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J Am Acad Orthop Surg, Vol 9, No 6, November/December 2001, 355-364.
© 2001 the American Academy of Orthopaedic Surgeons
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Mobile Bearings in Primary Knee Arthroplasty

Christopher J. Vertullo, MBBS, FRACS(Ortho), Mark E. Easley, MD, W. Norman Scott, MD and John N. Insall, MD

Dr. Vertullo is Fellow, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC. Dr. Easley is Assistant Professor of Orthopaedic Surgery, Duke University Medical Center, Durham. Dr. Scott is Director, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY. Dr. Insall is Director, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine.

Reprint requests: Dr. Easley, Box 2950, Division of Orthopaedics, Duke University Medical Center, Durham, NC 27710.

Mobile-bearing knee arthroplasty (MBKA) has potential advantages compared with conventional fixed-bearing total knee arthroplasty (TKA). By allowing unconstrained axial rotation, MBKA can offer greater articular conformity without an increased probability of loosening due to increased axial torque. Increased articular conformity minimizes polyethylene contact stresses, thereby reducing linear wear and subsurface fatigue failure. Axial rotation of the platform also enables self-correction of tibial component malrotation. Despite these advantages, the long-term clinical results obtained with current MBKA devices are similar to those obtained with well-designed fixed-bearing TKA prostheses, with no data suggesting their superiority. The disadvantages of MBKA include bearing dislocation and breakage, soft-tissue impingement, a steep technique learning curve, and concerns about volumetric wear. Hypothetically, longer-term follow-up of MBKA results may reveal a significant difference from fixed-bearing TKA results as the fatigue failure threshold of incongruent polyethylene is exceeded.






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