الفهرس 
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Abstract
Introduction: Total knee replacement is the mainstay in the treatment of advanced arthritis of the knee by its ability to achieve relief of pain, increase function, and improve the quality of life. Indications of total knee arthroplasty continue to expand as advances in implant design and surgical technique have improved the outcomes. Current total knee prosthesis devices includes fixed-bearing knees, where the polyethylene tibial insert locked with tibial tray, and mobile-bearing designs which facilitate movement of the insert relative to the tray. Aim of work: Fixed bearing TKA achieved excellent gold standard 10- to-15 year outcomes. But, implant loosening and polyethylene wear were recognized as major causes of late failure. This aimed to be solved by introducing mobile-bearing knee prosthesis by providing both congruity and mobility in the tibiofemoral bearing surface. Patients and methods: The present study included 88 patients (120 knees) with painful arthritis of the knee joint in the period between November 2006 and July 2009. They scheduled for primary TKA, for participation in a prospective, randomized clinical trial, to compare between mobile bearing and fixed bearing TKA. Operations were performed at El Mansoura University Hospital by medial parapatellar approach under general or epidural anesthesia. Tabial and femoral components were cemented, and no patellar components were implanted. All cases were staged and not simultaneously done. Perioperative antibiotic prophylaxis, prophylaxis against deep venous thrombosis, postoperative nursing care, and rehabilitative protocols were identical for the two groups Results: There were no significant difference between fixed bearing and mobile bearing groups as regard to preoperative clinical evaluation (pain, range of motion, stability of the knee, knee score, function score and total score) and preoperative radiological evaluation. The all clinical and radiological parameters improved markedly postoperatively with no significant difference between both designs of study. The mean of the knee score showed improvement form 27.44 preoperatively, to the mean postoperative knee score of 89.93. In fixed bearing group, the mean of the knee score showed improvement form 27.23preoperatively, to the mean postoperative knee score of 91.5 and in mobile bearing group, the mean of the knee score showed improvement form 27.65preoperatively, to the mean postoperative knee score of 88.35. The knee score did not differ significantly (p = 0.88) between the groups, although both improved markedly (p < 0.0001) from the preoperative values. Conclusions: No significant difference between the fixed bearing and mobile bearing designs with regard to the range of motion, knee society clinical or functional scores, radiographic parameters, patient satisfaction, or revisions due to aseptic loosening in the reported time frame (two years-results). No benefit of one design over the other could be demonstrated in this patient population, but with longer follow-up of this population we may be able to address the wear issue. We believe that our results justify the continued use of both designs in this population.