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Journal of Bone and Joint Surgery - British Volume, Vol 85-B, Issue 1, 62-67.
doi: 10.1302/0301-620X.85B1.13233  
Copyright © 2003 by British Editorial Society of Bone and Joint Surgery
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A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis

A MULTICENTRE SINGLE-BLIND RANDOMISED CONTROLLED TRIAL

A. J. Price, FRCS, Clinical Lecturer1; J. L. Rees, FRCS, Research Fellow1; D. Beard, DPhil, Clinical Scientist1; E. Juszczak, MSc, Clinical Statistician2; S. Carter, FRCS, Consultant Orthopaedic Surgeon3; S. White, FRCS, Consultant Orthopaedic Surgeon4; R. de Steiger, FRCS, Consultant Orthopaedic Surgeon5; C. A. F. Dodd, FRCS, Consultant Orthopaedic Surgeon1; M. Gibbons, FRCS Orth, Consultant Orthopaedic Surgeon1; P. McLardy-Smith, FRCS, Consultant Orthopaedic Surgeon1; J. W. Goodfellow, MS, FRCS, Honorary Consultant Orthopaedic Surgeon1; and D. W. Murray, MD, FRCS Orth, Professor of Orthopaedic Surgery1

1 Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
2 Centre for Statistics in Medicine (Oxford University), Institute of Health Sciences, Old Road, Oxford OX3 7LF, UK.
3 The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, UK.
4 The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobower, near Oswestry, Shropshire SY10 7AG, UK.
5 The Royal Melbourne Hospital, Flemington Road, Parkville 3052, Melbourne, Australia.

Correspondence should be sent to Mr A. J Price.

Before proceeding to longer-term studies, we have studied the early clinical results of a new mobile-bearing total knee prosthesis in comparison with an established fixed-bearing device. Patients requiring bilateral knee replacement consented to have their operations under one anaesthetic using one of each prosthesis. They also agreed to accept the random choice of knee (right or left) and to remain ignorant as to which side had which implant. Outcomes were measured using the American Knee Society Score (AKSS), the Oxford Knee Score (OKS), and determination of the range of movement and pain scores before and at one year after operation.

Preoperatively, there was no systematic difference between the right and left knees. One patient died in the perioperative period and one mobile-bearing prosthesis required early revision for dislocation of the meniscal component.

At one year the mean AKSS, OKS and pain scores for the new device were slightly better (p < 0.025) than those for the fixed-bearing device. There was no difference in the range of movement.

We believe that this is the first controlled, blinded trial to compare early function of a new knee prosthesis with that of a standard implant. It demonstrates a small but significant clinical advantage for the mobile-bearing design.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General