Fixed Bearings versus Rotating Platforms in Total Knee Arthroplasty

White, Peter B.; Ranawat, Amar S.; Ranawat, Chitranjan S.

doi:10.1055/s-0035-1550338

Cited by 10 publications

(7 citation statements)

References 48 publications

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“…Recently, the in vitro reduction of torque forces, demonstrated when using a rotating platform, has encouraged some surgeons to use this implant in younger patients with higher impact forces, and in revision operations using constrained implants for poor bone stock (White et al. 2015 , Small et al. 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Increased risk of aseptic loosening for 43,525 rotating-platform vs. fixed-bearing total knee replacements

et al. 2017

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Background and purpose — Given similar functional outcomes with mobile and fixed bearings, a difference in survivorship may favor either. This study investigated the risk of aseptic loosening for the most used subtypes of mobile-bearing rotating-platform knees, in Norway and Australia.Patients and methods — Primary TKRs reported to the Norwegian and Australian joint registries, between 2003 and 2014, were analyzed with aseptic loosening as primary end-point and all revisions as secondary end-point. We hypothesized that no difference would be found in the rate of revision between rotating-platform and the most used fixed-bearing TKRs, or between keeled and non-keeled tibia. Kaplan–Meier estimates and curves, and Cox regression relative risk estimates adjusted for age, sex, and diagnosis were used for comparison.Results — The rotating-platform TKRs had an increased risk of revision for aseptic loosening compared with the most used fixed-bearing knees, in Norway (RR =6, 95% CI 4–8) and Australia (RR =2.1, 95% CI 1.8–2.5). The risk of aseptic loosening as a reason for revision was highest in Norway compared with Australia (RR =1.7, 95% CI 1.4–2.0). The keeled tibial component had the same risk of aseptic loosening as the non-keeled tibia (Australia). Fixation method and subtypes of the tibial components had no impact on the risk of aseptic loosening in these mobile-bearing knees.Interpretation — The rotating-platform TKRs in this study appeared to have a higher risk of revision for aseptic loosening than the most used fixed-bearing TKRs.

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Section: Discussionmentioning

confidence: 99%

Increased risk of aseptic loosening for 43,525 rotating-platform vs. fixed-bearing total knee replacements

et al. 2017

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“…It is likely that even if backside wear was included, RP wear would not exceed FB wear. 40 In fact, some previous retrieval 27 and experimental 28 studies found lower total, and even backside, wear rates for RP than FB implants.…”

Section: Discussionmentioning

confidence: 97%

The influence of implant design and limb alignment on in vivo wear rates of fixed‐bearing and rotating‐platform knee implant retrievals

Dreyer,

Weisse,

Contreras Raggio

et al. 2023

Journal Orthopaedic Research

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Analysis of polyethylene wear in knee implants is crucial for understanding the factors leading to revision in total knee arthroplasty. Importantly, current experimental and computational methods for predicting insert wear can only be validated against true in vivo measurements from retrievals. This study quantitatively investigated in vivo polyethylene wear rates in fixed‐bearing (n=21) and rotating‐platform (n=53) implant retrievals. 3D surface geometry of the retrievals was measured using a structured light scanner. Then, a reference surface that included the deformation, but not the wear that the retrievals had experienced in vivo, was constructed using a fully automatic surface reconstruction algorithm. Finally, wear volume was calculated from the deviation between the worn and reconstructed surfaces. The measurement and analysis techniques were validated and the algorithm was found to produce errors of only 0.2% relative to the component volumes. In addition to quantifying cohort‐level wear rates, the effect of mechanical axis limb alignment on mediolateral wear distribution was examined for a subset of the retrievals (n=14+26). Our results show that fixed‐bearing implants produce significantly (p=0.04) higher topside wear rates (24.6±10.1 mm3/year) than rotating‐platform implants (15.3±8.0 mm3/year). This effect was larger than that of limb alignment, which had a smaller and non‐significant influence on overall wear rates (+4.5±11.6 mm3/year, p=0.43). However, increased varus alignment was associated significantly with greater medial compartment wear in both the fixed‐bearing and rotating‐platform designs (+1.7±1.3 %/° and +1.8±1.6 %/°). Our findings emphasize the importance of implant design and limb alignment on wear outcomes, providing reference data for improving implant performance and longevity.This article is protected by copyright. All rights reserved.

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“…Mobile-bearing systems such as rotating-platform TKAs were aimed at correcting these deficiencies. They were originally developed to provide dual-surface articulation that uncouples axial and translational forces of the knee [1]. Uncoupling of these forces was thought to reduce loosening rates of fixed-bearing designs, provide more normal kinematics, and increase survivorship [1].…”

Section: Discussionmentioning

confidence: 99%

“…They were originally developed to provide dual-surface articulation that uncouples axial and translational forces of the knee [1]. Uncoupling of these forces was thought to reduce loosening rates of fixed-bearing designs, provide more normal kinematics, and increase survivorship [1]. Although kinematic motion analysis supports the use of mobile-bearing TKAs, clinical studies have failed to report increased efficacy of mobile-bearing TKAs vs. fixed-bearing systems [6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous 180-Degree Rotatory Dislocation of Rotating-Platform Total Knee Arthroplasty

Sierra

Akalonu

West

et al. 2019

Case Reports in Orthopedics

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Rotating-bearing total knee arthroplasty has been theorized to have some advantages in the kinematics and wear characteristics of total knee arthroplasty. A rare complication of rotating-bearing total knee arthroplasty is rotary dislocation, spinout, of the polyethylene component. When these dislocations occur, they typically result in a 90-degree dislocation in respect to the axial axis of the knee. This case is unique in that it presents a complete 180-degree polyethylene dislocation without trauma.

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Fixed Bearings versus Rotating Platforms in Total Knee Arthroplasty

Cited by 10 publications

References 48 publications

Increased risk of aseptic loosening for 43,525 rotating-platform vs. fixed-bearing total knee replacements

Increased risk of aseptic loosening for 43,525 rotating-platform vs. fixed-bearing total knee replacements

The influence of implant design and limb alignment on in vivo wear rates of fixed‐bearing and rotating‐platform knee implant retrievals

Spontaneous 180-Degree Rotatory Dislocation of Rotating-Platform Total Knee Arthroplasty

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