Knee arthroplasty with rotating-hinge implant: an option for complex primary cases and revisions

Helito, Camilo Partezani; Giglio, Pedro Nogueira; Cavalheiro, Camila Maftoum; Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Camanho, Gilberto Luís

doi:10.1016/j.rboe.2017.01.010

Cited by 4 publications

(13 citation statements)

References 18 publications

(34 reference statements)

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“…In a European context, the use of RHK is more popular for historical reasons. More recent studies have thus conirmed good to very good survival rates with good function after implantation of constrained prostheses [3,4,7,9,15,16,21].…”

Section: Introductionmentioning

confidence: 92%

“…In contrast to this, VVC knees are commonly recommended in case of instability and produce better results than RHK [6, 11, 13, 15, 18]. RHK therefore have a selection bias in all publications, resulting from the fact that they are only used in disastrous cases as “salvage” implants [3, 4, 7, 9, 14, 21]. In a European context, the use of RHK is more popular for historical reasons.…”

Section: Introductionmentioning

confidence: 99%

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Good clinical and radiological results of total knee arthroplasty using varus valgus constrained or rotating hinge implants in ligamentous laxity

Röhner

Benad

Zippelius

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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PurposeThe optimal degree of constraint of a total knee arthroplasty for treatment of knee osteoarthritis with ligamentous laxity is under debate. While varus valgus constrained knees require a minimum level of ligamentous stability, rotating hinge knees can even be implanted if the collateral ligaments have been lost completely. It seems plausible that joint kinematics are determined by implant design in rotating hinge knees, whereas varus valgus constrained knees may be influenced by remaining stabilizers. This may result in more predictable clinical results of hinge knees. The hypothesis of the present study, therefore, was that stability and clinical outcome are better after total knee arthroplasty using rotating hinge knees than after using varus valgus constrained knees. MethodsAll patients who were treated using a mobile‐bearing varus valgus constrained knee or a rotating hinge knee for treatment of end‐stage osteoarthritis and ligamentous laxity were included. At follow‐up, clinical scores were determined (WOMAC, VAS, KSS, FJS, Lysholm). Furthermore, body mass index, operating time, and postoperative complications were documented. Whole leg radiographs as well as patella axial radiographs were analyzed for implant alignment and patella tracking. ResultsEighty‐five patients were included in this retrospective study. Both groups showed an average range of motion of 113°. No significant difference between the two groups was observed for any of the scores recorded. In the rotating hinge knee group, a more precise tibia positioning in relation to the mechanical axis but also a significant lateralisation and tilting of the patella were seen, compared with the varus valgus constrained knee group. ConclusionsRotating hinge knees did not perform better than mobile‐bearing varus valgus constrained knees clinically. Both prosthesis types showed equally good clinical outcomes with regard to stability, mobility, satisfaction, pain and operating time. Level of evidenceRetrospective case series, Level IV.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Good clinical and radiological results of total knee arthroplasty using varus valgus constrained or rotating hinge implants in ligamentous laxity

Röhner

Benad

Zippelius

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…35 In 2018, Helito et al indicated this implant for elderly patients with instability following TKA. 36…”

Section: Indications For Rotating Hinge Prostheses For Revision Tkamentioning

confidence: 99%

“…Table 2 shows the main data from the 15 publications between 2004 and 2018 on the Endo-Model rotating hinge prosthesis 22-36 . Figure 1 shows a rotating hinge knee prosthesis (Endo-Model) implanted as a primary TKA in an elderly patient with severe varus deformity.…”

Section: Indications For Rotating Hinge Prostheses For Revision Tkamentioning

confidence: 99%

Total knee arthroplasty using hinge joints: Indications and results

Rodríguez-Merchán¹

2019

EFORT Open Reviews

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Possible indications for a rotating hinge or pure hinge implant in primary total knee arthroplasty (TKA) include collateral ligament insufficiency, severe varus or valgus deformity (> 20°) with relevant soft-tissue release, relevant bone loss, including insertions of collateral ligaments, gross flexion-extension gap imbalance, ankylosis and hyperlaxity. The use of hinged implants in primary TKA should be limited to the aforementioned selected indications, especially for elderly patients. Potential indications for a rotating hinge or pure hinge implant in revision TKA include infection, aseptic loosening, instability and bone loss. Rotating hinge knee implants have a 10-year survivorship in the range of 51% to 92.5%. Complication rates of rotating hinge knee implants are in the range of 9.2% to 63%, with infection and aseptic loosening as the most common complications. Although the results reported in the literature are inconsistent, clinical results generally depend on the implant design, appropriate technical use and adequate indications. Considering that the revision of implants with long cemented stems can be challenging, in the future it would be better to use shorter stems in modular versions of hinged knee implants.Cite this article: EFORT Open Rev 2019;4:121-132. DOI: 10.1302/2058-5241.4.180056

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“…Helito et al investigated single rotating hinge knee implants prospectively and reported the KOOS after one-year follow-up. The study included only nine patients, however, and six of them were primary rotating hinge knee implants, and therefore it is difficult to compare them with KOOS [ 34 ]. We are unaware of any previous study that has reported the KOOS after revision RHK arthroplasty with mid-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

Hintze

Niemeläinen

Sintonen

et al. 2021

BMC Musculoskelet Disord

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Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

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Knee arthroplasty with rotating-hinge implant: an option for complex primary cases and revisions

Cited by 4 publications

References 18 publications

Good clinical and radiological results of total knee arthroplasty using varus valgus constrained or rotating hinge implants in ligamentous laxity

Good clinical and radiological results of total knee arthroplasty using varus valgus constrained or rotating hinge implants in ligamentous laxity

Total knee arthroplasty using hinge joints: Indications and results

Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

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