No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta‐analysis

Knee Surgery Sports Traumatology Arthroscopy, vol. 30, pp. 3138–3154

Abstract

PURPOSE: Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS: This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS: Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION: There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE: Level I.

Authors 6

1. Filippo Migliorini corresponding Aachen <!--<label>1</label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery Department of Orthopaedic, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   <!--<label>1</label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery RWTH University Hospital Pauwelsstraße 30 52074 Aachen Germany

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

2. Nicola Maffulli

   University of London · University of Salerno · Queen Mary University of London · Mile End Hospital · Keele University

   Affiliation as printed

   <!--<label>2</label>--> Department of Medicine, Surgery and Dentistry University of Salerno 84081 Baronissi SA Italy

   <!--<label>3</label>--> School of Pharmacy and Bioengineering Keele University Faculty of Medicine ST4 7QB Stoke‐on‐Trent England

   <!--<label>4</label>--> Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital Queen Mary University of London E1 4DG London England

   Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy

3. Francesco Cuozzo

   University of Salerno

   Affiliation as printed

   <!--<label>2</label>--> Department of Medicine, Surgery and Dentistry University of Salerno 84081 Baronissi SA Italy

   Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy

4. Marco Pilone

   University of Salerno

   Affiliation as printed

   <!--<label>2</label>--> Department of Medicine, Surgery and Dentistry University of Salerno 84081 Baronissi SA Italy

   Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy

5. Karen Elsner Aachen <!--<label>1</label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery Department of Orthopaedic, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   <!--<label>1</label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery RWTH University Hospital Pauwelsstraße 30 52074 Aachen Germany

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

6. Jörg Eschweiler Aachen <!--<label>1</label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery Department of Orthopaedic, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   <!--<label>1</label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery RWTH University Hospital Pauwelsstraße 30 52074 Aachen Germany

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany