Superior Survival of Fully Cemented Fixation Compared to Hybrid Fixation in a Single Design Rotating Hinge Knee Implant

Laarhoven, Simon van; Eerden, Abraham H J van; Hellemondt, Gijs G. van; Schreurs, B.W.; Wymenga, A. B.; Heesterbeek, Petra J.C.

doi:10.1016/j.arth.2021.11.037

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Nevertheless, a total of 8 patients had a preoperative stiff knee (range of motion < 90°) and improved at least 20° in range of motion at 2 years’ follow-up. Only 1 reoperation occurred (full allograft extensor mechanism reconstruction), which is very reasonable compared with previous studies on revision knee surgery with hinged implants ( 11 , 16 ).…”

Section: Discussionsupporting

confidence: 82%

“…This might confirm appropriate stability of the present fully cemented rotating hinged implants and might indicate that higher degrees of micromotion are acceptable in revision TKA along with the use of hinged implants. Moreover, long-term survival data of fully cemented rotating hinged implants showed excellent and superior survival over hybrid fixated implants ( 11 ). Extended clinical follow-up of the current patients will be needed to ascertain whether the degree of migration will lead to early re-revisions and, if so, to investigate a relationship with the migration patterns.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to this, the number of outliers (TT > 1 mm or TR > 1°) seems higher for femoral components compared with the tibial components in the current study (7/16 vs. 2/11) and in contrast to the study of Heesterbeek et al with cemented condylar revision TKA (4/15 vs. 5/14) ( 5 ). Higher rates of aseptic loosening of femoral components in rotating hinged knee implants have been reported, for which different explanations have been provided ( 10 , 11 ). Farid et al believed that the femoral component in rotating hinged knee implants is subject to more torsion and bending stresses due to differences in the anatomic femoral and mechanical axis ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

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Acceptable migration of a fully cemented rotating hinge-type knee revision system measured in 20 patients with model-based RSA with a 2-year follow-up

Laarhoven¹,

Molder

Hellemondt³

et al. 2023

ActaO

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Background and purpose: Rotating hinged knee implants are highly constrained prostheses used in cases in which adequate stability is mandatory. Due to their constraint nature, multidirectional stresses are directed through the bone–cement–implant interface, which might affect fixation and survival. The goal of this study was to assess micromotion of a fully cemented rotating hinged implant using radiostereometric analysis (RSA).Patients and methods: 20 patients requiring a fully cemented rotating hinge-type implant were included. RSA images were taken at baseline, 6 weeks, and 3, 6, 12, and 24 months postoperatively. Micromotion of femoral and tibial components referenced to markers in the bone was assessed with model-based RSA software, using implant CAD models. Total translation (TT), total rotation (TR), and maximal total point motion (MTPM) were calculated (median and range).Results: At 2 years, TTfemur was 0.38 mm (0.15–1.5), TRfemur was 0.71° (0.37–2.2), TTtibia was 0.40 mm (0.08–0.66), TRtibia was 0.53° (0.30–2.4), MTPMfemur was 0.87 mm (0.54–2.8), and MTPMtibia was 0.66 mm (0.29–1.6). Femoral components showed more outliers (> 1 mm, > 1°) compared with tibial components.Conclusion: Fixation of this fully cemented rotating hinge-type revision implant seems adequate in the first 2 years after surgery. Femoral components showed more outliers, in contrast to previous RSA studies on condylar revision total knee implants.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acceptable migration of a fully cemented rotating hinge-type knee revision system measured in 20 patients with model-based RSA with a 2-year follow-up

Laarhoven¹,

Molder

Hellemondt³

et al. 2023

ActaO

Self Cite

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“…In contrast, in a report of 275 revisions with rotating hinge components, van Laarhoven et al [207] noted higher rates of survival free from aseptic loosening for fully cemented stems compared with hybrid fixation. In a single surgeon retrospective study of 84 total knee revisions with stemmed femoral components, at a mean of 6 year follow-up, Lachiewicz and O’Dell noted no statistically significant difference in reoperation for loosening between cemented and uncemented stems.…”

Section: Panel 2: Achieving Durable Fixation In the Setting Of Signif...mentioning

confidence: 96%

“…Previously instrumented canals, which may be sclerotic in nature, can perform worse with fully cemented stems in the revision complex modular knee replacement scenario, as cement needs a more porous or cancellous surface for interdigitation and durable fixation. Hybrid stem fixation in conjunction with metaphyseal cone or sleeve augmentation is an alternative option [110,207,185]. Uncemented stems that allow for biologic fixation hold the potential for rotational stability and improved long-term fixation.…”

Section: Panel 4: Considerations Regarding Complex Modular Replacemen...mentioning

confidence: 99%

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

Sculco,

Flevas,

Jerabek

et al. 2024

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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The evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA) continue to be a complex and debated topic in revision TKA (rTKA). Despite the introduction of new evidence and innovative technologies aimed at addressing the approach and care of severe bone loss in rTKA, there is no single document that systematically incorporates these newer surgical approaches. Therefore, a comprehensive review of the treatment of severe bone loss in rTKA is necessary. The Stavros Niarchos Foundation Complex Joint Reconstruction Center Hospital for Special Surgery, dedicated to clinical care and research primarily in revision hip and knee replacement, convened a Management of Bone Loss in Revision TKA symposium on June 24, 2022. At this meeting, the 42 international invited experts were divided into groups; each group was assigned to discuss questions related to 1 of the 4 topics: (1) assessing preoperative workup and imaging, anticipated bone loss, classification system, and implant surveillance; (2) achieving durable fixation in the setting of significant bone loss in revision TKA; (3) managing patellar bone loss and the extensor mechanism in cases of severe bone loss; and (4) considering the use of complex modular replacement systems: hinges, distal femoral, and proximal tibial replacements. Each group came to consensus, when possible, based on an extensive literature review and interactive discussion on their group topic. This document reviews each these 4 areas, the consensus of each group, and directions for future research.

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Midterm results of modular hinge total knee arthroplasty using cementless osseointegrating stems: low fixation associated complications and good functional outcome in primary and revision knee arthroplasty

Schnetz,

Hofmann,

Ewald

et al. 2023

Arch Orthop Trauma Surg

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Superior Survival of Fully Cemented Fixation Compared to Hybrid Fixation in a Single Design Rotating Hinge Knee Implant

Cited by 7 publications

References 28 publications

Acceptable migration of a fully cemented rotating hinge-type knee revision system measured in 20 patients with model-based RSA with a 2-year follow-up

Acceptable migration of a fully cemented rotating hinge-type knee revision system measured in 20 patients with model-based RSA with a 2-year follow-up

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

Midterm results of modular hinge total knee arthroplasty using cementless osseointegrating stems: low fixation associated complications and good functional outcome in primary and revision knee arthroplasty

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