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Lateral retinacular release rates in mobile- versus fixed-bearing TKA.

ABSTRACT: UNLABELLED: Controversy exists as to whether bearing mobility facilitates centralization of the extensor mechanism after TKA. To assess the incidence of lateral retinacular release, we retrospectively reviewed 1318 consecutive primary TKAs (1032 patients) performed by one surgeon using either a rotating-platform bearing (940) or a fixed bearing (378) from the same implant system. The selection of a fixed- versus mobile-bearing TKA was primarily based on age with patients younger than 70 years receiving a mobile-bearing TKA. We performed a lateral release whenever continuous symmetric patellar facet contact with the trochlear groove from 0 degrees to 90 degrees of flexion was not obtained using the rule of no thumb after tourniquet release. One hundred four of 1318 knees (7.9%) had a lateral release. We performed more lateral releases in the fixed-bearing group (14.3% [54 of 378]) than in the mobile-bearing group (5.3% [50 of 940]). Patellar tilt occurred more often in the mobile-bearing group (10% [94 of 940]) than in the fixed-bearing group (6.9% [26 of 378]), although the magnitude of mean patellar tilt was small in both groups (mobile-bearing 3.0 degrees ; fixed bearing 2.55 degrees ). No patient had patellar subluxation greater than 5 mm. We suspect the fewer lateral releases in the mobile-bearing group is the result of better extensor mechanism centralization provided by bearing rotation. LEVEL OF EVIDENCE: Level III, prognostic study. See the Guidelines for a complete description of levels of evidence.

SUBMITTER: Yang CC

PROVIDER: S-EPMC2565058 | biostudies-other | 2008 Nov

REPOSITORIES: biostudies-other

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Project description:BackgroundMobile 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/purposesWe 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.MethodsSearches 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.ResultsThere 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.ConclusionsBased 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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Lateral retinacular release rates in mobile- versus fixed-bearing TKA.

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