Total knee arthroplasty using hinge joints: Indications and results

Abstract

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

Pushing the Surgical Limits: Primary Total Knee Arthroplasty Using Rotational Prosthesis in a 96-Year-Old Lady with End-Stage Osteoarthritis

“…The use of implants with a rotational hinge component in TKA is commonly reserved for complex revision procedures. Indications for rotating hinge implant in primary TKA include collateral ligament insufficiency, severe valgus/varus deformity (greater than 20°) with relevant soft-tissue release, relevant bone loss, including collateral ligament insertions, gap imbalance in flexion-extension, ankylosis, and hyperlaxity [ 4 ]. In this unusual case, such a device was implemented during the primary procedure.…”

Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique

“…The decision for using CCK implants over hinge components in this case was based on the integrity of the collateral ligaments and degree of bone loss. In situations, either primary or revision, where the collateral ligaments are incompetent, there is gross flexion-extension gap imbalance, or there is severe or relevant bone loss affecting the insertion site of the collateral ligaments, then a CCK would not provide adequate stability and a hinge component should be used instead [ 19 , 20 ]. In this case report, CCK components with fully cemented short stem extensions were used for both tibial and femoral components to increase the contact area of the bone-cement interface, which has been shown to reduce the rate of loosening and increase the longevity of the implant [ [21] , [22] , [23] ], although their necessity has been debated in literature [ 24 ].…”

Revision knee surgery: the practical approach

“…Patients who have been chronically walking on this deformity with a quadriceps-avoidance gait could stretch the posterior capsule to the point that correction cannot be managed by just stuffing the joint, but would require the adjunction of an anti-recurvatum mechanism of hinged implants. 27 It is important to notice that positive varus-valgus stress in full extension is indicative of postero-medial or postero-lateral structure deficiency and a hinged prosthesis is required. These types of implants have limited usage among relatively young and active patients because they are associated with increased risk of a secondary revision due to early loosening caused by excessive stress at the fixation interface.…”