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Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis.

ABSTRACT: Although the design features of the Medial Pivot fixed-bearing prosthesis reportedly improve kinematics compared with TKAs using fixed-bearings, clinical improvements have not been reported. We asked whether the clinical and radiographic outcomes, ranges of motion of the knee, patient satisfaction, and complication rates would be better in knees with a Medial Pivot fixed-bearing prosthesis than in those with a PFC Sigma mobile-bearing prosthesis. We compared the results of 92 patients who had a Medial Pivot fixed-bearing prosthesis implanted in one knee and a PFC Sigma mobile-bearing prosthesis implanted in the other. There were 85 women and seven men with a mean age of 69.5 years (range, 55-81 years). The minimum followup was 2 years (mean, 2.6 years; range, 2-3 years). The patients were assessed clinically and radiographically using the rating systems of the Hospital for Special Surgery and the Knee Society at 3 months, 1 year, and annually thereafter. Contrary to expectations, we found worse early clinical outcomes, smaller ranges of knee motion, less patient satisfaction, and a higher complication rate for the Medial Pivot fixed-bearing prosthesis than for the PFC Sigma mobile-bearing prosthesis.Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

SUBMITTER: Kim YH

PROVIDER: S-EPMC2628493 | biostudies-other | 2009 Feb

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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Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis.

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