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

Abstract

Purpose Rotating hinge knee prostheses are known to provide inherent stability. Yoke fractures of the hinged tibial insert of modern generation rotating hinge devices are a matter of continued concern. The aim of this study was to describe incidence and management of yoke fracture of the LPS™ hinged tibial insert. Methods Retrospective data analysis of two institutions identified 40 patients with a LPS™ total knee arthroplasty. Implant survival and prosthetic complications was calculated according to Kaplan-Meier.Results Out of the group of 40 patients, four fractures of the metal yoke occurred in four cases (failure rate: 10%). Furthermore, a second fracture occurred in two patients. The overall revision-free prosthetic survival was 57% at 38 months, while prosthetic survival until yoke fracture was 86% at 38 months. Conclusion Handling yoke fractures as mechanical complication includes replacing the hinged insert, stabilization of the joint and joint line height preservation in order to decrease the cantilever effect at the insert-base plate interface.

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].…”

Modular acetabular reconstructive cup in acetabular revision total hip arthroplasty at a minimum ten year follow-up

“…the survival of 43 % at 15 years in 21 hips [3] and 64.5 % at five years in 62 hips [16]. One of the reasons for poor results is mechanical failure [17] such as screw breakage [3] and hook and side plate breakage [16] of the uncemented non-porous metal-backed prosthesis with augmentation. On the other hand, an improved modular acetabular cup system including porous metal components [18] and components composed of a flanged metal socket, an iliac lag screw, and an ischial peg [7] has been reported; the latter modular acetabular reconstructive cup with hydroxyapatite granules grafting showed the survival of 74.2 % at 11 years with aseptic loosening as the endpoint [7].…”

Posterior Dislocation of the Hinge-Post Extension in a Rotating Hinge Total Knee Prosthesis

“…Failure of rotating hinge arthroplasty due to hinge dislocation has been widely published in the literature [7–12]. Most cases reported describe failure due to component fracture with an incidence of 2% to 10% [5, 7, 8, 13, 14].…”

“…Most cases reported describe failure due to component fracture with an incidence of 2% to 10% [5, 7, 8, 13, 14]. C. J. Wang and H. E. Wang reported breakage of the polyethylene bearing bush of the femoral channel component on the metallic tibial stud within 5 months from implantation of an Endo-Model arthroplasty (Waldemar Link GmbH & Co., Hamburg, Germany) [9].…”

“…In 2011, Schwarzkopf et al reported 2 cases of fracture of the tibial post in a DePuy S-ROM prosthesis (DePuy, Warsaw, IN USA). Subsequently, Friesenbichler et al reported fracture of the tibial metal yolk in patients with an LPS knee system (DePuy, Warsaw, IN USA) [7]. Recently, Chuang and colleagues reported failure of a rotating hinge megaprosthesis due to breakage of the tibial polyethylene stopper [14].…”