title: Mobile-bearing versus fixed-bearing total knee implants. Results of a series of 100 randomised cases after 9 years follow-up.
abstract: OBJECTIVE
  Mobile-bearing total knee arthroplasty (TKA) implants were developed as an alternative to fixed-bearing implants because of their theoretical advantages related to wear and range of motion. For all that, none of the short-term and medium-term studies published so far have reported a significant clinical improvement related to these mobile bearings. The goal of this study was to compare the outcomes of fixed and mobile bearings in the same type of TKA model after a longer follow-up.
  
  
  METHODS
  This series initially comprised 100 patients with a mean age of 73 years who were operated by a single surgeon. The patients were randomised to receive either a fixed bearing TKA implant or a mobile one; their outcomes evaluated after a mean of 9 years (7.2-12.2) follow-up. Twenty-two patients died before the final review, 15 were lost to follow-up and 2 were excluded. This resulted in 30 patients with a mobile-bearing knee and 31 with a fixed-bearing knee being available for analysis.
  
  
  RESULTS
  There were no significant clinical differences between the groups receiving a fixed or mobile bearing in terms of the range of motion, subjective outcomes or validated outcomes measured, such as the self-reported Oxford or the IKS. Conversely, there was a significantly higher rate of osteolysis in the fixed-bearing group, but it was not clinically relevant.
  
  
  CONCLUSIONS
  This study, which has the longest published follow-up, confirms the results found in the seven randomised studies published up to now: there are no significant differences in the clinical outcomes between fixed-bearing and mobile-bearing inserts of the same TKA model. Although the mobile bearing knees had a better radiographic appearance, this did not translate to better clinical outcomes. In practice, the superiority of mobile bearings is solely theoretical.
  
  
  METHODS
  Prospective randomised study.
authors.affiliation: Faculty of Medicine, université de Bretagne-Occidentale, 22, avenue Camille-Desmoulins, CS 93837, 29238 Brest cedex 3, France; Department of Orthopaedic Surgery, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France. Electronic address: nicolas.poirier@chu-brest.fr.
authors.forename: N
authors.initials: N
authors.lastname: Poirier
authors.affiliation: Clinique Pasteur-Lanroze, 32, rue Auguste-Kervern, 29200 Brest, France.
authors.forename: P
authors.initials: P
authors.lastname: Graf
authors.affiliation: Faculty of Medicine, université de Bretagne-Occidentale, 22, avenue Camille-Desmoulins, CS 93837, 29238 Brest cedex 3, France; Department of Orthopaedic Surgery, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
authors.forename: F
authors.initials: F
authors.lastname: Dubrana
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery; D010014:Osteolysis / Q000453:epidemiology; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography
keywords: Arthroplasty; Total knee replacement