005;87:1502–1506.
Bach CM, Biedermann R, Goebel G, Mayer E, Rachbauer F. Reproducible assessment of radiolucent lines in total knee arthroplasty. Clin Orthop Relat Res. 2005;434:183–188.
Bertin KC. Cruciate-retaining total knee arthroplasty at 5 to 7 years followup. Clin Orthop Relat Res. 2005;436:177–183.
Bozic KJ, Kinder J, Meneghini RM, Zurakowski D, Rosenberg AG, Galante JO. Implant survivorship and complication rates after total knee arthroplasty with a third-generation cemented system: 5 to 8 years followup. Clin Orthop Relat Res. 2005;430:117–124.
Buechel FF, Pappas MJ. The New Jersey Low-Contact-Stress Knee Replacement System: biomechanical rationale and review of the first 123 cemented cases. Arch Orthop Trauma Surg. 1986;105:197–204.
Buechel FF, Pappas MJ. Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee prostheses using meniscal bearings. Clin Orthop Relat Res. 1990;260:162–169.
Cadambi A, Engh GA, Dwyer KA, Vinh TN. Osteolysis of the distal femur after total knee arthroplasty. J Arthroplasty. 1994;9:579–594.
Callaghan JJ, O’Rourke MR, Iossi MF, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC. Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of fifteen years, of a previous report. J Bone Joint Surg Am. 2005;87:1995–1998.
Callaghan JJ, Squire MW, Goetz DD, Sullivan PM, Johnston RC. Cemented rotating-platform total knee replacement: a nine to twelve-year follow-up study. J Bone Joint Surg Am. 2000;82:705–711.
Collier JP, Sperling DK, Currier JH, Sutula LC, Saum KA, Mayor MB. Impact of gamma sterilization on clinical performance of polyethylene in the knee. J Arthroplasty. 1996;11:377–389.
Collier MB, Engh CA Jr, McAuley JP, Ginn SD, Engh GA. Osteolysis after total knee arthroplasty: influence of tibial baseplate surface finish and sterilization of polyethylene insert. Findings at five to ten years postoperatively. J Bone Joint Surg Am. 2005;87:2702–2708.
Dalury DF, Barrett WP, Mason JB, Goldstein WM, Murphy JA, Roche MW. Midterm survival of a contemporary modular total knee replacement: a multicentre study of 1970 knees. J Bone Joint Surg Br. 2008;90:1594–1596.
Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients: long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997;79:575–582.
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;87:598–603.
Duffy GP, Trousdale RT, Stuart MJ. Total knee arthroplasty in patients 55 years old or younger: 10- to 17-year results. Clin Orthop Relat Res. 1998;356:22–27.
Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.
Ezzet KA, Garcia R, Barrack RL. Effect of component fixation method on osteolysis in total knee arthroplasty. Clin Orthop Relat Res. 1995;321:86–91.
Faris PM, Keating EM, Farris A, Meding JB, Ritter MA. Hybrid total knee arthroplasty: 13-year survivorship of AGC total knee systems with average 7 years followup. Clin Orthop Relat Res. 2008;466:1204–1209.
Gioe TJ, Glynn J, Sembrano J, Suthers K, Santos ER, Singh J. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs: a prospective randomized trial. J Bone Joint Surg Am. 2009;91:2104–2112.
Goodfellow JW, O’Connor J. Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res. 1986;205:21–42.
Huang CH, Ma HM, Liau JJ, Ho FY, Cheng CK. Osteolysis in failed total knee arthroplasty: a comparison of mobile-bearing and fixed-bearing knees. J Bone Joint Surg Am. 2002;84:2224–2229.
Insall JN. Adventures in mobile-bearing knee design: a mid-life crisis. Orthopedics. 1998;21:1021–1023.
Insall JN, Ranawat CS, Aglietti P, Shine J. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am. 1976;58:754–765.
Kaplan EL, Meier R. Nonparametric estimation from incomplete observations. J Am Statist Assoc. 1958;53:457–481.
Kim YH, Kim JS. Prevalence of osteolysis after simultaneous bilateral fixed- and mobile-bearing total knee arthroplasties in young patients. J Arthroplasty. 2009;24:932–940.
Kim YH, Oh JH, Oh SH. Osteolysis around cementless porous-coated anatomic knee prostheses. J Bone Joint Surg Br. 1995;77:236–241.
Kim YH, Yoon SH, Kim JS. The long-term results of simultaneous fixed-bearing and mobile-bearing total knee replacements performed in the same patient. J Bone Joint Surg Br. 2007;89:1317–1323.
Lachiewicz PF, Soileau ES. The rates of osteolysis and loosening associated with a modular posterior stabilized knee replacement: results at five to fourteen years. J Bone Joint Surg Am. 2004;86:525–530.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.
Mikulak SA, Mahoney OM, dela Rosa MA, Schmalzried TP. Loosening and osteolysis with the press-fit condylar posterior-cruciate-substituting total knee replacement. J Bone Joint Surg Am. 2001;83:398–403.
O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year follow-up. J Bone Joint Surg Am. 2002;84:1362–1371.
Peters PC Jr, Engh GA, Dwyer KA, Vinh TN. Osteolysis after total knee arthroplasty without cement. J Bone Joint Surg Am. 1992;74:864–876.
Price AJ, Rees JL, Beard D, Juszczak E, Carter S, White S, de Steiger R, Dodd CA, Gibbons M, McLardy-Smith P, Goodfellow JW, Murray DW. A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis: a multicentre single-blind randomised controlled trial. J Bone Joint Surg Br. 2003;85:62–67.
Robinson EJ, Mulliken BD, Bourne RB, Rorabeck CH, Alvarez C. Catastrophic osteolysis in total knee replacement: a report of 17 cases. Clin Orthop Relat Res. 1995;321:98–105.
Sánchez-Sotelo J, Ordoñez JM, Prats SB. Results and complications of the low contact stress knee prosthesis. J Arthroplasty. 1999;14:815–821.
Sorrells RB, Stiehl JB, Voorhorst PE. Midterm results of mobile-bearing total knee arthroplasty in patients younger than 65 years. Clin Orthop Relat Res. 2001;390:182–189.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.
Wright TM, Bartel DL. The problem of surface damage in polyethylene total knee components. Clin Orthop Relat Res. 1986;205:67–74.
Acknowledgments
We thank Sang-Mi Lee, BA, for compiling the medical records.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she has no commercial association (eg, consultancies, stock ownership, equity interest, patent, licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
About this article
Cite this article
Kim, YH., Choi, Y. & Kim, JS. Osteolysis in Well-functioning Fixed- and Mobile-bearing TKAs in Younger Patients. Clin Orthop Relat Res 468, 3084–3093 (2010). https://doi.org/10.1007/s11999-010-1336-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-010-1336-2