Role of Primary Bearing Type in Revision Total Knee Arthroplasty

Abstract

Although it has been shown that mobile- and fixed-bearing (FB) prostheses yield equivalent functional outcomes, wear patterns and debris types associated with mobile-bearing (MB) knees have been correlated to an increased prevalence of osteolysis. The complexity of revision surgery was compared between both designs. Several markers, including operative time, use of augmentation, bone grafts, and level of constraint, were analyzed. Data support that for failed total knee arthroplasty, there is a significant difference in mean time to revision between the MB (54.7 months) and FB types (80.6 months) (p ≤ 0.0001). MB knees more frequently required hinged implants during revision, potentially increasing the complexity of the procedure. This study raises concern for use of the MB implants, especially in younger patients who are more likely to require a future revision.

Keywords

revision total knee arthroplasty - complexity - mobile-bearing - fixed-bearing - osteolysis

• References

• 1 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (7) 1487-1497
• 2 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4) 780-785
• 3 Bozic KJ, Kurtz SM, Lau E , et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (1) 45-51
• 4 Maloney WJ. National Joint Replacement Registries: has the time come?. J Bone Joint Surg Am 2001; 83-A (10) 1582-1585
• 5 Saleh KJ, Santos ER, Ghomrawi HM, Parvizi J, Mulhall KJ. Socioeconomic issues and demographics of total knee arthroplasty revision. Clin Orthop Relat Res 2006; 446: 15-21
• 6 Mikulak SA, Mahoney OM, dela Rosa MA, Schmalzried TP. Loosening and osteolysis with the press-fit condylar posterior-cruciate-substituting total knee replacement. J Bone Joint Surg Am 2001; 83-A (3) 398-403
• 7 Mulhall KJ, Ghomrawi HM, Scully S, Callaghan JJ, Saleh KJ. Current etiologies and modes of failure in total knee arthroplasty revision. Clin Orthop Relat Res 2006; 446: 45-50
• 8 Peters Jr PC, Engh GA, Dwyer KA, Vinh TN. Osteolysis after total knee arthroplasty without cement. J Bone Joint Surg Am 1992; 74 (6) 864-876
• 9 Sheng P, Lehto M, Kataja M, Halonen P, Moilanen T, Pajamäki J. Patient outcome following revision total knee arthroplasty: a meta-analysis. Int Orthop 2004; 28 (2) 78-81
• 10 Kurtz SM, Ong KL, Schmier J , et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (Suppl. 03) 144-151
• 11 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
• 12 Buechel FF, Pappas MJ. The New Jersey Low-Contact-Stress Knee Replacement System: biomechanical rationale and review of the first 123 cemented cases. Arch Orthop Trauma Surg 1986; 105 (4) 197-204
• 13 Callaghan JJ, Insall JN, Greenwald AS , et al. Mobile-bearing knee replacement: concepts and results. Instr Course Lect 2001; 50: 431-449
• 14 Ball ST, Sanchez HB, Mahoney OM, Schmalzried TP. Fixed versus rotating platform total knee arthroplasty: a prospective, randomized, single-blind study. J Arthroplasty 2011; 26 (4) 531-536
• 15 Morra EA, Postak PD, Plaxton NA, Greenwald AS. The effects of external torque on polyethylene tibial insert damage patterns. Clin Orthop Relat Res 2003; (410) 90-100
• 16 Werner F, Foster D, Murray DG. The influence of design on the transmission of torque across knee prostheses. J Bone Joint Surg Am 1978; 60 (3) 342-348
• 17 Bohl JR, Bohl WR, Postak PD, Greenwald AS. The Coventry Award. The effects of shelf life on clinical outcome for gamma sterilized polyethylene tibial components. Clin Orthop Relat Res 1999; (367) 28-38
• 18 Kuster MS, Horz S, Spalinger E, Stachowiak GW, Gächter A. The effects of conformity and load in total knee replacement. Clin Orthop Relat Res 2000; (375) 302-312
• 19 Gioe TJ, Glynn J, Sembrano J, Suthers K, Santos ER, Singh J. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (9) 2104-2112
• 20 Kim Y-H, Kim D-Y, Kim J-S. Simultaneous mobile- and fixed-bearing total knee replacement in the same patients. A prospective comparison of mid-term outcomes using a similar design of prosthesis. J Bone Joint Surg Br 2007; 89 (7) 904-910
• 21 Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD, Jacofsky DJ. Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary total knee arthroplasties. Clin Orthop Relat Res 2004; (428) 221-227
• 22 Wohlrab D, Ditl J, Herrschelmann R, Schietsch U, Hein W, Hube R. [Does the NexGen LPS flex mobile knee prosthesis offer advantages compared to the NexGen LPS?—a comparison of clinical and radiological results]. Z Orthop Ihre Grenzgeb 2005; 143 (5) 567-572
• 23 Carothers JT, Kim RH, Dennis DA, Southworth C. Mobile-bearing total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26 (4) 537-542
• 24 Huang C-H, Ho F-Y, Ma H-M , et al. Particle size and morphology of UHMWPE wear debris in failed total knee arthroplasties—a comparison between mobile bearing and fixed bearing knees. J Orthop Res 2002; 20 (5) 1038-1041
• 25 Kobayashi A, Bonfield W, Kadoya Y , et al. The size and shape of particulate polyethylene wear debris in total joint replacements. Proc Inst Mech Eng H 1997; 211 (1) 11-15
• 26 Schmalzried TP, Campbell P, Schmitt AK, Brown IC, Amstutz HC. Shapes and dimensional characteristics of polyethylene wear particles generated in vivo by total knee replacements compared to total hip replacements. J Biomed Mater Res 1997; 38 (3) 203-210
• 27 Huang C-H, Ma H-M, Liau J-J, Ho F-Y, Cheng C-K. Osteolysis in failed total knee arthroplasty: a comparison of mobile-bearing and fixed-bearing knees. J Bone Joint Surg Am 2002; 84-A (12) 2224-2229
• 28 Gupta SK, Chu A, Ranawat AS, Slamin J, Ranawat CS. Osteolysis after total knee arthroplasty. J Arthroplasty 2007; 22 (6) 787-799
• 29 Post ZD, Matar WY, van de Leur T, Grossman EL, Austin MS. Mobile-bearing total knee arthroplasty: better than a fixed-bearing?. J Arthroplasty 2010; 25 (6) 998-1003
• 30 Kalisvaart MM, Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD. Randomized clinical trial of rotating-platform and fixed-bearing total knee arthroplasty: no clinically detectable differences at five years. J Bone Joint Surg Am 2012; 94 (6) 481-489
• 31 Lädermann A, Lübbeke A, Stern R, Riand N, Fritschy D. Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomised, clinical and radiological study with mid-term results at 7 years. Knee 2008; 15 (3) 206-210
• 32 Oh KJ, Pandher DS, Lee SH, Sung Joon Jr SD, Lee ST. Meta-analysis comparing outcomes of fixed-bearing and mobile-bearing prostheses in total knee arthroplasty. J Arthroplasty 2009; 24 (6) 873-884
• 33 Smith TO, Ejtehadi F, Nichols R, Davies L, Donell ST, Hing CB. Clinical and radiological outcomes of fixed- versus mobile-bearing total knee replacement: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2010; 18 (3) 325-340
• 34 Green TR, Fisher J, Stone M, Wroblewski BM, Ingham E. Polyethylene particles of a 'critical size' are necessary for the induction of cytokines by macrophages in vitro. Biomaterials 1998; 19 (24) 2297-2302
• 35 Stinson NE. The tissue reaction induced in rats and guinea-pigs by polymethylmethacrylate (acrylic) and stainless steel (18/8/MO). Br J Exp Pathol 1964; 45: 21-29
• 36 Stinson NE. Tissue reaction induced in guinea-pigs by particulate polymethylmethacrylate, polythene and nylon of the same size range. Br J Exp Pathol 1965; 46: 135-146
• 37 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
• 38 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
• 39 Engh GA, Zimmerman RL, Parks NL, Engh CA. Analysis of wear in retrieved mobile and fixed bearing knee inserts. J Arthroplasty 2009; 24 (6) )(Suppl): 28-32
• 40 Engh GA, Lounici S, Rao AR, Collier MB. In vivo deterioration of tibial baseplate locking mechanisms in contemporary modular total knee components. J Bone Joint Surg Am 2001; 83-A (11) 1660-1665
• 41 Parks NL, Engh GA, Topoleski LD, Emperado J. The Coventry Award. Modular tibial insert micromotion. A concern with contemporary knee implants. Clin Orthop Relat Res 1998; (356) 10-15
• 42 Ridgeway S, Moskal JT. Early instability with mobile-bearing total knee arthroplasty: a series of 25 cases. J Arthroplasty 2004; 19 (6) 686-693
• 43 Naudie DDR, Ammeen DJ, Engh GA, Rorabeck CH. Wear and osteolysis around total knee arthroplasty. J Am Acad Orthop Surg 2007; 15 (1) 53-64
• 44 Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am 2007; 89 (8) 1735-1741
• 45 Barrack RL, Nakamura SJ, Hopkins SG, Rosenzweig S. Winner of the 2003 James A. Rand Young Investigator's Award. Early failure of cementless mobile-bearing total knee arthroplasty. J Arthroplasty 2004; 19 (7) (Suppl. 02) 101-106