The Journal of Bone and Joint Surgery (American). 2009;91:2104-2112.
doi:10.2106/JBJS.H.01442
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Mobile and Fixed-Bearing (All-Polyethylene Tibial Component) Total Knee Arthroplasty Designs

A Prospective Randomized Trial

Terence J. Gioe, MD1, Jason Glynn, MD1, Jonathan Sembrano, MD1, Kathleen Suthers, MS2, Edward R.G. Santos, MD1 and Jasvinder Singh, MD, MPH1

1 Departments of Orthopaedic Surgery (T.J.G., J.G., J. Sembrano, and E.R.G.S.) and Rheumatology (J. Singh), University of Minnesota Medical School, Department of Veterans Affairs Medical Center, Section 112E, 1 Veterans Drive, Minneapolis, MN 55417. E-mail address for T.J. Gioe: tjgioe{at}gmail.com
2 Clinical Research Department, DePuy, Inc., P.O. Box 988, 700 Orthopaedic Drive, Warsaw, IN 46581-0988

Investigation performed at Department of Veterans Affairs Medical Center, Minneapolis, Minnesota

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from DePuy, Inc. Neither they nor a member of their immediate families received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

This material is based on work supported (or supported in part) by the Office of Research and Development, Department of Veterans Affairs. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).

Background: Proponents of mobile-bearing total knee arthroplasty believe that it has potential advantages over a fixed-bearing design in terms of diminished wear and improved motion and/or function, but these advantages have not been demonstrated in a randomized clinical comparison to our knowledge. We conducted a patient-blinded, prospective, randomized clinical trial to compare mobile-bearing and fixed-bearing cruciate-substituting total knee arthroplasties of the same design.

Methods: Patients between the ages of sixty and eighty-five years were prospectively randomized to receive a cruciate-substituting rotating-platform design or a fixed-bearing design with an all-polyethylene tibial component. There were no significant differences in the demographic characteristics (mean age, 72.2 years; mean American Society of Anesthesiologists score, 2.7; mean body mass index, 31.8 kg/m2) or preoperative clinical or radiographic measures between the groups. Routine clinical and radiographic follow-up measures included the Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36) outcome measures.

Results: The results of 312 arthroplasties (136 with an all-polyethylene tibial component and 176 rotating-platform designs) in 273 patients were analyzed at a minimum of two years (mean, forty-two months) postoperatively. Although there was significant improvement in both groups, there was no significant difference between the groups with regard to the mean postoperative range of motion (110.9° and 109.1°, respectively; p = 0.21), the mean KSS clinical score (90.4 and 88.2 points; p = 0.168), or the mean KSS pain score (44.9 and 43.1 points; p = 0.108) at this follow-up point. There were ten revisions: seven because of infection, one because of patellar fracture, one because of instability, and one because of aseptic loosening.

Conclusions: The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. The rotating-platform design had no significant clinical advantage over the design with the all-polyethylene tibial component.

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


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T. J. Gioe and A. V. Maheshwari
The All-Polyethylene Tibial Component in Primary Total Knee Arthroplasty
J. Bone Joint Surg. Am., February 1, 2010; 92(2): 478 - 487.
[Abstract] [Full Text] [PDF]