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Revision arthroplasty with rotating hinge systems for total knee arthroplasty instability

Knieprothesenwechsel mit Rotationsscharnierprothesen bei Instabilität

  • Surgical Technique
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Abstract

Objective

Restoring stability after total knee arthroplasty (TKA) and improving joint function using a cemented rotating hinge system.

Indications

Ligament instability and/or osseous defects (including Anderson Orthopaedic Research Institute [AORI] classification type II defects) after primary TKA or TKA revision surgery.

Contraindications

Distal femoral or proximal tibial bowing requiring implant systems that provide femoral or tibial offset stems. Persistent periprosthetic infection. Poor therapeutic compliance. AORI type III defects.

Surgical technique

Medial arthrotomy. Femoral and tibial component removal with small saw blades and chisels. Intramedullary alignment for the tibial and femoral cuts. Debridement and removal of membranes and cement remnants. Reconstruction of joint line and correct TKA alignment. Trial reduction. Cement fixation.

Postoperative management

Unrestricted range of motion, partial weight bearing for 4 weeks.

Results

Between 2012 and 2013, 18 patients suffering from ligament insufficiency after TKA were revised using the described system and included in a prospective study protocol. The mean follow-up was 37 months (range 30–46 months). There was a significant improvement of the Oxford Knee Score (OKS) from 19 (range 7–29) preoperatively to 29 (range 10–45) postoperatively (p = 0.004). The Knee Society Score (KSS) knee assessment subscore improved from 35 (range 9–70) to 67 (range 35–97) (p = 0.002) and the pain score from 7 (range 0–50) to 24 (range 0–50) (p = 0.008).

Zusammenfassung

Operationsziel

Funktionsverbesserung und Behandlung der Knieprotheseninstabilität durch Wechsel auf eine vollständig zementierte, rotationsachsgeführte Knieprothese.

Indikationen

Bandinsuffizienz und/oder Knochenverlust (bis einschließlich AORI [Anderson Orthopaedic Research Institute] Typ-II-Defekte) nach primärer Knieprothesenimplantation oder Revision.

Relative Kontraindikationen

Höhergradige femorale oder tibiale Achsabweichungen, die ein stielgeführtes Revisionssystem mit Offset-Varianten notwendig machen. Persistierende periprothetische Infektion. Fehlende Compliance. Knochendefekt AORI Typ III.

Operationstechnik

Mediale Arthrotomie, Entfernung der einliegenden femoralen und tibialen Komponenten mit kleinen, flachen Sägeblättern und Meißeln. Intramedulläres Alignment für den tibialen und femoralen Sägeschnitt. Débridement und Entfernen von Membranen und Zementresten. Knochensparende Resektion für eine suffiziente Prothesenauflage. Rekonstruktion der Gelenklinie und korrektes Prothesenalignment. Probereposition. Vollständig zementierte Verankerung.

Nachbehandlung

Keine Bewegungseinschränkung. Teilbelastung für 4 Wochen.

Ergebnisse

In einer prospektiven Studie konnten 18 Patienten eingeschlossen werden, welche zwischen 2012 und 2013 aufgrund einer klinisch relevanten Instabilität nach Knieprothesenimplantation revidiert wurden. Das durchschnittliche Follow-up lag bei 37 Monaten (30–46). Es zeigte sich eine signifikante Verbesserung des OKS (Oxford Knee Score) von 19 (7–29) auf 29 (10–45) Punkte (p = 0,004), des KSS (Knie Funktion Scores) von 35 (9–70) auf 67 (35–97) Punkte (p = 0,002) und des Schmerz-Scores von 7 (0–50) auf 24 (0–50) Punkte (p = 0,008).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstr. 11, 97074, Würzburg, Germany

    Jörg Arnholdt, Sebastian Philipp Boelch, Fatma Dogan, Maik Hoberg, Boris Michael Holzapfel & Maximilian Rudert

  2. Department of Orthopaedic Surgery, Marienstift Arnstadt, Arnstadt, Germany

    Maik Hoberg

Authors
  1. Jörg Arnholdt
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  2. Sebastian Philipp Boelch
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  3. Fatma Dogan
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  4. Maik Hoberg
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  5. Boris Michael Holzapfel
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  6. Maximilian Rudert
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Corresponding author

Correspondence to Jörg Arnholdt.

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Conflict of interest

J. Arnholdt, S.P. Boelch, F. Dogan, M. Hoberg, B.M. Holzapfel and M. Rudert declare that they have no competing interests.

For this study, we received institutional review board approval (approval no. 195/10) from the university.

Additional information

Editor

D.C. Wirtz, Bonn

Illustrator

R. Himmelhan, Mannheim

Jörg Arnholdt and Sebastian P. Boelch have equally contributed as first author to this article.

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Arnholdt, J., Boelch, S.P., Dogan, F. et al. Revision arthroplasty with rotating hinge systems for total knee arthroplasty instability. Oper Orthop Traumatol 32, 298–308 (2020). https://doi.org/10.1007/s00064-020-00663-x

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  • DOI: https://doi.org/10.1007/s00064-020-00663-x

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