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Rotating-platform TKA No Different from Fixed-bearing TKA Regarding Survivorship or Performance: A Meta-analysis

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Clinical Orthopaedics and Related Research®

An Erratum to this article was published on 15 April 2014

A CORR Insights to this article was published on 26 March 2014

Abstract

Background

Mobile bearings have been compared with fixed bearings used in TKA. However, rotating platforms, a specific type of mobile bearing, have not been compared with fixed-bearings using meta-analysis.

Questions/purposes

We asked whether the performance of a rotating-platform bearing is superior to, comparable to, or worse than a fixed bearing. Four areas were investigated: clinical performance, component alignment, adverse event rates, and revision rates.

Methods

Searches of Medline, EMBASE, Google Scholar, and the Cochrane databases, combined with reference lists from published meta-analyses and systematic reviews of mobile-bearing versus fixed-bearing prostheses used in TKAs, provided 17 nonlanguage-restricted studies consisting of 1910 TKAs (966 rotating platform versus 944 fixed bearing). Random-effect modeling was used for all meta-analyses, thereby mitigating possible effects of heterogeneity among studies. All meta-analyses were examined for publication bias using funnel plots; publication bias was not detected for any meta-analysis.

Results

There were no statistically or clinically significant differences in clinical performance (clinical scores, ROM, and radiographic evaluation), component alignment, revision rates, or adverse event rates except for tibial component alignment in the AP plane, which favored TKA with fixed-bearings (p = 0.020; standardized mean difference, 0.229; 95% CI, 0.035–0.422), but the effect size was small enough that it was not considered clinically important.

Conclusions

Based on our findings, which agree substantially with those of prior systematic reviews of TKAs with mobile-bearing versus fixed-bearing prostheses, there is no compelling case for either rotating-platform or fixed-bearing implant design in terms of clinical performance, component alignment, adverse event frequencies, or survivorship. This dataset, which was limited to a maximum 6 years followup, is insufficient to address questions related to wear or late revisions. We therefore suggest that implant choice should be made on the basis of other factors, perhaps including cost or surgeon experience.

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Authors and Affiliations

  1. Virginia Tech Carilion School of Medicine, Roanoke, VA, USA

    Joseph T. Moskal MD

  2. BENSOL, 488 East Bell Drive, Warsaw, IN, 46582, USA

    Susan G. Capps PhD

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Corresponding author

Correspondence to Susan G. Capps PhD.

Additional information

One or more of the authors (JTM) has received funding from DePuy, a Johnson & Johnson Company (Warsaw, IN, USA); Zimmer (Warsaw, IN, USA); and Medtronic (Minneapolis, IN, USA). One or more of the authors (SGC) has received funding from DePuy, a Johnson & Johnson Company.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

This work was performed at Carilion School of Medicine, Roanoke, VA, USA, and BENSOL, Warsaw, IN, USA.

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Moskal, J.T., Capps, S.G. Rotating-platform TKA No Different from Fixed-bearing TKA Regarding Survivorship or Performance: A Meta-analysis. Clin Orthop Relat Res 472, 2185–2193 (2014). https://doi.org/10.1007/s11999-014-3539-4

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