Rotating Hinge Implants for Complex Primary and Revision Total Knee Arthroplasty

Kearns, Seán; Culp, Brian M.; Bohl, Daniel D.; Sporer, Scott M.; Valle, Craig J. Della; Levine, Brett R.

doi:10.1016/j.arth.2017.10.009

Cited by 47 publications

(35 citation statements)

References 13 publications

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“…Kearns et al, 29 in their study of 79 knees (14 primary and 65 revision cases), found a high mortality and complication rate (38.7%). At five years, the probability of not undergoing re-operation was 70%.…”

Section: Outcomes Of Hinged Implants In Tka Revision (Table 1)mentioning

confidence: 95%

The role of rotating hinge implants in revision total knee arthroplasty

2019

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Hinged implants are the most constrained knee replacement prostheses. They are very useful in complex cases of total knee arthroplasty (TKA) revision. Hinged implants have evolved with rotating bearings and modularity that allows local joint reconstruction or segmental bone replacement. They are required when significant instability persists in cases with inadequate collateral ligaments and significant flexion laxity. They are now used when a large bone defect is reconstructed, or when bone fixation of the implant is questionable especially in the metaphyseal zone. The use of hinged implants in TKA revision is associated with high complication rates. Published outcomes differ based on the patients’ aetiology. The outcomes of rotating-hinged implants used in septic revisions or salvage situations are poorer than other types of revision and have a higher complication rate. The poor general health of these patients is often a limitation. Despite these relatively poor results, hinged implants continue to have a place in revision surgery to solve major instability or to obtain stable bone fixation of an implant when the metaphysis is filled with bone grafts or porous devices.Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180070

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Section: Outcomes Of Hinged Implants In Tka Revision (Table 1)mentioning

confidence: 95%

The role of rotating hinge implants in revision total knee arthroplasty

2019

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“…In 2018, Kearns et al studied 79 knees in 76 patients (16 men and 60 women) who underwent implantation of a rotating hinge knee of a single design for either a complex primary (14 knees) or revision TKA (65 knees). 68 The mean age of the patients was 66.7 years (39 to 89).The study included 19% undergoing a rotating hinge knee implantation for peri-prosthetic joint infection and 32.9% who had concomitant extensor mechanism repair. At a minimum of two years, 13 patients had died and four were lost to follow-up, leaving 62 knees in 59 patients who were followed for a mean of 55.2 months (24 to 146).…”

Section: Indications For Rotating Hinge Prostheses For Revision Tkamentioning

confidence: 99%

“…These authors stated that despite improvements in design and biomaterials, there remains a relatively high complication rate associated with the use of a modern rotating hinge knee implant. 68…”

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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“…The reasons for the increased periprosthetic fracture risk with HTKA prosthesis remains uncertain, although this complication has been noted in other small case series of HTKA prostheses. 7,[18][19][20] A recent biomechanical study has compared the bone stresses and implant micromotions of a HTKA to FSTKA prosthesis. 21 This study has demonstrated that HTKA prostheses have the highest implant to bone stress, especially at the tip of the stems.…”

Section: Discussionmentioning

confidence: 99%

“…In the primary setting, this difference was most evident in patients aged >75 years. The reasons for the increased periprosthetic fracture risk with HTKA prosthesis remains uncertain, although this complication has been noted in other small case series of HTKA prostheses 7,18–20 . A recent biomechanical study has compared the bone stresses and implant micromotions of a HTKA to FSTKA prosthesis 21 .…”

Section: Discussionmentioning

confidence: 99%

Survivorship of highly constrained prostheses in primary and revision total knee arthroplasty: analysis of 6070 cases

Knight

Lewis

Peng

et al. 2020

ANZ Journal of Surgery

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Background: Concerns exist about the survival and complication rates of highly constrained total knee arthroplasty (TKA) prostheses. The aims of this study were to determine if there were differences between the revision and complication rates of fully stabilized (FSTKA) and hinged (HTKA) TKA, when used in both primary and revision procedures. Methods: Survivorship of all highly constrained TKA prostheses implanted over a 17 year period were analysed by the Australian Orthopaedic Association National Joint Replacement Registry. The primary outcome measure was time to first revision using Kaplan Meier estimates of survivorship. Results: In the primary setting, the cumulative percent revision at 11 years was higher for HTKA than for FSTKA prostheses (P = 0.014). However, this finding was only significant for patient >75 years. In the revision setting, there were no differences in the revision rates for either category of prosthesis for any age group. For the indication of periarticular/periprosthetic fracture, HTKA resulted in a lower revision rate than FSTKA in both primary and revision cohorts. There were no differences in the rates of revision for infection and aseptic loosening for either prosthesis type in primary or revision settings. The revision risk for periprosthetic fracture was higher after HTKA prostheses. Conclusion: Both FSTKA and HTKA prostheses provide similar outcomes in primary and revision procedures except for the setting of periarticular/periprosthetic fracture, where a HTKA should be used. In elderly patients, a FSTKA prosthesis is recommended as the risk of periprosthetic fracture is higher with a HTKA.

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Rotating Hinge Implants for Complex Primary and Revision Total Knee Arthroplasty

Cited by 47 publications

References 13 publications

The role of rotating hinge implants in revision total knee arthroplasty

The role of rotating hinge implants in revision total knee arthroplasty

Total knee arthroplasty using hinge joints: Indications and results

Survivorship of highly constrained prostheses in primary and revision total knee arthroplasty: analysis of 6070 cases

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