A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five-year follow-up

Abstract

This study compared the outcome of total knee replacement (TKR) in adult patients with fixed- and mobile-bearing prostheses during the first post-operative year and at five years' follow-up, using gait parameters as a new objective measure. This double-blind randomised controlled clinical trial included 55 patients with mobile-bearing (n = 26) and fixed-bearing (n = 29) prostheses of the same design, evaluated pre-operatively and post-operatively at six weeks, three months, six months, one year and five years. Each participant undertook two walking trials of 30 m and completed the EuroQol questionnaire, Western Ontario and McMaster Universities osteoarthritis index, Knee Society score, and visual analogue scales for pain and stiffness. Gait analysis was performed using five miniature angular rate sensors mounted on the trunk (sacrum), each thigh and calf. The study population was divided into two groups according to age (≤ 70 years versus > 70 years). Improvements in most gait parameters at five years' follow-up were greater for fixed-bearing TKRs in older patients (> 70 years), and greater for mobile-bearing TKRs in younger patients (≤ 70 years). These findings should be confirmed by an extended age controlled study, as the ideal choice of prosthesis might depend on the age of the patient at the time of surgery.

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

“…The minimal differences observed based on component design are consistent with previous reports that have been unable to demonstrate a difference in PS versus CR TKA [29,41], mobile bearing versus fixed bearing TKA [28,[30][31][32]49], high-flexion versus standard TKA [18], or sex-specific versus no-sex-specific TKA [7,42,59,61]. The poor results in young patients reported by Price et al [50] were achieved with implants and surgical techniques from more than 10 years ago and it is certainly possible that the improved level of satisfaction of our patients may be due, in part, to improvements in surgical technique and component design.…”

Does Insert Type Affect Clinical and Functional Outcome in Total Knee Arthroplasty? A Randomised Controlled Clinical Trial With 5-Year Follow-Up

“…For function [7][8][9][10], radiological outcome [8,11] and quality of life [7] generally no significant differences between both types of TKA were reported, although one meta-analysis did find lower pain scores in MB-TKA [27]. Furthermore, there are indications of an interaction with age, as younger patients tended to show better outcomes for the MB-TKA [13].…”

“…MB-TKA is assumed to cause less wear of the insert, associated with less loosening and revisions, and provide a more natural movement of the knee joint [3][4][5]. So far, studies have not been able to prove these theoretical advantages, with similar results in FB-TKA and MB-TKA when looking at in vivo kinematics [3,5,6], clinical function [7][8][9][10], quality of life (QoL) [7], radiological outcome [6,11] and gait parameters [12,13].…”

Reference-Free Automated Magnetic Sensor Calibration for Angle Estimation in Smart Knee Prostheses

“…To apply them for finding the optimal parameters of the problem (6), we first defined a cost function (Cost(β)) to fuse the constraints into the main objective (9). Here the constraint was plugged two times, once multiplied by the main objective to boost the effect of unsatisfied constraint in an exponential way, and once as a summation to be influential …”

“…The range of error is very high particularly for knee internal-external rotations with an RMS reaching 4° [7]. The importance of monitoring the IE rotation has been shown in case of mobile-bearing prosthesis [8], [9] which are designed to reduce the polyethylene wear via a better stress distribution. Body-fixed inertial sensors (e.g.…”