The Journal of Bone and Joint Surgery (American). 2005;87:2290-2296.
doi:10.2106/JBJS.D.02221
© 2005 The Journal of Bone and Joint Surgery, Inc.
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A Comparison of Fixed-Bearing and Mobile-Bearing Total Knee Arthroplasty at a Minimum Follow-up of 4.5 Years

S. Bhan, MS, FRCS1, R. Malhotra, MS1, E. Krishna Kiran, MS1, Sourav Shukla, MS1 and Mahesh Bijjawara, MS1

1 Department of Orthopaedics, Room 5019, All India Institute of Medical Sciences, New Delhi 110 029, India. E-mail address for R. Malhotra: rmalhotra62{at}hotmail.com

Investigation performed at the Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge.

Methods: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared.

Results: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection.

Conclusions: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


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