Noise Generation After Total Knee Arthroplasty: Comparison Between Mobile-Bearing and Cruciate-Retaining Designs with Minimum Two-Year Follow-Up

Background: The occurrence of noise after total knee arthroplasty (TKA), whether audible or perceived by the patient, is commonly reported during daily activities. Although generally benign and rarely associated with implant failure, such noise may negatively influence patient perception of surgical success and overall satisfaction. This study aimed to evaluate whether implant design affects the occurrence of prosthetic noise and to assess its relationship with patient satisfaction. Methods: A retrospective comparative study was conducted at a single orthopedic center, including patients who underwent primary TKA between 2020 and 2023 with a minimum follow-up of two years. Functional outcomes were assessed using the Simple Knee Value (SKV) and the International Knee Score (IKS). Prosthetic noise was evaluated using a validated questionnaire addressing noise perception during daily activities. Two implant designs were compared: mobile-bearing and cruciate-retaining prostheses. Results: A total of 212 patients were included. In the mobile-bearing group, 61.4% of patients reported no prosthetic noise compared with 62.1% in the cruciate-retaining group. Overall, 39% of patients perceived some degree of noise. Patients without perceived noise reported significantly higher satisfaction than those with noise, while functional outcomes (SKV and IKS) were comparable between groups. Conclusions: Within the limitations of this retrospective study, no statistically significant difference in prosthetic noise was detected between mobile-bearing and cruciate-retaining total knee arthroplasty designs. Prosthetic noise was associated with lower patient satisfaction but not with functional outcomes. These findings should be confirmed in adequately powered prospective studies. Level of evidence: III, retrospective comparative study.