[Implant with a mobile or a fixed bearing in unicompartmental knee joint replacemen].
Although the goal of anatomical and functional joint reconstruction in unicompartmental knee replacement is well defined, no uniform implant design has become established. In particular, the differential indications for implantation of an implant with a mobile or a fixed bearing are still not clear. The long-term results of mobile and with fixed bearings are comparable, but there are significant differences in resulting knee joint kinematics, tribological properties and implant-associated complications. In unicompartmental knee replacement mobile bearings restore the physiological joint kinematics better than fixed implants, although the differences to total knee arthroplasty seem minor. The decoupling of mobile bearings from the tibia implant allows a high level of congruence with the femoral implant, resulting in larger contact areas than with fixed bearings. This fact in combination with the more physiological joint kinematics leads to less wear and a lower incidence of osteolyses with mobile bearings. Disadvantages of mobile bearings are the higher complication and early revision rates resulting from bearing dislocation and impingement syndromes caused by suboptimal implantation technique or instability. Especially in cases with ligamentous pathology fixed bearings involve a lower complication rate. It seems their use can also be beneficial in patients with a low level of activity, as problems related to wear are of minor importance for this subgroup. The data currently available allow differentiations between various indications for implants with mobile or fixed bearings, so that the implants can be matched to the patient and the joint pathology in unicompartmental knee joint replacement.
Matziolis
G
G
Centrum für Muskuloskeletale Chirurgie, Orthopädische Klinik, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. Georg.Matziolis@Charite.de
Tohtz
S
S
Gengenbach
B
B
Perka
C
C
D019645:Arthroplasty, Replacement, Knee; D001696:Biomechanical Phenomena; D019544:Equipment Failure Analysis; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D007720:Knee Prosthesis; D011183:Postoperative Complications / Q000503:physiopathology; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology