Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not a mobile-bearing vs. fixed-bearing total knee replacement affects post-operative knee pain at one year.

STUDY DESIGN: Review of three English language primary studies, published between 2008 and 2012.

DATA SOURCES: Three randomized controlled trials published after 2008 comparing post-operative knee pain in mobile vs. fixed-bearing total knee replacements using PubMed and Cochrane databases.

OUTCOMES MEASURED: Knee pain, reported by patients post-operatively using various professional questionnaires, was the primary outcome measured. Subjects reported pain experienced during specific provoking activities on the EuroQol, Western Ontario & McMaster Universities OA Index, Knee Society Score, visual analog scales, Oxford 12-item Questionnaire, and SF-36. Results were then compared one year postoperatively. The tool used to assess significance of outcomes measured was p-value.

RESULTS: One year post-operatively, Lampe et al showed no significant difference in post-operative knee pain in mobile vs. fixed-bearing knee replacements. Breugem et al demonstrated less knee pain when using the mobile-bearing implant. Jolles et al showed significantly less pain in the fixed-bearing knee implants in two of the questionnaires, but no difference in the three other evaluation methods, consequently deeming the study inconclusive.

CONCLUSIONS: The results of the RCTs are inconclusive in determining whether or not type of implant affects post-operative knee pain one year after a total knee replacement. Further research may identify one of the implants as more effective in a particular gender or race.

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