Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

Abstract

Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure

“…Smith et al demonstrated a complication rate at two years follow-up of 34% in a septic and aseptic mixed cohort [ 21 ]. Von Hintze et al reported that PJI was the most common cause for revision after implanting rotating-hinge prostheses at a mid-term follow-up [ 22 ]. It is known that silver coating can reduce the revision rate after implanting megaprostheses in the case of PJI [ 23 ].…”

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

“…While a modern rotating design significantly reduces this complication, a yoke design on the tibial component allows the tibial platform to rotate around the femur, thereby offloading the shearing force on the prostheses–bone interface ( 45 ). This property enables excellent mid- to long-term survival rates of RHK in both pTKA and rTKA ( 46 , 47 ). This indication is generally acceptable but still controversial: (i) massive bone loss sacrifices the attachment of the collateral ligament; (ii) gross ligamentous incompetence is defined as the clinical absence of all four major knee ligaments; (iii) severe bone osteolysis or soft tissue defects are caused by sepsis debridement or component removal; (iv) severe valgus or varus deformity is combined with flexion contracture or recurvatum; and (v) severe gonarthrosis is combined with neuromuscular diseases, such as polio and syphilis ( 6 , 35 ).…”

Does stem profile have an impact on the failure patterns in revision total knee arthroplasty?

“…This can be attributed to a cohort inhomogeneity (TKA vs. RTKA, risk factors and complexity of cases, number or previous revisions, septic vs. aseptic, use of metaphyseal fixation, FU time, implant design and fixation technique, missing values, study design, industry influence, etc.) that leads to a wide discrepancy of outcomes that range from excellent [36,40,55,[68][69][70][71][72][73][74][75][76][77] to moderate results [16,20,24,41,62,[78][79][80]. However, when considering recent (2008-2020) high-volume studies that are not associated with a certain implant, the incidence rates of aseptic loosening and PJI are more representative and coincide with our data: Suarez et al in a series of 566 RTKA cases (including 123 PJI) published a 12-year survival of 82% with 19% aseptic loosening and 46% PJI [19].…”