Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: A meta-analysis

Abstract

There is debate in the literature whether rotating hinge knee (RHK) or constrained condylar knee (CCK) prostheses lead to better clinical outcomes and survival rates in patients undergoing revision total knee arthroplasty (RTKA). The purpose of this meta-analysis is to compare the survivorship and clinical outcomes of RHK and CCK prostheses. In this meta-analysis, we reviewed studies that evaluated pain and function scores, range of motion (ROM), complications, and survival rates in patients treated with RHK or CCK with short-term (<5 years) or midterm (5–10 years) follow-up. The survivorship was considered as the time to additional surgical intervention such as removal or revision of the components. A total of 12 studies (one randomized study and 11 non-randomized studies) met the inclusion criteria and were analyzed in detail. The proportion of the knees in which short-term (<5 years) survival rates (RHK, 83/95; CCK, 111/148; odds ratio [OR] 0.52; 95% CI, 0.24–1.11; P = 0.09) and midterm (5–10 years) survival rates (RHK, 104/128; CCK, 196/234; OR 1.05; 95% CI, 0.56–1.97; P = 0.88) were evaluated did not differ significantly between RHK and CCK prostheses. In addition, there were no significant differences in ROM (95% CI: -0.40 to 9.93; P = 0.07) and complication rates (95% CI: 0.66 to 2.49; P = 0.46). In contrast, CCK groups reported significantly better pain score (95% CI: 0.50 to 2.73; P = 0.005) and function score (95% CI: 0.01 to 2.00; P = 0.05) than RHK groups. This meta-analysis revealed that 87.4% of RHK and 75.0% of CCK prostheses survive at short-term (<5 years), while 81.3% of RHK and 83.8% of CCK prostheses survive at midterm (5–10 years). The differences in standardized mean pain and function scores we detected were likely to be imperceptible to patients and almost certainly below the minimum clinically important level, despite a significant difference in both groups. Based on the findings of the current meta-analysis, RHK prostheses continue to be an option in complex RTKA with reasonable midterm survivorship.

Long-term outcomes of one single-design varus valgus constrained versus one single-design rotating hinge in revision knee arthroplasty after over 10-year follow-up

“…Shen et al [ 1 ] found no increase in the rate of infections or aseptic loosening with the use of hinges in AORI II and III defects in septic or aseptic revisions. Similar data were recently been published by Malcon et al and Yoon et al [ 27 , 29 ]. Our results differ from those of these authors, who found a significantly higher complication rate with the use of semi-constrained implants (CCK) (32/61) as compared to rotary hinged implants (12/56).…”

The knee prosthesis constraint dilemma: Biomechanical comparison between varus‐valgus constrained implants and rotating hinge prosthesis. A cadaver study

“…In their meta‐analysis, Malcolm et al 31 conclude that both implants have similar survival and functionality, although the revision rate in CCKs is 9% higher. Yoon et al 32 published similar results, but highlight the higher 5‐year survival rate of RHKs (87.4%) versus CCKs (75%). Many retrospective studies have found similar results in both prostheses in terms of joint mobility, functionality, survival and complications, but in most of these studies, TKA in the RHK group was more complex 7,10,33 .…”

Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

“…The rotating hinge knee implant models were variable. The meta-analysis revealed an overall survival rate of 81.3% for all RHK implants at the mid-term (5–10 years) follow-up [ 38 ].…”