[Mobile-Bearing versus Fixed-Bearing Total Knee Arthroplasty: A Comparative Analysis of Long-Term Clinical and Implant Survival Outcomes].

Objective: The present study compared clinical outcomes, implant survival, and axial mobility between mobile-bearing (MB) and fixed-bearing (FB) prostheses in patients with medial knee osteoarthritis. Methods: A retrospective cohort study of 1,289 patients who underwent primary cemented total knee arthroplasty (TKA) from 2003 to 2022 was conducted. Mobile-bearing prostheses were used in 820 patients (mean follow-up: 8.1 years), and FB in 469 patients (mean follow-up: 15.2 years). Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Kujala scores. Range of motion and axial tibial rotation were clinically evaluated. Statistical tests included analysis of variance, t -tests, and Fisher's F-test (significance p  < 0.05). Results: Both groups showed significant functional improvement ( p  < 0.001). At the final follow-up, no significant differences were found between MB and FB in the IKDC or Kujala scores. Implant survival was 96.3% (MB) versus 95.7% (FB) ( p  = 0.67). Axial tibial rotation was significantly higher in MB (23.1 ± 4.5°) than in FB (19.4 ± 4.2°) ( p  = 0.003). No bearing dislocations occurred. Conclusion: Mobile-bearing and FB designs offer durable functional benefits. Although MB provided greater axial mobility, it did not result in superior functional outcomes or implant longevity. Prosthesis selection should be tailored to individual patient needs, surgeon preference, and cost. Further prospective studies are needed to define the clinical relevance of enhanced kinematics.