Risk Factors for Aseptic Loosening After Total Knee Arthroplasty with a Rotating-Hinge Implant

Abstract

Background: Successful results have been reported in association with the use of a rotating-hinge prosthesis for primary total knee arthroplasty (TKA). The objective of the present study was to identify risk factors for aseptic loosening in patients who underwent primary TKA with rotating-hinge knee prostheses. Methods: The records of 1,235 patients who underwent primary TKA with a rotating-hinge prosthesis at our center were evaluated. A total of 125 patients who underwent revision were further evaluated according to the inclusion and exclusion criteria, and 33 patients who underwent revision because of aseptic loosening were then compared with a group of 30 patients who did not require revision surgery. All data, including radiographic measurements, were obtained from records prior to the primary TKA. Results: On the basis of our review of demographic, anthropometric, clinical, surgical, and radiographic findings, we found that higher body mass index (BMI) was associated with revision. The majority of patients with aseptic loosening had loosening of the femoral component. Furthermore, the inner femoral diameter at 20 cm proximal to the knee joint (on both anteroposterior and lateral images) was found to be predictive of revision among those with aseptic loosening. Receiver operating characteristic curve analysis showed that an inner diameter of the femur of >19 mm on anteroposterior images had a sensitivity of 91% and specificity of 87% for predicting the need for revision surgery in patients with aseptic loosening. Conclusions: This is one of few studies that has focused on determining risk factors for the failure of rotating-hinge prostheses following TKA surgery. Our findings indicate that a novel variable, the inner (diaphyseal) diameter of the femur at the point 20 cm proximal to the knee joint, is an extremely reliable predictor of revision surgery in patients with aseptic loosening. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A new robotically assisted system for total knee arthroplasty: A sheep model study

“…Approximately 20% of patients undergone manual TKA may complain of their clinical outcomes, and more than 6% of patients who underwent primary TKA need revision 5,33,34 . Successful TKA require an understanding of case‐specific anatomy and meticulous techniques to protect soft tissue, preserve joint balance, rebuild the mechanical axis and obtain range of motion 35,36 . The implementation of TKA is subject to technical thresholds and errors that potentially lead to joint instability, loosening or persistent pain 37–39 .…”

Reply to the Letter to Editor by Aliyev et al.: Think about the distal femoral anatomy differences!

“…Regarding the PJI diagnosis, all patients were diagnosed according to the standard pre-operative protocol of ENDO-Klinik [2] and the definition of PJI was made according to the first ICM criteria [3], as asked by Aliyev et alCorresponding to the second concern that the cement mantle thickness or the ratio of stem diameter to femoral canal diameter might be an independent risk factor is in general good aspects. In our previous study [4], aseptic loosening (AL) was significantly found higher in patients with a wider femoral inner diaphyseal parameter even in the in the setting of primary rotating hinge implants without any bone loss. In both studies [1,4], the ROKNEP Endo-Model (Waldemar…”

“…In our previous study [4], aseptic loosening (AL) was significantly found higher in patients with a wider femoral inner diaphyseal parameter even in the in the setting of primary rotating hinge implants without any bone loss. In both studies [1,4], the ROKNEP Endo-Model (Waldemar…”

“…The other sizes have a diameter of 7.4mm resulting in a diameter difference of 0.6mm. However, isolated tibial component loosening was relatively rare our previous study [4], because the tibial canal is thinner than the femoral canal. Therefore, we believe that a greater endocortical width is associated with aseptic loosening, since the difference of the inner diameter is greater than the 0.7 mm diameter difference.…”

Enhancing the radiological classification system from the distal femur to the proximal tibia

“…Subsequently, the novel radiological classi cation system, also known as Citak Classi cation, was introduced to the literature [5]. The Citak Classi cation divides the distal femur into three groups, where the population with a wider inner diaphyseal diameter is represented by type C with the highest risk for AL of the femoral component [9]. In this context, we aimed to identify anatomical variants of the proximal tibia shaft to develop a novel classi cation system for proximal tibia.…”