Instructional Course Lecture   |    
Mobile-Bearing Knee Replacement Concepts and Results*†
John J. Callaghan, M.D.‡; John N. Insall, M.D.§; A. Seth Greenwald, D.Phil.(Oxon)#; Douglas A Dennis, M.D.**; Richard D. Komistek, Ph.D.**; David W. Murray, M.D., F.R.C.S.††; Robert B. Bourne, M.D.‡‡; Cecil H. Rorabeck, M.D.‡‡; Lawrence D. Dorr, M.D.§§
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
*Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
†One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding sources were Sulzer, Austin, Texas; DePuy, Warsaw, Indiana; and Johnson and Johnson, New Brunswick, New Jersey.
‡Department of Orthopaedics, University of Iowa College of Medicine, Iowa City, Iowa 52242. E-mail address for J. J. Callaghan: john-callaghan@uiowa.edu.
§170 East End Avenue, Fourth Floor, New York, N.Y. 10128.
#Orthopaedic Research Laboratories, Lutheran Hospital, Cleveland Clinic Health System, 1730 West 25th Street, Cleveland, Ohio 44113.
**Rose Musculoskeletal Research Laboratory, 2425 South Colorado Boulevard, Suite 280, Denver, Colorado 80222.
††Nuffield Orthopaedic Center, Windill Road, Headington, Oxford OX3 7LD, England.
‡‡London Health Science Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
§§Samaritan Hospital, 1245 Wilshire Boulevard, Second Floor, Los Angeles, California 90017.

J Bone Joint Surg Am, 2000 Jul 01;82(7):1020-1020
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Durable long-term fixation has been documented for many designs of fixed-bearing total knee replacement20,30,59,69. However, in the late 1970s and the early 1980s, implant fixation and polyethylene wear became recognized as long-term causes of late failure. Mobile-bearing knee replacements, with a polyethylene insert that articulates with a metallic femoral component and a metallic tibial tray, were designed to create a dual-surface articulation. This feature was intended to reduce the surface and subsurface stress states at the bearing surfaces and at the bone-implant surfaces by maximizing the conformity of the tibial and femoral components and allowing mobility of the bearing surface. We reserve the description "meniscal-bearing" for implants in which the femoral condyle is spherical and the bearing can function like its analogue in nature. These design features were developed to decrease the fatigue wear associated with failure of the polyethylene in knee arthroplasty. Currently, there are few intermediate-term follow-up reports and no long-term follow-up reports, as far as we know, on the use of these devices, but almost every manufacturer of total knee-replacement components is developing a product that they hope to introduce to the market. In this Instructional Course Lecture, we explore the rationale for the use of mobile-bearing knee devices and we update the clinical follow-up of these devices. The clinical results of use of the Oxford unicompartmental replacement (Biomet, Warsaw, Indiana), the Low-Contact Stress knee replacement (LCS; DePuy, Warsaw, Indiana), and the Self-Aligning knee replacement (SAL; Sulzer, Austin, Texas) are highlighted, as these devices have been followed for at least five years.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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