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Pérez M, Vicente M, Amat C, Lahoz B, Carrera L, Corona PS. Outcomes of a cemented modular rotational-hinge design as the final implant in a two-stage replacement due to chronic knee periprosthetic joint infection. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05516-x. [PMID: 39287785 DOI: 10.1007/s00402-024-05516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Marta Pérez
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.
| | - Matías Vicente
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Carles Amat
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Berta Lahoz
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Lluís Carrera
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Pablo S Corona
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Maslaris A, Grimberg A, Melsheimer O, Tsiridis E, Matziolis G. Aseptic midterm survival rates between different cemented tibial stem designs in hinged total knee arthroplasty: a 6-year evaluation from the German Arthroplasty Registry. Arch Orthop Trauma Surg 2024; 144:2283-2295. [PMID: 38625551 PMCID: PMC11093826 DOI: 10.1007/s00402-024-05273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The rate of revision TKA and thus the use of hinged implants (HI) steadily rises. Aseptic loosening lies on the top of the failure patterns. However, no evidence exists until now based on national scale high-caseloads that analyzes the impact of cemented HI stem-design on aseptic survival rates. METHODS Data on aseptic HI-revisions with full-cemented tibia-stems were conducted from the German Arthroplasty Registry. Cases were divided in primary HI (PHI) and HI used in revision operations (RHI). Endpoint was a new revision following either a PHI or an RHI. The impact of stem conicity (conical vs. cylindrical), diameter (≤ 13 mm vs. > 13 mm), length (≤ 90 mm vs. > 90 mm) and offset on the 6-Year-Cumulative-Aseptic-Revision-Rate (6Y-CARR) was estimated via Kaplan-Meier curve and compared between groups via Log-Rank-Tests. RESULTS 3953 PHI and 2032 RHI fulfilled inclusion-criteria. Stem conicity had no impact on 6Y-CARR (p = 0.08 and p = 0.8). Diameter > 13 mm hat an impact on PHI (p = 0.05) with lower 6Y-CARR but not on RHI (p = 0.2). Length > 90 mm showed significantly worst 6Y-CARR in PHI (p = 0.0001) but not in RHI (p = 0.3). Offset-stems showed significantly better 6Y-CARR in PHI (p = 0.04), but not in RHI (p = 0.7). CONCLUSION There was no significant impact of the cemented tibia-stem conicity on 6Y-CARR, neither in PHI nor in RHI. The effect of length, diameter and offset on the 6Y-CARR observed in the PHI, was not detectable in the more complex RHI-cases reflecting its limited clinical relevance by itself in more multifactorial backgrounds. Therefore, results must be interpreted with caution due to considerable system-effects and different utilization-scenarios.
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Affiliation(s)
- Alexander Maslaris
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Alexander Grimberg
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Elefterios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloníki, Greece
| | - Georg Matziolis
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Stroobant L, de Taeye T, Byttebier P, Van Onsem S, Jacobs E, Burssens A, Victor J. Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5365-5380. [PMID: 37747534 DOI: 10.1007/s00167-023-07572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA. METHODS Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component. RESULTS A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°). CONCLUSION This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lenka Stroobant
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium.
| | - Thijmen de Taeye
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
| | - Paul Byttebier
- Department Orthopaedic Surgery, ASZ Aalst, Aalst, Belgium
| | | | - Ewoud Jacobs
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Arne Burssens
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
| | - Jan Victor
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
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Maslaris A, Tsiridis E, Schoeneberg C, Pass B, Spyrou G, Maris A, Matziolis G. Does stem profile have an impact on the failure patterns in revision total knee arthroplasty? Arch Orthop Trauma Surg 2023; 143:1549-1569. [PMID: 36450936 PMCID: PMC9957861 DOI: 10.1007/s00402-022-04683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/23/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Revision total knee arthroplasty (RTKA) has been increasing continuously. The results of RTKA still remain unsatisfactory. Failure patterns and risk factors in RTKA were thoroughly analyzed, with periprosthetic joint infections (PJI) and aseptic loosening remaining at the forefront of re-revision (ReRTKA) causes. While there is evidence that stem profile impacts the revisability of cemented implants, its association with the modes of RTKA failure is unknown. METHODS 50 consecutive ReRTKA performed in a single orthopedic center during 2016-2017 were retrospectively analyzed. The cases were stratified according to age, sex, number of preexisting revisions, fixation technique, stem design and causes of re-revision. All explanted implants with conical vs. cylindrical stem profiles were compared. RESULTS Mean age was 67 ± 11.5, and 54% were females. 72% of the cases had ≥ 3 previous revisions. 88% were full-cemented, 3% hybrid and 9% press-fit stems. 36% of the RTKA had conical, 58% cylindrical and 6% combined stem profiles. 92% of the RTKA components were removed. Removal causes were: PJI (52.2%), aseptic loosening (34.8%), implant malposition (9.8%), painful knee (1.1%) and instability (2.2%). While the overall RTKA failure patterns were equally distributed between conical and cylindrical stems, subgroup analysis of only cemented ReRTKA revealed a higher incidence of aseptic loosening within cylindrical stem profiles (46.7% vs. 25.7%, P = 0.05). CONCLUSION Stem profile may have an impact on the process of aseptic loosening in cemented non-metaphyseal engaging RTKA, with cylindrical designs tending to worse outcomes than conical designs. Large cohort studies could provide more clarity on current observation.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopedics, Waldkliniken Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany. .,Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Eleftherios Tsiridis
- grid.4793.90000000109457005Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC Greece
| | - Carsten Schoeneberg
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Bastian Pass
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Georgios Spyrou
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Alexandros Maris
- grid.420468.cDepartment of Orthopedics, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Georg Matziolis
- grid.275559.90000 0000 8517 6224Department of Orthopedics, Waldkliniken Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
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Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants. Arch Orthop Trauma Surg 2023; 143:469-479. [PMID: 35930052 PMCID: PMC9886614 DOI: 10.1007/s00402-022-04559-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION While re-revision total knee arthroplasty (ReRTKA) steadily increases, the ease and bone-sparing removal of RTKA implants is gaining more and more in importance. Biomechanical data suggest that cemented conical stems can be removed significantly easier than cylindrical stems. However, no clinical evidence exists supporting this observation. Aim of this study was to compare the revisability and need for osteotomy (OT) between removals of well-fixed cemented conical vs. cylindrical RTKA stems. MATERIALS AND METHODS 55 removals of well-fixed full-cemented RTKA stems (29 knees) performed between 2016 and 2018 were retrospectively analyzed. Main outcome variables were: bone loss, fractures, osteotomy incidence, surgery duration, early postoperative complications (EPC), hemoglobin drop and blood transfusion. SPSS was used for the statistical analysis. RESULTS 44.8% were conical, 48.3% cylindrical, and 6.9% combined stem designs. Causes for re-revision were PJI (75.9%), malposition (17.2%) and persistent pain (6.9%). 10 stem removals (18.2%) required an OT (four femoral, six tibial): eight stems (14.5%) had cylindrical and two (3.6%) conical designs (P = 0.041). Fractures were noted solely in removals without OT (11.1% vs. 0%,). There was a tendency to more bone loss in cylindrical stem revisions (53.8% vs. 32%, P = 0.24). A longer overall surgery time was observed in revisions of cylindrical stems (+ 37 min, P = 0.05). There was higher hemoglobin drop and need for blood transfusion in revisions of cylindrical stems or after OT but without reaching statistical significance. The EPC rates were slightly higher in ReRTKA on cylindrical stems (P = 0.28). CONCLUSION Well-fixed cemented conical stems may be revision friendlier with less demands on OT and shorter overall surgery time than cemented cylindrical stems.
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Deehan DJ, Clement ND, Avery P, Mason J, Baker PN. Temporal trends of primary hinge knee arthroplasty and risk factors associated with revision: National Joint Registry data from 2003 to 2018 for 4921 patients. Knee 2022; 34:279-287. [PMID: 35101741 DOI: 10.1016/j.knee.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim was to describe temporal changes and associated changes in patient demographics and surgical variables, revision rate and factors associated with revision of primary hinge knee arthroplasty (HKA) in the UK. METHODS National Joint Registry data for England, Wales, Northern Ireland and Isle of Mann was used to examine the temporal trends in patient demographics, surgical factors and indications for primary HKA usage over a 16-year (2003 to 2018) period and associated risk factors for revision. RESULTS There were 4921 patient episodes with a median follow up of 5.5 (range 0 to 16.3) years. The median age was 75years and the majority were female (72.9%). There was a tenfold increase in the use of HKA (p < 0.001), with an increased relative usage in female patients (p = 0.010), but no significant changes in age (p = 0.484) or BMI (p = 0.781). There were 227 revisions performed at a median of 695days. The overall unadjusted probabilities of revision at 1, 5 and 10 years were 1.5% (95% confidence intervals (CI) 1.1to1.8), 4.4% (95%CI 3.7 to 5.0) and 6.4% (95%CI 5.5 to 7.3), respectively. Cox proportional hazard analysis demonstrated younger age (p < 0.01), male sex (hazard ratio (HR) 1.43, p < 0.01), morbid obesity (HR 2.31, p = 0.022) or previous trauma as the indication (HR 1.48, p = 0.025) were associated with an increased risk of revision. CONCLUSION There was an increase in the use of HKA with increased uptake among female patients. The revision rate was a 6.4% at 10 years, however, younger age, male sex, morbid obesity or previous trauma were associated with an increased risk of revision. LEVEL OF EVIDENCE III Retrospective study.
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Affiliation(s)
- David J Deehan
- Department of Orthopaedic Surgery, Level 7, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK.
| | - Nick D Clement
- Edinburgh Orthopaedics Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - Peter Avery
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - James Mason
- Warwick Clinical Trials Unit Medical School Building, Coventry CV4 7HL, UK
| | - Paul N Baker
- Department of Orthopaedic Surgery, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Caron É, Gabrion A, Ehlinger M, Verdier N, Rubens-Duval B, Neri T, Martz P, Putman S, Pasquier G. Complications and failures of non-tumoral hinged total knee arthroplasty in primary and aseptic revision surgery: A review of 290 cases. Orthop Traumatol Surg Res 2021; 107:102875. [PMID: 33652151 DOI: 10.1016/j.otsr.2021.102875] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Hinged total knee arthroplasty (TKA) implants are a commonly used option during revision or even primary surgery, but their complications are not as well known, due to the rapid adoption of gliding implants. The literature is inconsistent on this topic, with studies having a small sample size, varied follow-up duration and very different indications. This led us to carry out a large multicentre study with a minimum follow-up of 5 years to evaluate the complications after hinged TKA in a non-tumoral context based on the indications of primary arthroplasty, aseptic surgical revision or fracture treatment around the knee. HYPOTHESIS Hinged TKA was associated with a high complication rate, no matter the indication. MATERIAL AND METHODS Two hundred and ninety patients (290 knees) were included retrospectively between January 2006 and December 2011 at 17 sites, with a minimum follow-up of 5 years. The patients were separated into three groups: primary surgery (111 patients), aseptic revision surgery (127 patients) and surgery following a recent (<3 months) fracture (52 patients: 13 around the TKA and 39 around the knee treated by hinged TKA). Patients who had an active infection the knee of interest were excluded. All the patients were reviewed based on a standardised computer questionnaire validated by the SOFCOT. RESULTS The mean follow-up was 71±39 months [range, 0 to 188]. Of the 290 patients included in the study, 108 patients (37%) suffered at least one complication and 55 patients (19%) had to undergo revision surgery: 16 in the primary TKA group (16/111, 14% of primary TKA), 28 in the revision surgery group (28/127, 22% of revision TKA) and 11 in the fracture treatment group (11/52, 21% of fracture TKA). The complications due to the hinged TKA for the entire cohort from most to least common were stiffness (41/290, 14%), chronic postoperative pain (37/290, 13%), infection (32/290, 11%), aseptic loosening (23/290, 8%), general complications (20/290, 7%), extensor mechanism complications (19/290, 6%), periprosthetic fracture (9/290, 3%), mechanical failure (2/290, 0.7%). In the primary TKA group, the main complication leading to re-operation was infection (12/111, 11%), while it was loosening for the revision TKA group (15/127, 12%) and infection (8/52, 15%) for the fracture TKA group. DISCUSSION The 37% complication rate for hinged TKA implants is high, with 19% of them requiring re-operation. The frequency of complications differed depending on the context in which the hinged implant was used (primary, revision, fracture). The complications requiring revision surgery were major ones that prevented patients from preserving their autonomy (infection, symptomatic loosening, fracture, implant failure). The most found complications - stiffness and chronic pain - rarely led to revision. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Étienne Caron
- Université Lille Nord de France, 59000 Lille, France; Service de chirurgie orthopédique II, Hôpital Roger-Salengro, CHU Lille, place de Verdun, 59037 Lille, France.
| | - Antoine Gabrion
- Service de chirurgie orthopédique, Hôpital Sud, CHU Amiens-Picardie, 80054 Amiens, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Nicolas Verdier
- Clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, Urgences traumatiques des membres, Hôpital sud, CHU Grenoble Alpes, CS 90338, 38434 Échirolles, France
| | - Thomas Neri
- Service de chirurgie orthopédique, Hôpital Nord, CHU Saint-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en Jarez, France
| | - Pierre Martz
- Service de chirurgie orthopédique et traumatologique adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - Sophie Putman
- Université Lille Nord de France, 59000 Lille, France; Service de chirurgie orthopédique II, Hôpital Roger-Salengro, CHU Lille, place de Verdun, 59037 Lille, France
| | - Gilles Pasquier
- Université Lille Nord de France, 59000 Lille, France; Service de chirurgie orthopédique II, Hôpital Roger-Salengro, CHU Lille, place de Verdun, 59037 Lille, France
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Levent A, Suero EM, Gehrke T, Citak M. Risk Factors for Aseptic Loosening After Total Knee Arthroplasty with a Rotating-Hinge Implant: A Case-Control Study. J Bone Joint Surg Am 2021; 103:517-523. [PMID: 33369984 DOI: 10.2106/jbjs.20.00788] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Successful results have been reported in association with the use of a rotating-hinge prosthesis for primary total knee arthroplasty (TKA). The objective of the present study was to identify risk factors for aseptic loosening in patients who underwent primary TKA with rotating-hinge knee prostheses. METHODS The records of 1,235 patients who underwent primary TKA with a rotating-hinge prosthesis at our center were evaluated. A total of 125 patients who underwent revision were further evaluated according to the inclusion and exclusion criteria, and 33 patients who underwent revision because of aseptic loosening were then compared with a group of 30 patients who did not require revision surgery. All data, including radiographic measurements, were obtained from records prior to the primary TKA. RESULTS On the basis of our review of demographic, anthropometric, clinical, surgical, and radiographic findings, we found that higher body mass index (BMI) was associated with revision. The majority of patients with aseptic loosening had loosening of the femoral component. Furthermore, the inner femoral diameter at 20 cm proximal to the knee joint (on both anteroposterior and lateral images) was found to be predictive of revision among those with aseptic loosening. Receiver operating characteristic curve analysis showed that an inner diameter of the femur of >19 mm on anteroposterior images had a sensitivity of 91% and specificity of 87% for predicting the need for revision surgery in patients with aseptic loosening. CONCLUSIONS This is one of few studies that has focused on determining risk factors for the failure of rotating-hinge prostheses following TKA surgery. Our findings indicate that a novel variable, the inner (diaphyseal) diameter of the femur at the point 20 cm proximal to the knee joint, is an extremely reliable predictor of revision surgery in patients with aseptic loosening. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ali Levent
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany
| | - Eduardo M Suero
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany.,Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany
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Rouquette L, Batailler C, Muller B, Neyret P, Servien E, Lustig S. Early complications and causes of revision after rotating-hinge TKA. Arch Orthop Trauma Surg 2020; 140:109-119. [PMID: 31664574 DOI: 10.1007/s00402-019-03290-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of rotating-hinge total knee arthroplasties (TKA), despite several developments in prosthetic design, remains controversial. Results as well as indications of these devices are still discussed in primary intention and for young patients. The aim was to analyze early complications and survival rate of rotating-hinge TKA in primary intention and for revisions. METHODS A retrospective study included all the patients operated for primary or revision TKA procedure using a rotating-hinge TKA between 2015 and 2018. Clinical and radiological data were collected before surgery and then at a minimum follow-up of 1 year. The primary endpoint was the aseptic revision-free survival rate. Secondary endpoints were the overall survival rate, IKS scores, range of motion and patellar complications. RESULTS Forty patients were included at an average follow-up of 18 months. Primary implantation was performed for 12 patients (30%), and revision for 28 cases (70%). At a mean follow-up of 18 months, only one implant was removed for a septic cause. The cumulative survival rate at 24 months was 95%. At final review, eight knees (20%) had been revised, five (12.5%) due to infection, two (5%) because of extensor mechanism failure, two (5%) for global stiffness. The objective and subjective IKS were significantly higher postoperatively in both primary and revision groups (p < 0.0001). Patellar height was significantly smaller after revision (p = 0.04), while ROM significantly improved in this group (p = 0.02). At final endpoint, one implant was removed for a septic cause. CONCLUSION This rotating-hinge TKA provides satisfying clinical and functional outcomes in primary intentions and in revision cases. There was no implant-associated complication. The complication rate remains high for revision surgery cases, mostly due to previous joint infections and poor soft tissue quality causing extensor mechanism failure. A longer-term study should be conducted to confirm this trend.
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Affiliation(s)
- L Rouquette
- Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - C Batailler
- Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
| | - B Muller
- Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - P Neyret
- Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - E Servien
- Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - S Lustig
- Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
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