Mahoney, Clin Orthop Relat Res 2012 - The John Insall Award: No Functional Advantage of a Mobile Bearing Posterior Stabilized TKA

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The John Insall Award: No Functional Advantage of a Mobile Bearing Posterior Stabilized TKA

Mahoney, Shen, et al.·Clin Orthop Relat Res·2012·37 citations·RCT

Free Full Text·DOI·PubMed

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Background

Mobile bearing (MB) total knee design has been advocated as a means to enhance the functional characteristics and decrease the wear rates of condylar total knee arthroplasty (TKA). However, it is unclear if these designs achieve these goals.

Purpose

We asked whether function of patients or survivorship would be greater or complications would be lesser in groups of patients with MB compared with fixed bearing (FB) TKA. We also sought to describe retrieval findings.

Methods

We randomized 507 primary TKAs in 416 eligible patients to receive MB (n = 252) or FB (n = 255) devices from November 2001 to August 2007 (Investigational Device Exemption G000180, ClinicalTrials.gov registration number NCT00946075).
Patients were blinded to treatment allocation.
WOMAC Index, SF-12 Health Survey, knee range of motion, and Knee Society scores were collected and compared preoperatively and at 6, 12, and 24 months postoperatively.
We recorded device failures and complications until October 2009.
Kaplan-Meier survivorship was compared using the log rank test.
12 retrieved MB devices underwent pathologic analysis.
The minimum postoperative time was 2.2 years (mean, 5.9 years; range, 2.2-7.9 years).

Results

We found no differences in mean clinical assessment scores or mean score changes from baseline at any postoperative interval through 2 postoperative years.
19 of the 252 MB and 13 of the 255 FB knees had undergone revision of any component.
Estimated survival at 6 postoperative years was similar for the 2 devices: 90.1% (95% confidence interval [CI], 84.1-93.9) for MB and 94.2% (95% CI, 90.1-96.6) for FB.
2 MB and no FB tibial components were revised for loosening.
There was one case of MB insert dislocation.
Retrieved MB devices demonstrated no unexpected wear or mechanical device failures.

Conclusions

We found no evidence of functional advantage of the MB design. Survivorship was similar, although the study is limited by short duration of followup.

Copyright remains with the authors and publisher.

The John Insall Award: No Functional Advantage of a Mobile Bearing Posterior Stabilized TKA.

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The John Insall Award: No Functional Advantage of a Mobile Bearing Posterior Stabilized TKA

Mahoney, Shen, et al.·Clin Orthop Relat Res·2012·37 citations·RCT

Free Full Text·DOI·PubMed

|

Background

Mobile bearing (MB) total knee design has been advocated as a means to enhance the functional characteristics and decrease the wear rates of condylar total knee arthroplasty (TKA). However, it is unclear if these designs achieve these goals.

Purpose

We asked whether function of patients or survivorship would be greater or complications would be lesser in groups of patients with MB compared with fixed bearing (FB) TKA. We also sought to describe retrieval findings.

Methods

We randomized 507 primary TKAs in 416 eligible patients to receive MB (n = 252) or FB (n = 255) devices from November 2001 to August 2007 (Investigational Device Exemption G000180, ClinicalTrials.gov registration number NCT00946075).
Patients were blinded to treatment allocation.
WOMAC Index, SF-12 Health Survey, knee range of motion, and Knee Society scores were collected and compared preoperatively and at 6, 12, and 24 months postoperatively.
We recorded device failures and complications until October 2009.
Kaplan-Meier survivorship was compared using the log rank test.
12 retrieved MB devices underwent pathologic analysis.
The minimum postoperative time was 2.2 years (mean, 5.9 years; range, 2.2-7.9 years).

Results

We found no differences in mean clinical assessment scores or mean score changes from baseline at any postoperative interval through 2 postoperative years.
19 of the 252 MB and 13 of the 255 FB knees had undergone revision of any component.
Estimated survival at 6 postoperative years was similar for the 2 devices: 90.1% (95% confidence interval [CI], 84.1-93.9) for MB and 94.2% (95% CI, 90.1-96.6) for FB.
2 MB and no FB tibial components were revised for loosening.
There was one case of MB insert dislocation.
Retrieved MB devices demonstrated no unexpected wear or mechanical device failures.

Conclusions

We found no evidence of functional advantage of the MB design. Survivorship was similar, although the study is limited by short duration of followup.

Copyright remains with the authors and publisher.

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