Dislocation of Rotating Hinge Knee Prostheses

Case Report: Failure of Rotating-hinge Total Knee Prosthesis by Disengagement of the Hinge-post Extension

“…Despite these findings, major complication rates ranging from 0% to 44% at 3.8 to 15 years have been reported secondary to infection, aseptic loosening, patellar instability, and prosthetic dislocation [6,16]. Less common modes of failure also have been identified, including failure of the polyethylene bushing [20], fracture of the tibial metal post [18], fracture of the tibial yoke [8], failure of an antidislocation mechanism [12], and tibiofemoral distraction disengagement [21].…”

“…Additionally, diligent attempts at appropriate flexion and extension gap balancing should be done to minimize any residual instability at the time of implantation of a rotating-hinged knee prosthesis. Alternatively, a design in which the interlocking devices were not used in the rotating hinge could avoid this complication, although documented cases of distraction dislocation have occurred with such implant designs [21].…”

Failure rate of a rotating hinge knee design due to yoke fracture of the hinged tibial insert: a retrospective data analysis and review of the literature

“…There are several reports in the literature about dislocated rotating hinge knee prostheses but in most cases the dislocation was associated with implant breakage or fatigue failure of the tibial antidislocation device [5,10,11,16,18,22,24,26]. All authors hypothesized that excessive flexion gap instability and posterior dislocating forces were responsible for the mechanical failure of the yokes, indicating the need for an appropriated knee ligamentous balance, especially the flexion gap.…”

“…There are several reports in the literature, and in most of the cases dislocation is associated with breakage or fatigue failure of the implant's mechanical antidislocation device, such as the anti-subluxation plateau of the LINK® Endo Model™ (Wright Medical Technology, Arlington, TN) [5,10,11,16,18,22,24,26]. To our knowledge, there are only three publications in the literature reporting yoke fractures as a mechanical complication [11,19,20].…”

Long Term Outcome of Total Knee Arthroplasty. Condylar Constrained Prostheses

“…Controversy also exists concerning the use of a rotation hinge rather than a CCK. As mentioned above, McAuley et al [ 21 ] highlighted the risk of CCK dislocation when the soft tissue envelope presents gross instability rather than insuffi cient fl exion and extension gap balance in both varus and valgus knees. In such conditions a rotating hinge or even a hinge implant should be considered, given that numerous dislocations have been reported even in rotating hinge TKAs [ 21 ].…”