Mobile-bearing total knee arthroplasty: better than a fixed-bearing?

The purported advantages of mobile-bearing knee include increased survivorship and restoration of more natural knee kinematics compared to a standard fixed-bearing design. To evaluate these claims, an extensive review of the available literature was undertaken. We compared survivorship and clinical function, including patient preference. We found no difference in survivorship at 12 to 23 years. Kinematic profiles of both designs did not differ significantly: rotation, flexion, and extension were comparable. Studies evaluating both designs in the same patient showed no difference in range of motion, knee preference, knee scores, and survivorship at midterm follow-up. Both designs were capable of producing excellent long-term results and clinical outcomes if properly implanted. The available evidence does not point to the superiority of one design over another in survivorship and clinical function.