Elsevier

The Journal of Arthroplasty

Volume 28, Issue 9, October 2013, Pages 1551-1555
The Journal of Arthroplasty

Assessment of Reactive Synovitis in Rotating-Platform Posterior-Stabilized Design: A 10-Year Prospective Matched-Pair MRI Study

https://doi.org/10.1016/j.arth.2013.01.023Get rights and content

Abstract

This is the first long-term (mean 11.6 years), prospective, matched-pair study (based on age, gender, BMI and UCLA scores) using MAVRIC (multi-acquisition variable-resonance image combination) magnetic resonance imaging to analyze reactive synovitis and osteolysis between rotating-platform posterior-stabilized (RP-PS), fixed-bearing metal-back (FB-MB), and all-polyethylene tibial (APT) in active patients (24 total, 8 in each group, mean age of 64 years, mean UCLA of 8.5) with identical femoral component and polyethylene. Reactive synovitis was observed in 6 RP-PS (75%), all 8 FB-MB (100%), and 6 APT (75%). There was a significant difference between the RP-PS and FB-MB knees in volumetric synovitis (P = 0.023). Osteolysis with bone loss more than 4 mm was seen in 3 FB-MB, 2 APT and none for RP-PS. These were not statistically significant.

Section snippets

Material and Methods

From September 1999 to October 2001, 433 TKAs were performed in 3 consecutive cohorts of patients: 126 APT, 183 FB-MB, and 124 RP-PS knees, which were included in our prospective institutional database. A total of 58 patients had University of California Los Angeles (UCLA) activity scores of 5 or above. A power analysis was performed based on our prior pilot study using MRI to measure particle burden between RP-PS and FB-MB in the same patients [25]. We calculated that 8 matched pair cohorts

Results

The mean follow-up was 11.6 ± 0.7 years (range 10.2–13). There was no significant difference in WOMAC, KSS, or UCLA activity score at final follow-up among the three groups (Table 2). All patients were satisfied with a mean satisfaction score of 8.6 ± 2.5 (range 6.5–10). Sixteen patients (89%) were still participating in recreational activity with a UCLA score of 4 or above. There was no instability on physical exam in any patient. One patient in the RP-PS group had mild effusion on examination,

Discussion

The mobile-bearing knee design was introduced more than three decades ago [32]. The rotating platform is a unidirectional posterior stabilized knee that was designed to decrease the cross-shear forces, wear and fixation failure as compared to the fixed bearing design 4., 5., 24.. Despite the results of in-vitro studies showing reduction of wear 1., 2., 3., 4., 5. and a long-term clinical report demonstrating excellent survivorship for mechanical failures in RP-PS knees [24], superiority of this

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.01.023.

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