Rotating Hinged Total Knee Replacement

Abstract

The present study highlights the commonly held opinion that a modular kinematic rotating hinged total knee prosthesis has a role for salvage reconstruction of the knee. In light of the relatively high rate of complications, we believe that this salvage procedure should be reserved primarily for elderly and sedentary patients.

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

“…Studies with structural allografts and tumor megaprostheses during revision knee arthroplasty have reported encouraging mid-term results, but the high number of complications is a concern. Complications with these techniques include infection, graft resorption, nonunion, failure of graft incorporation, concerns regarding disease transmission, aseptic loosening, and periprosthetic fracture [1,7,14,17,33]. Although the short-term results with tantalum cones have been promising [9,18,21,23,24,26,[34][35][36]42], to our knowledge, there have been no studies reporting mid-term outcomes with their use.…”

“…Major tibial and femoral bone defects, classified as Anderson Orthopaedic Research Institute (AORI) [10] Types 2B and 3, have been reconstructed using impaction bone grafting with or without mesh augmentation [22,25,38,40,44], structural or bulk allografts [7,11,14,16,17,28,31,39], modular metal augmentations of prostheses [15,32], and tumor-type megaprostheses [2]. Studies using structural allografts have reported numerous complications and minimum 5-year survivorship of 67% to 96% [1,6,7,14,17], whereas reconstructions with tumor-type megaprostheses have shown a 5-year survivorship of 68% [33]. Although there have been studies reporting encouraging mid-term results with these treatment options [6,43], the best method has not been established [10].…”

Distal Femoral Replacement in Nontumor Cases with Severe Bone Loss and Instability

“…Many authors have described the indications and outcomes of using a rotating-hinge prosthesis in salvage revision TKAs [1, 3-5, 7, 8, 14, 15, 22, 26-29, 31, 32, 34, 37]. Indications have included revision of a previous hinged prosthesis, severe bone loss in revision and reimplantation TKA, extreme instability with collateral ligament deficiency, and various magnitudes of distal femoral fractures [3,26]. The outcomes, much like the indications, have been mixed.…”

Hinged Total Knee Arthroplasty in the Presence of Ligamentous Deficiency

“…Postoperatively, 33 presented excellent or good results (better results in patients with aseptic loosening). Pour et al [16] included in their study 44 knee arthroplasties using modern-generation kinematic rotating-hinge prostheses with a mean followup of 4.2 years. The prostheses provided substantial improvement in function and reduction in pain, but a relatively large number of complications and failures (periprosthetic infection in three knees, aseptic loosening in four, and a periprosthetic fracture in one) were encountered.…”

“…Competent and functional collateral ligaments are a prerequisite when performing a conventional TKA [16]. In cases of primary surgery for knees with severe deformities or in revision surgery in knees with substantial bone loss, standard condylar implants do not allow for proper stabilization of the joint, even when using models with constraint.…”