J Knee Surg 2015; 28(05): 358-362
DOI: 10.1055/s-0035-1550338
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fixed Bearings versus Rotating Platforms in Total Knee Arthroplasty

Peter B. White
1   Department of Othopedics, Hospital for Special Surgery, New York, New York
,
Amar S. Ranawat
1   Department of Othopedics, Hospital for Special Surgery, New York, New York
,
Chitranjan S. Ranawat
1   Department of Othopedics, Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

12 February 2015

26 February 2015

Publication Date:
05 May 2015 (online)

Abstract

Rotating platforms were introduced as an alternative to fixed bearings in hopes of providing more natural kinematics and improved clinical outcomes. In-vitro wear studies showed significantly less wear with rotating platforms as opposed to fixed-bearing designs. Kinematic follow-up studies showed significantly improved axial rotation with rotating-platform knees. However, these benefits have failed to translate into improved clinical outcomes or survivorship. This article reviews our institution's experience, as well as the latest clinical research on wear, kinematics, clinical outcomes, and survivorship of fixed-bearing and rotating-platform knees.

 
  • References

  • 1 Ranawat AS, Meftah M, Rodriguez-Elizalde S , et al. The incidence of anterior knee pain and crepitation after total knee replacement: a matched pair analysis between rotating platform and fixed bearing posterior stabilized designs. ASTM Int 2012; ;STP 1531: 46-54
  • 2 Feng B, Weng X, Lin J, Jin J, Wang W, Qiu G. Long-term follow-up of cemented fixed-bearing total knee arthroplasty in a Chinese population: a survival analysis of more than 10 years. J Arthroplasty 2013; 28 (10) 1701-1706
  • 3 Vasdev A, Kumar S, Chadha G, Mandal SP. Fixed- versus mobile-bearing total knee arthroplasty in Indian patients. J Orthop Surg (Hong Kong) 2009; 17 (2) 179-182
  • 4 Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 2003; 85-A (2) 259-265
  • 5 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
  • 6 McEwen HM, Barnett PI, Bell CJ , et al. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech 2005; 38 (2) 357-365
  • 7 Fisher J, McEwen H, Tipper J , et al. Wear-simulation analysis of rotating-platform mobile-bearing knees. Orthopedics 2006; 29 (9, Suppl): S36-S41
  • 8 Grupp TM, Kaddick C, Schwiesau J, Maas A, Stulberg SD. Fixed and mobile bearing total knee arthroplasty—influence on wear generation, corresponding wear areas, knee kinematics and particle composition. Clin Biomech (Bristol, Avon) 2009; 24 (2) 210-217
  • 9 Haider H, Garvin K. Rotating platform versus fixed-bearing total knees: an in vitro study of wear. Clin Orthop Relat Res 2008; 466 (11) 2677-2685
  • 10 Kelly NH, Fu RH, Wright TM, Padgett DE. Wear damage in mobile-bearing TKA is as severe as that in fixed-bearing TKA. Clin Orthop Relat Res 2011; 469 (1) 123-130
  • 11 Schwarzkopf R, Scott RD, Carlson EM, Currier JH. Does increased topside conformity in modular total knee arthroplasty lead to increased backside wear?. Clin Orthop Relat Res 2015; 473 (1) 220-225
  • 12 Lu YC, Huang CH, Chang TK, Ho FY, Cheng CK, Huang CH. Wear-pattern analysis in retrieved tibial inserts of mobile-bearing and fixed-bearing total knee prostheses. J Bone Joint Surg Br 2010; 92 (4) 500-507
  • 13 Garcia RM, Kraay MJ, Messerschmitt PJ, Goldberg VM, Rimnac CM. Analysis of retrieved ultra-high-molecular-weight polyethylene tibial components from rotating-platform total knee arthroplasty. J Arthroplasty 2009; 24 (1) 131-138
  • 14 Berry DJ, Currier JH, Mayor MB, Collier JP. Knee wear measured in retrievals: a polished tray reduces insert wear. Clin Orthop Relat Res 2012; 470 (7) 1860-1868
  • 15 Most E, Li G, Schule S , et al. The kinematics of fixed- and mobile-bearing total knee arthroplasty. Clin Orthop Relat Res 2003; (416) 197-207
  • 16 Delport HP, Banks SA, De Schepper J, Bellemans J. A kinematic comparison of fixed- and mobile-bearing knee replacements. J Bone Joint Surg Br 2006; 88 (8) 1016-1021
  • 17 Shi X, Shen B, Yang J, Kang P, Zhou Z, Pei F. In vivo kinematics comparison of fixed- and mobile-bearing total knee arthroplasty during deep knee bending motion. Knee Surg Sports Traumatol Arthrosc 2014; 22 (7) 1612-1618
  • 18 Daniilidis K, Höll S, Gosheger G , et al. Femoro-tibial kinematics after TKA in fixed- and mobile-bearing knees in the sagittal plane. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2392-2397
  • 19 Tibesku CO, Daniilidis K, Vieth V, Skwara A, Heindel W, Fuchs-Winkelmann S. Sagittal plane kinematics of fixed- and mobile-bearing total knee replacements. Knee Surg Sports Traumatol Arthrosc 2011; 19 (9) 1488-1495
  • 20 Ranawat CS, Komistek RD, Rodriguez JA, Dennis DA, Anderle M. In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses. Clin Orthop Relat Res 2004; (418) 184-190
  • 21 Bottlang M, Erne OK, Lacatusu E, Sommers MB, Kessler O. A mobile-bearing knee prosthesis can reduce strain at the proximal tibia. Clin Orthop Relat Res 2006; 447: 105-111
  • 22 Malinzak RA, Small SR, Rogge RD , et al. The effect of rotating platform TKA on strain distribution and torque transmission on the proximal tibia. J Arthroplasty 2014; 29 (3) 541-547
  • 23 Zingde SM, Leszko F, Sharma A, Mahfouz MR, Komistek RD, Dennis DA. In vivo determination of cam-post engagement in fixed and mobile-bearing TKA. Clin Orthop Relat Res 2014; 472 (1) 254-262
  • 24 Okamoto N, Nakamura E, Nishioka H, Karasugi T, Okada T, Mizuta H. In vivo kinematic comparison between mobile-bearing and fixed-bearing total knee arthroplasty during step-up activity. J Arthroplasty 2014; 29 (12) 2393-2396
  • 25 Sawaguchi N, Majima T, Ishigaki T, Mori N, Terashima T, Minami A. Mobile-bearing total knee arthroplasty improves patellar tracking and patellofemoral contact stress: in vivo measurements in the same patients. J Arthroplasty 2010; 25 (6) 920-925
  • 26 Russo A, Montagna L, Bragonzoni L, Visani A, Marcacci M. Changes in knee motion over the first 3 years with a mobile-bearing prosthesis. Knee 2006; 13 (4) 301-306
  • 27 Wolterbeek N, Garling EH, Mertens B, Valstar ER, Nelissen RG. Mobile bearing knee kinematics change over time. A fluoroscopic study in rheumatoid arthritis patients. Clin Biomech (Bristol, Avon) 2009; 24 (5) 441-445
  • 28 Garling EH, Kaptein BL, Nelissen RG, Valstar ER. Limited rotation of the mobile-bearing in a rotating platform total knee prosthesis. J Biomech 2007; 40 (Suppl. 01) S25-S30
  • 29 Breugem SJ, Sierevelt IN, Schafroth MU, Blankevoort L, Schaap GR, van Dijk CN. Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res 2008; 466 (8) 1959-1965
  • 30 Kim YH, Yoon SH, Kim JS. Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res 2009; 467 (2) 493-503
  • 31 Smith H, Jan M, Mahomed NN, Davey JR, Gandhi R. Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty 2011; 26 (8) 1205-1213
  • 32 Bailey O, Ferguson K, Crawfurd E , et al. No clinical difference between fixed- and mobile-bearing cruciate-retaining total knee arthroplasty: a prospective randomized study (e-pub ahead of print). Knee Surg Sports Traumatol Arthrosc 2014; ; doi: 10.1007/s00167-014-2877-9
  • 33 Shemshaki H, Dehghani M, Eshaghi MA, Esfahani MF. Fixed versus mobile weight-bearing prosthesis in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20 (12) 2519-2527
  • 34 Breugem SJ, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN. No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc 2014; 22 (3) 509-516
  • 35 Mahoney OM, Kinsey TL, D'Errico TJ, Shen J. The John Insall Award: no functional advantage of a mobile bearing posterior stabilized TKA. Clin Orthop Relat Res 2012; 470 (1) 33-44
  • 36 Lampe F, Sufi-Siavach A, Bohlen KE, Hille E, Dries SP. One year after navigated total knee replacement, no clinically relevant difference found between fixed bearing and mobile bearing knee replacement in a double-blind randomized controlled trial. Open Orthop J 2011; 5: 201-208 . doi:10.2174/1874325001105010201. [Epub 2011 May 27]
  • 37 Hanusch B, Lou TN, Warriner G, Hui A, Gregg P. Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomised controlled trial. Int Orthop 2010; 34 (3) 349-354
  • 38 Rjonild M, Soballe K, Hansen PM , et al. Mobile- vs fixed-bearing total knee replacement: a randomized radiosterometric and bone mineral density study. Acta Orthop 2015; 86 (2) 208-14
  • 39 Aglietti P, Baldini A, Buzzi R, Lup D, De Luca L. Comparison of mobile-bearing and fixed-bearing total knee arthroplasty: a prospective randomized study. J Arthroplasty 2005; 20 (2) 145-153
  • 40 Ranawat AS, Rossi R, Loretti I , et al. Comparison of PFC sigma fixed-bearing and rotating-platform total knee arthroplasty in the same patient. J Arthroplasty 2004; 19 (1) 39
  • 41 Ranawat AS, Ranawat CS, Slamin JE, Dennis DA. Patellar crepitation in the P.F.C. sigma total knee system. Orthopedics 2006; 29 (9, Suppl): S68-S70
  • 42 Meftah M, Ranawat AS, Ranawat CS. Ten-year follow-up of a rotating-platform, posterior-stabilized total knee arthroplasty. J Bone Joint Surg Am 2012; 94 (5) 426-432
  • 43 Moskal JT, Capps SG. Rotating-platform TKA no different from fixed-bearing TKA regarding survivorship or performance: a meta-analysis. Clin Orthop Relat Res 2014; 472 (7) 2185-2193
  • 44 Cheng M, Chen D, Guo Y, Zhu C, Zhang X. Comparison of fixed- and mobile-bearing total knee arthroplasty with a mean five-year follow-up: a meta-analysis. Exp Ther Med 2013; 6 (1) 45-51
  • 45 Li YL, Wu Q, Ning GZ , et al. No difference in clinical outcome between fixed- and mobile-bearing TKA: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (3) 565-575
  • 46 Choi WC, Ryu KJ, Lee S, Seong SC, Lee MC. Painful patellar clunk or crepitation of contemporary knee prostheses. Clin Orthop Relat Res 2013; 471 (5) 1512-1522
  • 47 Hamilton WG, Sritulanondha S, Engh Jr CA. Prospective randomized comparison of high-flex and standard rotating platform total knee arthroplasty. J Arthroplasty 2011; 26 (6, Suppl): 28-34
  • 48 Fukunaga K, Kobayashi A, Minoda Y, Iwaki H, Hashimoto Y, Takaoka K. The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteriorly stabilised total knee replacement. J Bone Joint Surg Br 2009; 91 (4) 463-468
  • 49 Carothers JT, Kim RH, Dennis DA, Southworth C. Mobile-bearing total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26 (4) 537-542
  • 50 Kim YH, Choi Y, Kim JS. Osteolysis in well-functioning fixed- and mobile-bearing TKAs in younger patients. Clin Orthop Relat Res 2010; 468 (11) 3084-3093
  • 51 Nguyen LC, Lehil MS, Bozic KJ. Trends in total knee arthroplasty implant utilization (e-pub ahead of print). J Arthroplasty 2014; ; doi: 10.1016/j.arth.2014.12.009