Early complications and causes of revision after rotating-hinge TKA

Rouquette, Louis; Batailler, Cécile; Muller, Bart; Neyret, Philippe; Servien, Elvire; Lustig, Sébastien

doi:10.1007/s00402-019-03290-9

Cited by 12 publications

(10 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[21] Even current generation RHKs such as the one used in this cohort were shown to be associated with high revision rates of 10-20% during the first 2 years when used in revision and complex primary cases. [7,8,22,23] There is an ongoing debate on, whether RHK should be used in complex primary cases. [9] Recent studies showed acceptable survival rates of 80-90% after Abbreviations: ASA American society of anesthesiologists, BMI body mass index, TKA total knee arthroplasty, RHK rotating hinge knee, ROM range of motion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases

Hecker

Pütz

Wangler

et al. 2022

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

Purpose The purpose of this study is to report and compare outcome data of both primary and revision cases using a rotating hinge knee (RHK) implant. Methods This study retrospectively analyzed 63 cases (19 primary, 44 revisions) at a mean follow-up of 34 ± 8 months after RHK implantation. Outcome parameters were stability, range of motion (ROM), loosening, Hospital of Special Surgery Score (HSS), Knee Society Score (KSS), Oxford Knee Score (OKS), EQ-5D-3L, and Visual Analog Scale (VAS) for overall function. Revision rates and implant survival are reported. Results Eleven percent showed medio-lateral instability < 5 mm, a mean ROM of 115° ± 17° and radiologic loosening occurred in 8% (2% symptomatic). PROMS showed the following results: HSS 79 ± 18, KSS 78 ± 27, OKS 26 ± 10, EQ-5D index 0.741 ± 0.233 and VAS 70 ± 20. Primary cases revealed better outcomes in HHS (p = .035) and OKS (p = 0.047). KSS, EQ-5D index and VAS did not differ between primary and revision cases (p = 0.070; p = 0.377; p = 0.117). Revision rate was 6.3% with an implant survival of 96.8%. Conclusions RHK arthroplasty can be performed with good clinical outcome and low revision rate in revision and complex primary cases. RHK is an option in cases where standard arthroplasty and even implants with a higher degree of constraint have reached their limits. Level of Evidence Level III, retrospective cohort study.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Due to these mechanical improvements, complications of hinged TKA decreased dramatically [ 14 ]. Nevertheless, heterogeneous results and frequency of complications have been reported [ 14 , 23 ]. A short-term (1–5 years) survival of up to 92% and mid-term (6–10 years) survival of up to 82% has been shown.…”

Section: Introductionmentioning

confidence: 99%

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases

Hecker

Pütz

Wangler

et al. 2022

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

show abstract

“…In 40 primary and revision rotating-hinge knees, one study found a 2-year survival rate of 95%. However, in a subgroup of 28 aseptic revision rotating-hinge knees, 46% (13 of 28) experienced complications (of which 14% [4 of 28] underwent revision for infection) [32]. Another study found a 5-year survival rate of 72% (94) in 131 patients after rotating-hinge knee implantation for aseptic or septic revision.…”

Section: Discussionmentioning

confidence: 99%

“…The associated loss of bone stock and compromise of stabilizing soft tissue during septic TKA revision often results in the use of hinged implants for sufficient stabilization [25,45]. The use of these implants is associated with frequent complications, and a correspondingly lower survival rate [32]. In 40 primary and revision rotating-hinge knees, one study found a 2-year survival rate of 95%.…”

Section: Survivorshipmentioning

confidence: 99%

See 1 more Smart Citation

What Is the Mid-term Survivorship of Infected Rotating-hinge Implants Treated with One-stage-exchange?

Ohlmeier

Alrustom

Citak

et al. 2021

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Despite the growing number of studies reporting on periprosthetic joint infection (PJI), there is little information on one-stage exchange arthroplasty for the revision of infected rotating-hinge prostheses, which can be among the most difficult PJI presentations to treat. Questions/purposes After one-stage direct exchange revision for an infected rotating-hinge TKA prosthesis, and using a multimodal approach for infection control, we asked: (1) What is the survivorship free from repeat revision for infection and survivorship free from reoperation for any cause? (2) What is the clinical outcome, based on the Oxford Knee Score, of these patients at the latest follow-up? Methods Between January 2011 and December 2017, we treated 101 patients with infected rotating-hinge knee prostheses at our hospital. All patients who underwent a one-stage exchange using another rotating-hinge implant were potentially eligible for this retrospective study. During that period, we generally used a one-stage approach when treating PJIs. Eighty-three percent (84 of 101) of patients were treated with one-stage exchange, and the remainder were treated with two-stage exchange. Of the 84 treated with one-stage exchange, eight patients died of unrelated causes and were therefore excluded, one patient declined to participate in the study, and another eight patients were lost before the minimum study follow-up of 2 years or had incomplete datasets, leaving 80% (67 of 84) for analysis in this study. The included study population consisted of 60% males (40 of 67) with a mean age of 64 ± 8 years and a mean (range) BMI of 30 ± 6 kg/m2 (21 to 40). The mean number of prior surgeries was 4 ± 2 (1 to 9) on the affected knee. Fifteen percent (10 of 67) of knees had a preoperative joint communicating sinus tract, and 66% (44 of 67) had experienced a prior PJI on the affected knee. The antimicrobial regimen was chosen based on the advice of our infectious disease consultant and individually adapted for the organism cultured. The mean follow-up duration was 6 ± 2 years. Kaplan-Meier survivorship analysis was performed using the endpoints of survivorship free from repeat revision for infection and survivorship free from all-cause revision. The functional outcome was assessed using the Oxford Knee Score (on a 12- to 60-point scale, with lower scores representing less pain and greater function), obtained by interviewing patients for this study at their most recent follow-up visit. Preoperative scores were not obtained. Results The Kaplan-Meier analysis demonstrated an overall survivorship free from reoperation for any cause of 75% (95% CI 64% to 87%) at the mean follow-up of 6 years postoperatively. Survivorship free from any repeat operative procedure for infection was 90% (95% CI 83% to 97%) at 6 years. The mean postoperative Oxford Knee Score was 37 ± 11 points. Conclusion With an overall revision rate of about 25% at 6 years and the limited functional results based on the poor Oxford Knee Scores, patients should be counseled to have modest expectations concerning postoperative pain and function level after one-stage exchange of an infected rotating-hinge arthroplasty. Nevertheless, patients may be informed about a reasonable chance of PJI eradication and might opt for this approach as a means to try to avoid high transfemoral amputation or joint arthrodesis, which in this population often is associated with the inability to ambulate at all. Regarding the relatively high number of patients with aseptic loosening, future studies might focus on implant design of revision knee systems as well. A longer course of oral antibiotics after such procedures may also be warranted to limit the chance of reinfection but requires further study. Level of Evidence Level IV, therapeutic study.

show abstract

The anatomical shape of the distal femur is an independent risk factor for aseptic loosening following one-stage septic knee revision using rotating hinge knee prosthesis

Scholz

Akkaya

Linke

et al. 2022

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Early complications and causes of revision after rotating-hinge TKA

Cited by 12 publications

References 24 publications

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases

What Is the Mid-term Survivorship of Infected Rotating-hinge Implants Treated with One-stage-exchange?

The anatomical shape of the distal femur is an independent risk factor for aseptic loosening following one-stage septic knee revision using rotating hinge knee prosthesis

Contact Info

Product

Resources

About