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Intervention Review

Mobile bearing vs fixed bearing prostheses for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis

  1. Wilco Jacobs1,*,
  2. Patricia G Anderson2,
  3. Jacques van Limbeek3,
  4. Ate AB Wymenga4

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 23 APR 2001

Assessed as up-to-date: 15 FEB 2001

DOI: 10.1002/14651858.CD003130.pub2


How to Cite

Jacobs W, Anderson PG, van Limbeek J, Wymenga AAB. Mobile bearing vs fixed bearing prostheses for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003130. DOI: 10.1002/14651858.CD003130.pub2.

Author Information

  1. 1

    Sint Maartenskliniek, Research, Development & Education, Nijmegen, Netherlands

  2. 2

    Sint Maartenskliniek, Orthopedic Research Unit, Nijmegen, Netherlands

  3. 3

    Sint Maartenskliniek, Rehabilitation Center Sint Maartenskliniek, Nijmegen, Netherlands

  4. 4

    Sint Maartenskliniek, Orthopedics, Nijmegen, Gelderland, Netherlands

*Wilco Jacobs, Research, Development & Education, Sint Maartenskliniek, Hengstdal 3, PO Box 9011, Nijmegen, 6523RV, Netherlands. w.jacobs@maartenskliniek.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The polyethylene insert in a total knee replacement (TKR) can be fixed to the tibial plateau or it can have freedom of rotation and / or translation. It is not yet clear whether there are differences in functional or clinical results between the two prosthesis types.

Objectives

The goal of this review is to assess if a mobile bearing total knee prosthesis provides a better range of motion (ROM) and a better functional outcome than a fixed bearing prosthesis in patients with rheumatoid arthritis or osteoarthritis after total knee arthroplasty.

Search methods

We searched the Cochrane Library (issue 2002-3), Current contents (1996 to September 2002), and MEDLINE (1966 to September 2002). Reference lists of selected articles were also included.

Selection criteria

Randomised controlled trials or controlled clinical trials were selected which used a functional or clinical outcome measure comparing mobile (rotating and/or sliding) with fixed bearing types.

Data collection and analysis

Data was collected on relevant demographic data and functional outcome measures like Range of Motion, specific measures of activities with daily tasks, and composite knee scores such as Knee Society Score, Hospital for Special Surgery score and similar scores. Only controlled studies comparing a fixed bearing with a mobile bearing type of TKP were considered.

Main results

Two randomised studies were encountered evaluating the difference in functional or clinical outcome of the two prosthesis types. The methodological quality of the studies was low. The study with the best quality found no difference in ROM, but found a superiority of the mobile bearing on Knee Society Score and Oxford Knee Score and the pain sub scores of these clinical measures. The second study found no differences.

Authors' conclusions

We could find no evidence of superiority for one of the two prosthesis types with regard to ROM or functional performance of the patients. The majority (96%) of patients in the 2 included studies had OA. Therefore, the results reflect primarily results in OA patients.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Which type of knee implant is better in Total Knee Replacement surgery for osteoarthritis and rheumatoid arthritis of the knee: mobile or fixed bearing?

To answer this question, scientists analysed 2 studies that tested over 150 people with osteoarthritis of the knee (6 had rheumatoid arthritis). These people had total knee replacement surgery with either a mobile or fixed bearing knee implant and were studied 1 or 7 years after the surgery. These studies provide the best evidence we have today.

What is osteoarthritis and rheumatoid arthritis of the knee and what types of knee implants are there?

Osteoarthritis and rheumatoid arthritis are two forms of arthritis that can affect the knees. In some people, damage and pain in the knee from arthritis may be severe enough for surgery. In these people, the whole knee joint can be replaced by an artificial joint or knee implant. In total knee replacement surgery the ends of the long bones of the leg are usually replaced with metal ends and an insert is placed in between them. The insert can either be "fixed" into place on the end of one bone or not as fixed which makes the insert more movable or "mobile". It is thought that people with a mobile bearing may be able to move their knee more and function better than people with a fixed bearing.

What did the studies show?

The two studies show that the range of motion/movement of the knee was about the same in people who had a fixed or mobile bearing knee implant. The year long study shows that slightly more people with a mobile bearing knee implant had less pain and better function than with a fixed bearing knee implant. But the seven year long study showed no differences in pain or function between the mobile or fixed bearing knee implants.

What is the bottom line?

The level of quality of the 2 studies in this review is "silver". It appears that mobile bearing knee implants provide the same amount of range of motion/movement and pain relief as fixed bearing implants in total knee replacement for osteoarthritis and rheumatoid arthritis of the knee. Ability to function with either type of implant is also the same.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用移動式或固定式的人工關節在患有骨關節炎及類風濕性關節炎需要全膝關節置換的病患手術後之功能狀態

在全膝關節置換術 (total knee replacement; TKR)中置入聚乙烯可以將其固定在脛骨高原上,或是可以使其自由旋轉移動。 目前尚未釐清到底在兩種人工關節之間在功能上或是臨床上有無不同。

目標

本篇文獻回顧的目標是檢視移動性的膝人工關節是否在患有類風濕性關節炎或骨關節炎的病患身上比起固定式人工關節還要能夠提供較佳的活動性 (range of motion; ROM)及較好的功能性結果。

搜尋策略

我們搜尋了the Cochrane Library (issue−3 2002年)、Current contents (1996年 2002年9月),以及 MEDLINE (1966年 2002年9月)。所挑選的文章的參考文獻也被納入。

選擇標準

我們納入了使用測量功能性及臨床性結果的隨機對照試驗或對照臨床試驗來比較移動性的膝人工關節(旋轉和/或滑動)及固定式的膝人工關節

資料收集與分析

我們從相關的人口統計學的數據中來收集數據,而功能性結果則以活動範圍、日常生活活動的精細測量、綜合性膝蓋量表(例如 Knee Society Score 、 Hospital for Special Surgery score 、或其他相似量表)來做測量。 僅納入比較膝關節置換術的固定式人工關節及移動式人工關節的對照性試驗。

主要結論

兩個隨機試驗被用來評估使用固定式人工關節或移動式人工關節術後兩者之間的功能性或臨床性結果。 這些試驗的統計方法品質相當低。 在這些當中擁有最佳品質的研究並沒有在活動範圍中發現任何不同,但是卻發現了使用移動式人工關節後在 Knee Society Score 和Oxford Knee Scor上表現較佳,除此之外其疼痛指數也較低。 第二佳的研究卻無顯示任何不同。

作者結論

我們並未發現任何證據證明哪一種的人工關節在促進病患活動範圍或功能性表現時較佳。 在兩個被納入的試驗中絕大多數的病患(96%)患有骨關節炎。因此,這些試驗結果可以反映出大部份的骨關節炎病患術後的結果。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在治療膝蓋患有骨關節炎及類風濕性關節炎的病患身上使用全膝關節置換術,那一種的人工關節較佳呢: 移動式還是固定式的人工關節? 為了要回答這個問題,科學家分析了兩個測試超過150位患有膝蓋骨關節炎患者的研究(六位患有類風濕性關節炎)。這些人皆在全膝關節置換術的手術時使用過移動式或是固定式的人工關節,並且在術後1到7年不等接受了研究。 這些研究我們現今的醫學提供了最佳的證據。 到底什麼是骨關節炎及類風濕性關節炎而到底又有哪些種類的膝蓋植入物呢? 骨關節炎及類風濕性關節炎是兩種會影響膝蓋的關節炎。 在某些人身上,由關節炎所導致的膝蓋損傷及疼痛也許會嚴重到需要用手術來治療。 在這些人身上,我們可以使用人工關節或膝蓋植入物來替換整個膝關節。 在全膝關節置換術中,在大腿骨的末端我們通常會用金屬頭來替換,並在中間放置一個插入物。 這個插入物可以被固定在長骨末端成為”固定式“,或不固定在骨頭末端而使得其成為”可移動式“。 一般認為裝了可移動式人工關節的病患也許比較能夠活動它們的膝蓋並比固定式補體術的病患功能還要來的好。 然而這些研究結果顯示了什麼? 這兩項試驗不論在固定式或可移動式人工關節的病患身上都顯示了相同的膝蓋活動範圍。 以年為計算單位的研究顯示僅有少數的裝有移動式補體術的病患比起那些裝有固定式補體術的病患會有降低疼痛並有功能較佳的效果。 但那項為時七年的研究顯示在疼痛及功能性上兩者並無顯著差異。 底線為何? 在本篇文獻回顧中的兩項研究的品質水平約為”銀級”。 這表示在膝蓋患有骨關節炎及類風濕性關節炎的病患身上使用全膝關節置換術治療後置入的可移動式人工關節在促進病患活動範圍及緩解疼痛上與固定式人工關節並無兩樣。 在功能性上這兩種植入物也並無差異。