Mobile bearing total knee arthroplasty does not lead to better joint awareness compared to fixed bearing design: A systematic review and meta-analysis.

Purpose: Mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing (FB) TKA are both widely used, with MB-TKA theoretically offering better functional outcomes due to its natural kinematics. This systematic review and meta-analysis aimed to compare joint awareness between MB-TKA and FB-TKA, as measured by Forgotten Joint Score-12 (FJS-12), to provide insights into patient-perceived outcomes.

Methods: A comprehensive literature search was conducted across major databases following PRISMA guidelines, without date or language restrictions. Studies focusing on TKA with MB or FB as the intervention and control groups, respectively, and reporting on FJS-12 were included. The selection process involved two independent reviewers. Data extraction was carried out using a structured checklist and assessed for quality using the Newcastle-Ottawa Scale (NOS). The meta-analysis employed Hedge's method to compare FJS-12 and assessed publication bias using Egger's test and funnel plot analyses.

Results: Six studies, including two randomized clinical trials and four cohort studies with 731 participants and mean follow-up of 5.4 years, met the inclusion criteria. The meta-analysis revealed no significant difference in FJS-12 between MB and FB TKA (pooled difference = 0.132, 95% confidence interval: -0.103 to 0.367,  = 0.271), with moderate heterogeneity observed (  = 53.5%). Publication bias assessment indicated no significant bias. Meta-regression did not identify factors contributing to heterogeneity.

Conclusion: MB-TKA does not provide superior patient-perceived outcomes in terms of joint awareness compared to FB-TKA. This suggests that the clinical advantage of MB-TKA in terms of joint awareness is likely negligible. Therefore, the choice between MB and FB TKA should be based on other considerations, such as surgeon preference, implant cost and individual patient needs.

Level Of Evidence: Level III.