Comparative Study of the Function and Quality of Life of Patients Submitted to Total Knee Arthroplasty with Fixed and Mobile Tibial Platforms

Nacca, Daiane Cavenaghi; Amaro, Joicemar Tarouco; Miyahira, Mateus Kenji Christo; Novaretti, João Victor; Astur, Diego Costa; Cohen, Moisés

doi:10.1055/s-0040-1709989

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Original Articles, Knee • Rev. bras. ortop. 56 (1) • Jan-Feb 2021 • https://doi.org/10.1055/s-0040-1709989 copy

Comparative Study of the Function and Quality of Life of Patients Submitted to Total Knee Arthroplasty with Fixed and Mobile Tibial Platforms

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the function and quality of life of patients undergoing total knee arthroplasty (TKA) with fixed tibial platform and mobile tibial platform.

Methods

We evaluated 240 patients with knee osteoarthritis, randomized into two groups - Group A consisted of 120 patients who underwent TKA with fixed tibial platform, and the B group, consisting of 120 patients who underwent mobile platform arthroplasty. Patients were accessed according to the function and quality of life by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Short Form Health Survey (SF-36), and pain scores by visual analog scale (VAS) of pain, preoperatively and at 6 months, 1 year, 2 years, 4 years and 8 years of surgery.

Results

Regarding the various domains of the SF-36, we observed that the average behavior of functional capacity scores, physical aspects, pain and emotional aspects in the patient groups were statistically different during follow-up. The other domains of quality of life showed no mean differences. Regarding the pain assessed by VAS and WOMAC pain scores, we can see that it showed a mean change in follow-up in both patient groups. However, at 2 years of follow-up, they were statistically worse in group A, equaling group B in the other moments.

Conclusion

After 2 years of follow-up, we observed that pain scores and VAS were lower in the fixed platform group. However, these differences did not remain in the mid-term, suggesting that the mobile tibial platform arthroplasty has a short-term advantage, and may help in the rehabilitation process.

Keywords
arthroplasty, replacement, knee; quality of life; osteoarthrosis

Variable	Prosthesis type		Total (N = 240)	p Value
Variable	Fixed (N = 120)	Mobile (N = 120)	Total (N = 240)	p Value
Gender, n (%)
Female	96 (80)	100 (83.3)	196 (81.7)	0.505^* * Chi-squared test.
Male	24 (20)	20 (16.7)	44 (18.3)	0.505^* * Chi-squared test.
Operated side, n (%)
Right	64 (53.3)	57 (47.5)	121 (50.4)	0.366^* * Chi-squared test.
Left	56 (46.7)	63 (52.5)	119 (49.6)	0.366^* * Chi-squared test.
Age (years)
mean (SD)	65.9 (3.9)	65.4 (3.4)	65.7 (3.7)	0.369
median (P25; P75)	66 (63; 70)	65 (63; 68)	65 (63; 69)	0.369
Weight (Kg)
Mean (SD)	78.4 (12.1)	80.3 (13.5)	79.4 (12.8)	0.276
median (P25; P75)	78.5 (73; 85)	78.5 (71; 87)	78.5 (72; 86)	0.276
Height (m)
mean (SD)	1.62 (0.06)	1.62 (0.14)	1.62 (0.10)	0.320
median (P25; P75)	1.63 (1.6; 1.66)	1.63 (1.57; 1.67)	1.63 (1.59; 1,67)	0.320
BMI (Kg/m2)
mean (DP)	29.7 (4.2)	30.2 (5.1)	30 (4.7)	0.426
median (P25; P75)	29.5 (27.2; 32.3)	30.1 (27.2; 33.1)	29.7 (27.2; 32,9)	0.426

Variable	Moment	Prosthesis type						p Value Prosthesis type	p Value Moment	p Value Interaction
		Fixed			Mobile
		Mean	SD	N	Mean	SD	N
Functional capacity	Preoperative	20.22	18.10	120	17.17	14.79	120	0.219	<0.001	0.019
	6 months	57.54	19.47	120	62.79	19.39	120
	1 year	65.46	15.38	120	74.42	17.32	120
	2 years	68.37	16.76	120	73.88	16.71	120
	4 years	61.63	15.46	120	63.88	15.14	120
	8 years	51.46	16.72	120	55.46	16.09	120
Physical aspects	Preoperative	13.48	26.58	120	17.23	25.76	120	0.910	<0.001	0.536
	6 months	71.68	28.24	120	67.86	37.68	120
	1 year	77.08	24.38	120	73.96	31.49	120
	2 years	88.27	65.30	120	82.75	29.13	120
	4 years	84.77	23.00	120	75.43	35.65	120
	8 years	78.93	25.52	120	78.34	28.06	120
Pain	Preoperative	41.89	26.12	120	35.34	22.69	120	0.053	<0.001	0.004
	6 months	80.19	26.03	120	79.39	23.79	120
	1 year	75.41	30.97	120	86.20	18.29	120
	2 years	69.63	34.84	120	92.49	86.12	120
	4 years	76.72	28.09	120	81.05	19.50	120
	8 years	74.07	27.78	120	85.28	62.49	120
General Health Status	Preoperative	69.58	18.19	120	71.60	16.32	120	0.512	<0.001	0.167
	6 months	77.96	13.10	120	80.53	12.77	120
	1 year	78.10	12.54	120	76.38	15.23	120
	2 years	76.18	12.89	120	72.29	18.29	120
	4 years	77.21	14.26	120	75.18	15.45	120
	8 years	74.88	14.10	120	73.51	14.69	120
Vitality	Preoperative	68.03	18.79	120	68.45	19.16	120	0.366	<0.001	0.779
	6 months	78.64	14.60	120	78.14	15.10	120
	1 year	79.49	13.16	120	77.23	16.89	120
	2 years	78.36	14.18	120	75.43	17.09	120
	4 years	78.85	14.14	120	77.98	15.59	120
	8 years	79.56	16.12	120	77.98	15.93	120
Social Aspects	Preoperative	45.90	26.75	120	50.80	27.66	120	0.062	<0.001	0.080
	6 months	81.65	23.33	120	86.17	20.40	120
	1 year	84.28	23.08	120	87.68	20.49	120
	2 years	85.06	21.43	120	84.22	23.49	120
	4 years	83.60	22.30	120	84.38	24.01	120
	8 years	78.95	25.64	120	87.13	20.68	120
Emotional Aspects	Preoperative	52.68	45.09	120	40.26	45.11	120	0.771	<0.001	0.036
	6 months	73.54	36.84	120	81.40	35.59	120
	1 year	79.74	34.68	120	86.65	29.79	120
	2 years	92.98	109.76	120	86.61	30.13	120
	4 years	86.88	90.35	120	86.08	29.47	120
	8 years	81.36	30.33	120	87.21	27.42	120
Mental health	Preoperative	71.04	20.07	120	73.81	18.15	120	0.317	<0.001	0.484
	6 months	77.27	17.25	120	76.85	16.31	120
	1 year	76.87	17.04	120	77.20	13.12	120
	2 years	75.05	19.15	120	75.99	14.34	120
	4 years	75.09	19.65	120	78.43	14.58	120
	8 years	73.58	19.55	120	75.90	16.25	120

Variable	Moment	Prosthesis type						p Value Prosthesis type	p Value Moment	p Value Interaction
		Fixed			Mobile
		Mean	SD	N	Mean	SD	N
VAS for Pain	Preoperative	84.69	17.04	120	85.40	17.49	120	0.016	<0.001	<0.001
	6 months	26.43	22.13	120	24.70	22.43	120
	1 year	25.63	15.08	120	20.53	20.85	120
	2 years	28.83	19.40	120	16.57	18.97	120
	4 years	14.06	17.39	120	13.04	18.07	120
	8 years	13.78	16.37	120	10.56	16.59	120
WOMAC for Pain	Preoperative	13.60	3.86	120	14.04	3.42	120	0.032	<0.001	<0.001
	6 months	3.46	3.53	120	3.42	3.82	120
	1 year	3.86	3.30	120	2.67	3.91	120
	2 years	5.11	3.97	120	2.86	4.01	120
	4 years	2.91	3.06	120	2.24	3.92	120
	8 years	2.31	3.21	120	1.77	3.72	120
WOMAC function	Preoperative	43.64	13.91	120	45.36	12.60	120	0.037	<0.001	0.001
	6 months	14.11	11.78	120	10.94	9.45	120
	1 year	9.62	9.81	120	8.53	7.79	120
	2 years	8.83	9.81	120	7.11	7.39	120
	4 years	13.12	9.81	120	10.13	7.96	120
	8 years	21.37	10.90	120	18.31	8.47	120
WOMAC stiffness	Preoperative	4.40	2.43	120	5.01	2.34	120	0.198	<0.001	0.203
	6 months	1.38	1.66	120	1.31	1.40	120
	1 year	0.98	1.49	120	0.99	1.25	120
	2 years	0.88	1.49	120	0.58	1.00	120
	4 years	0.94	1.43	120	0.63	1.02	120
	8 years	0.93	1.49	120	0.68	1.04	120

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Mateus Kenji Christo Miyahira, Instituto Cohen, Av Lineu de Paula Machado 660, Cidade Jardim, São Paulo, SP, 05601-000, Brazil (e-mail: kenjimiyahira23@hotmail.com).