The anatomical shape of the distal femur is an independent risk factor for aseptic loosening following one-stage septic knee revision using rotating hinge knee prosthesis

Aims Rotating-hinge knee prostheses are commonly used to reconstruct the distal femur after resection of a tumour, despite the projected long-term burden of reoperation due to complications. Few studies have examined the factors that influence their failure and none, to our knowledge, have used competing risk models to do so. The purpose of this study was to determine the risk factors for failure of a rotating-hinge knee distal femoral arthroplasty using the Fine-Gray competing risk model. Methods We retrospectively reviewed 209 consecutive patients who, between 1991 and 2016, had undergone resection of the distal femur for tumour and reconstruction using a rotating-hinge knee prosthesis. The study endpoint was failure of the prosthesis, defined as removal of the femoral component, the tibial component, or the bone-implant fixation; major revision (exchange of the femoral component, tibial component, or the bone-implant fixation); or amputation. Results Multivariate Fine-Gray regression analyses revealed different hazards for each Henderson failure mode: percentage of femoral resection (p = 0.001) and extent of quadriceps muscle resection (p = 0.005) for overall prosthetic failure; extent of quadriceps muscle resection (p = 0.002) and fixation of femoral component (p = 0.011) for type 2 failure (aseptic loosening); age (p = 0.009) and percentage of femoral resection (p = 0.019) for type 3 failure (mechanical failure); and type of joint resection (p = 0.037) for type 4 (infection) were independent predictors. A bone stem ratio of > 2.5 reliably predicted aseptic loosening. Conclusion We identified independent risk factors for overall and cause-specific prosthetic failure after rotating-hinge knee distal femoral arthroplasty using a competing risk Fine-Gray model. A bone stem ratio > 2.5 reliably predicts aseptic loosening. An accurate knowledge of the risks of distal femoral arthroplasty after resection for tumour assists surgical planning and managing patient expectations. Cite this article: Bone Joint J 2021;103-B(8):1405–1413.

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Is There a Place for Rotating-Hinge Arthroplasty in Knee Revision Surgery for Aseptic Loosening?

The Journal of Arthroplasty ◽

10.1016/j.arth.2007.10.016 ◽

2008 ◽

Vol 23 (8) ◽

pp. 1204-1211 ◽

Cited By ~ 53

Author(s):

Nayana Joshi ◽

Antonio Navarro-Quilis

Keyword(s):

Aseptic Loosening ◽

Revision Surgery ◽

Knee Revision Surgery ◽

Rotating Hinge ◽

Knee Revision

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Mid-term results after implantation of rotating-hinge knee prostheses: primary versus revision

Orthopedic Reviews ◽

10.4081/or.2012.e35 ◽

2012 ◽

Vol 4 (4) ◽

pp. 35 ◽

Cited By ~ 10

Author(s):

Turgay Efe ◽

Philip P. Roessler ◽

Thomas J. Heyse ◽

Carsten Hauk ◽

Caroline Pahrmann ◽

...

Keyword(s):

Knee Prosthesis ◽

Survival Rates ◽

Functional Results ◽

Clinical Results ◽

Knee Prostheses ◽

Kaplan Meier ◽

Rotating Hinge ◽

Rotating Hinge Knee ◽

Primary Implantation

The aim of the study was to evaluate the mid-term clinical results and survivorship of a rotating-hinge knee prosthesis (LINK® Endo-Model) in difficult primary and complex revision situations. Results after primary implantation were compared with those of revision procedures. Forty-nine prostheses in 45 patients were reviewed clinically during follow up. Twenty-one of these were implanted in primary and 28 in revision situations. Outcome was evaluated using commonly used scores (Knee Society, UCLA Activity, Lequesne) and a visual analog scale after a mean follow up of 56±37 months for 49 prostheses. Implant survival was analyzed using the Kaplan-Meier method. There were no significant differences in clinical examination and evaluation scores between the two groups (P>0.05). Survival rates at final follow up were 95% after primary implantation and 76% in revision procedures. The risk of prosthesis loss (odds ratio 5.7) was significantly higher after revision procedures (P=0.004). These data suggest that rotating-hinge knee prostheses provided good clinical and functional results in selected cases of advanced primary gonarthrosis associated with severe bone loss, ligamentous instability or comminuted fractures. They also provide good results in revision situations. However, the failure rate was significantly higher in cases of revision surgery.

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Posterior Dislocation of the Hinge-Post Extension in a Rotating Hinge Total Knee Prosthesis

Case Reports in Orthopedics ◽

10.1155/2013/756538 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Givenchy Manzano ◽

Ran Schwarzkopf

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Prosthesis ◽

Knee Dislocation ◽

Posterior Dislocation ◽

Rotating Hinge ◽

History Of ◽

Total Knee ◽

Rotating Hinge Knee ◽

Anterior Knee

The rotating hinge knee prosthesis is a popular intervention in patients lacking stability with highly constrained total knee arthroplasty. Despite improvements in design, nonmechanical and mechanical complications continue to be a problem. Dislocation of the hinge has been widely described, mainly due to the component fracture. Few reports describe isolated dislocation of the rotating stem. We report a case of isolated disengagement of the rotating hinge mechanism, due to severe flexion gap imbalance, leading to subsequent posterior dislocation of the hinge and anterior knee dislocation, in a patient with a history of multiple total knee arthroplasty revisions. This case suggests the importance of the soft tissue balancing, the adequate patellar tracking, and use of a long cylindrical, minimally tapered rotating stem in hinge arthroplasty to minimize hinge dislocation.

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Comparison between Constrained and Semiconstrained Knee Allograft-Prosthesis Composite Reconstructions

Sarcoma ◽

10.1155/2013/489652 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 13

Author(s):

German L. Farfalli ◽

Luis A. Aponte-Tinao ◽

Miguel A. Ayerza ◽

D. Luis Muscolo ◽

Patrick J. Boland ◽

...

Keyword(s):

Survival Rate ◽

Aseptic Loosening ◽

Knee Prosthesis ◽

Functional Results ◽

Soft Tissue Reconstruction ◽

Functional Scores ◽

Rotating Hinge ◽

Tissue Reconstruction ◽

Group 2 ◽

Group 1

Allograft-prosthesis composite (APC) can restore capsular and ligamentous tissues of the knee sacrificed in a tumor extirpation. We asked if performing APC would restore knee stability and allow the use of nonconstrained arthroplasty while preventing aseptic loosening. We retrospectively compared 50 knee APCs performed with non-constrained revision knee prosthesis (Group 1) with 36 matched APCs performed with a constrained prosthesis (Group 2). In Group 1, the survival rate was 69% at five and 62% at ten years. Sixteen reconstructions were removed due to complications: eight deep infections, three fractures, two instabilities, one aseptic loosening, one local recurrence, and one nonunion. In Group 2, the survival rate was 80% at five and 53% at ten years. Nine reconstructions were removed: 3 due to deep infections, 3 to fractures, and 3 to aseptic loosening. In both groups, we observed more allograft fractures when the prosthetic stem does not bypass the host-donor osteotomy (). Both groups had mainly good or excellent MSTS functional results. Survival rate and functional scores and aseptic loosening were similar in both groups. A rotating-hinge APC is recommended when host-donor soft tissue reconstruction fails to restore knee instability. The use of a short prosthetic stem has a statistical relationship with APC fractures.

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Total knee arthroplasty using hinge joints: Indications and results

EFORT Open Reviews ◽

10.1302/2058-5241.4.180056 ◽

2019 ◽

Vol 4 (4) ◽

pp. 121-132 ◽

Cited By ~ 10

Author(s):

E. Carlos Rodríguez-Merchán

Keyword(s):

Total Knee Arthroplasty ◽

Bone Loss ◽

Aseptic Loosening ◽

Knee Arthroplasty ◽

Soft Tissue Release ◽

Complication Rates ◽

Flexion Extension ◽

Rotating Hinge ◽

Total Knee ◽

Rotating Hinge Knee

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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