Objective To compare the clinical results of mobile-bearing and fixed-bearing prostheses in total knee arthroplasty (TKA) during 10 years follow-up so as to provide a reference for clinical selection of TKA prosthesis. Methods Between January 2002 and December 2005, 113 patients with osteoarthritis of the knee joint underwent primary TKA, and the clinical data were retrospectively analyzed. Mobile-bearing prosthesis was used in 47 cases (group A) and fixed-bearing prosthesis in 66 cases (group B). There was no significant difference in age, gender, body mass index, varus and flexion deformity of the knee, range of motion (ROM) of the knee, knee society score (KSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) between 2 groups before operation (P>0.05), so the data were comparable. Results The operation time of groups A and B was (88.1±6.5) and (90.3±7.2) minutes respectively, showing no significant difference (t=1.666,P=0.099). The wounds healed by first intention in all patients of both groups, and no postoperative early complications of incision infection and deep venous thrombosis occurred. The follow-up time was 10.2-12.3 years (mean, 10.8 years) in group A, and was 10.2-12.6 years (mean, 11.3 years) in group B. Revision was performed in 3 cases of group A and 4 cases of group B; the survival rates of prosthesis were 93.6% and 93.9% in groups A and B respectively, showing no significant difference (χ2=0.005,P=0.944). The postoperative knee ROM, KSS score, and WOMAC score were significantly improved when compared with preoperative ones (P<0.05). The knee ROM and KSS score of group B were significantly better than those of group A at 6 weeks after operation (P<0.05), but no significant difference was found between 2 groups at 1, 3, and 10 years after operation (P>0.05). The WOMAC score of group A was significantly better than that of group B at 10 years after operation (t=2.086,P=0.037), but no significant difference was shown at 6 weeks, 1 year, and 3 years after operation (P>0.05). At 10 years after operation, the excellent and good rate of KSS score was 87.2% in group A and was 84.8% in group B, showing no significant difference (χ2=0.018,P=0.893). Conclusion Good medium- and long-term clinical results can be achieved in TKA with both mobile-bearing and fixed-bearing prostheses. The TKA with fixed-bearing prosthesis is relatively simple with better early effectiveness of rehabilitation; and the TKA with mobile-bearing prosthesis could provide better long-term degree of satisfaction in WOMAC score, but a higher surgical skill and soft tissue balance techniques are needed.
Objective To investigate the early effectiveness of fixed-bearing unicompartmental knee arthroplasty (FBUKA) in patients with anterior cruciate ligament deficiency (ACLD), and to evaluate postoperative muscle strength and functional recovery through isokinetic muscle strength testing. Methods A retrospective analysis was performed on the clinical data of 181 patients with unilateral medial compartment knee osteoarthritis who underwent FBUKA treatment between January 2023 and June 2024 and met the selection criteria. According to the integrity of the anterior cruciate ligament, the patients were divided into the ACLD group (45 cases) and the anterior cruciate ligament intact (ACLI) group (136 cases). There was no significant difference in baseline data between the two groups (P>0.05), including age, gender, body mass index, affected side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, Lysholm score, and visual analogue scale (VAS) score. A standardized rehabilitation protocol was adopted after surgery. Isokinetic muscle strength parameters [peak torque (PT) and total work (TW) of quadriceps and hamstring, and hamstring-to-quadriceps ratio (H/Q) at angular velocities of 60°/s and 180°/s] and HSS score, Lysholm score, and VAS score were measured preoperatively and at 6 weeks, 3 months, 6 months, and 12 months after operation; posterior tibial slope (PTS) was measured at 12 months after operation. Results All patients were followed up 12-18 months, with a mean of 13.6 months. No complication such as aseptic loosening of the prosthesis, dislocation of the mobile bearing insert, infection, or revision occurred after operation. Isokinetic muscle strength testing showed that at angular velocities of 60°/s and 180°/s, the PT and TW of quadriceps and hamstring significantly decreased and H/Q increased in both groups at 6 weeks after operation when compared with preoperative values (P<0.05); then PT and TW increased gradually, and H/Q decreased gradually. Except for no significant difference at 3 months after operation compared with preoperative values (P>0.05), all indicators were significantly different from preoperative values at 6 and 12 months after operation (P<0.05). There was no significant difference in isokinetic muscle strength parameters between the two groups at any time point before and after operation (P>0.05). The HSS score, Lysholm score, and VAS score at each postoperative time point in both groups significantly improved when compared with preoperative values (P<0.05), and there was no significant difference in each score between the two groups at each postoperative time point (P>0.05). At 12 months after operation, the PTS in the ACLD group was significantly smaller than that in the ACLI group (P<0.05). Conclusion For ACLD patients without anteroposterior knee instability, the isokinetic muscle strength recovery trajectory and clinical functional scores after FBUKA are comparable to those of ACLI patients. For such patients, FBUKA can achieve satisfactory muscle strength and functional recovery, and isokinetic muscle strength testing can provide objective quantitative evidence for postoperative rehabilitation evaluation.