Thesis

Clinical investigation of the functional outcome of fixed bearing versus mobile bearing knees

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Awarding institution
  • University of Strathclyde
Date of award
  • 2022
Thesis identifier
  • T16234
Person Identifier (Local)
  • 201458326
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Department, School or Faculty
Abstract
  • Total Knee Arthroplasty is a high-volume and high-cost procedure, with persisting limitations to patient satisfaction. Prosthesis designs aim to restore function whilst providing stability, without joint constraint. This double-blinded randomised controlled trial is the first of its kind where the functional performance of a low congruent fixed (CR DD), ultra-congruent fixed (UC), and ultra-congruent mobile (UCR) bearing Columbus Total Knee Systems were assessed. The pre- and postoperative function of twenty-four osteoarthritic patients was evaluated against nine control participants whilst carrying out activities of daily living. Spatiotemporal, kinematic, and kinetic gait parameters during walking, stair navigation and sloped walking were extracted using fully instrumented motion capture. Questionnaire responses were also recorded. Across all ADLs, postoperative patient function improved, although not to control levels. The average postoperative increase in range of sagittal knee motion across all tasks came to: 7.3±3.1o (CRDD), 4.9±4.9o (UC), 0.7±7.7o (UCR), and peak knee flexion was mostly reduced at postoperative. Both fixed bearing implants presented larger post-surgery hip and ankle kinetics in magnitude, and improved distinction between knee adduction moment maxima, linked to improved loading to the mobile bearing group. Overall, the CRDD group showed more significant changes to preoperative and any significant inter-implant differences at post-surgery was also to this group. The UC and UCR groups showed less improvements during challenging activities, with the UCR group showing some limits to knee extension. The UCR group also self-reported more difficulty, pain, and tiredness than the fixed bearing groups. Kinematic cross talk error significantly impacted the interpretation of non-sagittal kinematics, and small and unequal sample sizes reduced statistical power. Despite the limitations it was concluded that both fixed bearing implants initially outperformed the mobile bearing joint and the CRDD group showed the most prominent improvements. Clinically relevant thresholds for all parameters, would further determine whether functional advantages exist between implant bearing types.
Advisor / supervisor
  • Murphy, Andrew
  • Riches, Philip
  • Childs, Craig
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DOI

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