Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery

Baker, Paul; Critchley, Rebecca; Gray, Andrew; Jameson, Simon; Gregg, P. J.; Port, A.; Deehan, David J.

doi:10.1007/s00167-012-2305-y

Cited by 24 publications

(22 citation statements)

References 23 publications

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“…A study from the NJR (Baker et al. 2014) found that the implant survival for hinged knee replacements was comparable to conventional knee replacements, in contrast to our study, whereas others found the risk of revision to be higher in constrained primary implants (Moussa et al. 2017).…”

Section: Discussioncontrasting

confidence: 78%

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Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994–2017

2019

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Background and purpose — The number of primary, highly constrained knee arthroplasty implants has increased with a theoretically increased risk of early failure. Therefore we analyzed the risk of all revision following total knee arthroplasty (TKA) in patients receiving a hinged or condylar constrained knee (CCK) compared with a conventional unconstrained TKA.Patients and methods — The analyses included 401 primary highly constrained or hinged implants from 1994 to 2017. Kaplan–Meier survival curves were used to evaluate time to first revision with a maximum follow-up of 20 years. Cox regression was used to calculate hazard ratio (HR) comparing condylar constrained knee (CCK), hinged, and unconstrained TKA.Results — Kaplan–Meier estimated prosthesis survival after 2 years was 94.8% (95% CI 91.4–98.2) and 93.5% after 5 years for the primary CCK and 91.0% (CI 86.6–95.4) after 2 years and 85.5% after 5 years for the primary hinged TKA. Adjusted for sex, age groups, diagnosis, time period, previous surgery, and surgery time HR was 1.4 (CI 0.8–2.3) for the CCK and 2.4 (CI 1.6–3.7) for the hinged implants. The most common cause of revision in hinged implants was infection: 14 of 22 revisions. When excluding infection as revision cause, there were no differences in survival between the implant types. Estimated survival excluding infection revisions at 5 years was 96% for unconstrained, CCK, and hinged primary TKA implants.Interpretation — Primary rotating hinge total knee arthroplasty had a higher risk of revision compared with conventional TKA after 2 and 5 years’ follow-up. Infection was the most common cause of revision. When excluding infection revisions from the survival analysis, hinged and CCK implants had similar performance to unconstrained TKA.

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Section: Discussioncontrasting

confidence: 78%

“…2017), but the rates of failure leading to revision surgery have previously only been evaluated in 1 registry study to our knowledge (Baker et al. 2014). Due to the limited use of these implants and the heterogeneity of the studies, it is difficult to obtain certain conclusions regarding the long-term results.…”

mentioning

confidence: 99%

Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994–2017

2019

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“…Hinged implants used for primary TKA failed mostly due to infection (49.1%) and periprosthetic fracture (15.8%) (►Table 8). [90][91][92][93][94] The incidence of infection was relatively higher than that for the PS and VVC implants. It is difficult to determine whether this occurred due to the higher baseline comorbidities in these patients or due to flaws in the implant design.…”

Section: Hinged Implantsmentioning

confidence: 99%

Modes of Failure of Total Knee Arthroplasty: Registries and Realities

2014

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Revision knee arthroplasty places a major strain on the health care system and is associated with high rates of complications, readmissions, and reoperations. Determining the modes of failure of total knee arthroplasty (TKA) preoperatively is essential for a successful revision procedure. Nationwide arthroplasty registries have served as reliable quality control instruments and as data sources of clinical studies that can potentially help guide the investigation of a failed TKA. Modes of failure vary according to the setting of the procedure (primary vs revision arthroplasty) and the prosthesis level of constraint. This article reviews the most prevalent modes of failure of primary and revision TKA, and further quantifies rates and specific modes of failure of bicruciate retaining, posterior cruciate retaining, posterior stabilizing, varus-valgus constrained, and hinged implants.

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“…Different results have been reported with the hinged knee prosthesis in the literature [ Table 4 ] 22 23 24 25 26 27 28 29 and the overall results were low for fixed hinged knee prosthesis. 30 Although the results of rotating type hinge knee prosthesis were better, the followup periods were short and the design of the prosthesis was different.…”

Section: Discussionmentioning

confidence: 99%

The impact of joint line restoration on functional results after hinged knee prosthesis

Yılmaz

Çankaya

Devecı

et al. 2016

IJOO

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Background:Hinged knee prosthesis is an effective treatment method as a salvage procedure in marked ligamentous insufficiency and severe bone defects. Joint line determination and restoration are difficult due to large bone defects and distorted anatomy. We evaluated the impact of joint line alteration on the outcome in rotating hinge knee arthroplasty (RHKA).Materials and Methods:35 patients who had rotating hinged knee prosthesis applied between 2008 and 2013 were evaluated in this retrospective study. The patients were studied radiologically and clinically. Five patients were lost to followup and two patients died, leaving a total of 28 (7 male, 21 female) patients for final evaluation. The average age of the patients was 66.19 ± 8.35 years (range 52–83 years). The patients were evaluated clinically with Knee Society knee and functional score and patellar score. The joint line positions were evaluated radiographically with femoral epicondylar ratio method. The outcomes were also evaluated according to age, body weight and gender. Student's t-test, independent t-test, and the Wilcoxon signed rank test were used in the statistical analysis.Results:The mean Knee Society knee and functional score significantly improved from preoperative 19.52 ± 11.77 and 12.5 ± 15.66 respectively to 72.46 ± 14.01 and 70.36 ± 9.22 respectively postoperatively (P < 0.001). The mean range of motion of the knee improved from 55.95° ± 25.08° preoperatively to 92.14° ± 13.47° postoperatively (P < 0.001). Joint line position was restored in 20 patients (71.4%). Joint line alteration did not affect Knee Society Scores (KSSs) in contrast to patellar scores. Additionally, KSS was better in the patients with body mass index ≤30 at followup (P = 0.022 and P = 0.045).Conclusion:RHKA is an effective salvage procedure for serious instability and large bone defects. Restoration of the joint line improves the patellar score although it had no effect on the clinical outcome.

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Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery

Abstract: Prospective cohort study, Level II.

Cited by 24 publications

References 23 publications

Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994–2017

Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994–2017

Modes of Failure of Total Knee Arthroplasty: Registries and Realities

The impact of joint line restoration on functional results after hinged knee prosthesis

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