Abstract
We previously reported no clinical differences in short-term results in 26 patients that underwent fixed-bearing (FB) total knee arthroplasty in one knee followed by a rotating-platform (RP) version of the same implant in the contralateral knee at a later date. This study presents intermediate-term results in this unique cohort and uses optimised MRI for detection of particle disease in both knees.
Patients from the original series were asked to complete questionnaires regarding both knees. In addition, both knees were evaluated with optimised MRI, which has been shown to be useful in evaluating early particle disease and osteolysis before its appearance on radiographs.
Nine patients have been enrolled to date. At an average follow-up of 8.3 years for the FB side and 6.5 years for the RP side, no significant differences were found with respect to knee preference, pain, or overall satisfaction. Seven patients underwent MRI studies of both knees. Two FB knees demonstrated a massive intracapsular burden of particle disease (average 3066 mm3) with reactive synovitis, compared to no obvious particle disease in any RP knees. Osteolysis was seen around the femur in one FB knee and around the patella in two FB knees, compared to only around a single patella in the RP side.
RP knees continue to demonstrate excellent patient satisfaction that is comparable to clinical results of the FB design; however, FB knees demonstrate higher rates of particle disease and early osteolysis on MRI. This is the first study to demonstrate in vivo advantages of RP over FB designs. It is unclear whether this is due to the slightly longer follow-up period for the FB knees or a decreased wear rate in the RP design; these differences may become apparent with longitudinal follow-up.
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