TY  - JOUR
T1  - Risk of Revision for Fixed Versus Mobile-Bearing Primary Total Knee Replacements
AU  - Namba, Robert S.
AU  - Inacio, Maria C.S.
AU  - Paxton, Elizabeth W.
AU  - Ake, Christopher F.
AU  - Wang, Cunlin
AU  - Gross, Thomas P.
AU  - Marinac-Dabic, Danica
AU  - Sedrakyan, Art
Y1  - 2012/11/07
N1  - 10.2106/JBJS.K.01363
JO  - The Journal of Bone & Joint Surgery
SP  - 1929
EP  - 1935
VL  - 94
IS  - 21
N2  - Background: 
  Mobile-bearing total knee arthroplasty prostheses were developed to reduce wear and revision rates; however, these benefits remain unproven. The purposes of this study were to compare the short-term survivorship and to determine risk factors for revision of mobile-bearing and fixed-bearing total knee replacements.Methods: 
  A prospective cohort study of primary total knee arthroplasties performed from 2001 to 2009 was conducted with use of a community total joint replacement registry. Patient characteristics and procedure details were identified. Cox regression models were used. Bearing type was investigated as a risk factor for revision while adjusted for other risk factors such as age, American Society of Anesthesiologists (ASA) score, body mass index, sex, race, diagnosis, bilateral procedures, cruciate-retaining versus posterior-stabilized components, surgical approach, fixation, patellar resurfacing, hospital and surgeon volumes, and fellowship training.Results: 
  The study cohort consisted of 47,339 total knee arthroplasties, with 62.6% of the procedures in women. Fixed bearings were used in 41,908 knees (88.5%) and mobile bearings in 4830 (10.2%). Rotating-platform designs were used in all mobile-bearing total knee arthroplasties (3112 had a Rotating-Platform Press-Fit Condylar posterior-stabilized design; 1053, a Low Contact Stress [LCS] design; and 665, a Rotating-Platform Press-Fit Condylar cruciate-retaining design). Patients who received fixed-bearing total knee arthroplasty systems were older (mean age, 68.1 years) than those who received mobile-bearing total knee arthroplasty systems (mean age, 62.2 years); the difference was significant (p < 0.001). Overall, 515 knees (1.1%) were revised for reasons other than infection. The survival rate was 97.8% (95% confidence interval [CI], 97.4% to 98.0%) at 6.7 years. The adjusted risk of aseptic revision for the LCS total knee replacements was 2.01 times (95% CI, 1.41 to 2.86) higher than that for fixed-bearing total knee replacements (p < 0.001).There was no significant revision risk for the other mobile-bearing total knee arthroplasty systems. There was no association with surgeon and hospital case volumes and the risk of revision total knee arthroplasty.Conclusions: 
  Our study suggests the benefit of potential long-term wear reduction with the LCS implant may not be realized in a community-based setting, where a variety of surgical skills, surgical experience, and diverse patient demographic factors may affect early outcomes.Level of Evidence: 
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.K.01363
UR  - http://dx.doi.org/10.2106/JBJS.K.01363
ER  -