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International Orthopaedics

, Volume 36, Issue 5, pp 993–998 | Cite as

Failure rate of a rotating hinge knee design due to yoke fracture of the hinged tibial insert: a retrospective data analysis and review of the literature

  • Joerg Friesenbichler
  • Ran Schwarzkopf
  • Patrick Sadoghi
  • Scott E. Marwin
  • Mathias GlehrEmail author
  • Werner Maurer-Ertl
  • Andreas Leithner
Original Paper

Abstract

Purpose

Rotating hinge knee prostheses are known to provide inherent stability. Yoke fractures of the hinged tibial insert of modern generation rotating hinge devices are a matter of continued concern. The aim of this study was to describe incidence and management of yoke fracture of the LPS™ hinged tibial insert.

Methods

Retrospective data analysis of two institutions identified 40 patients with a LPS™ total knee arthroplasty. Implant survival and prosthetic complications was calculated according to Kaplan-Meier.

Results

Out of the group of 40 patients, four fractures of the metal yoke occurred in four cases (failure rate: 10%). Furthermore, a second fracture occurred in two patients. The overall revision-free prosthetic survival was 57% at 38 months, while prosthetic survival until yoke fracture was 86% at 38 months.

Conclusion

Handling yoke fractures as mechanical complication includes replacing the hinged insert, stabilization of the joint and joint line height preservation in order to decrease the cantilever effect at the insert-base plate interface.

Keywords

Total Knee Arthroplasty Joint Line Mechanical Complication Revision Total Knee Arthroplasty Tibial Insert 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Barrack RL (2001) Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res 392:292–299PubMedCrossRefGoogle Scholar
  2. 2.
    Barrack RL, Lyons TR, Ingraham RQ, Johnson JC (2000) The use of a modular rotating hinge component in salvage revision total knee arthroplasty. J Arthroplasty 15(7):858–866PubMedCrossRefGoogle Scholar
  3. 3.
    Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM (2002) Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res 400:225–235PubMedCrossRefGoogle Scholar
  4. 4.
    Choong PF, Sim FH, Pritchard DJ, Rock MG, Chao EY (1996) Megaprostheses after resection of distal femoral tumors. A rotating hinge design in 30 patients followed for 2–7 years. Acta Orthop Scand 67(4):345–351PubMedCrossRefGoogle Scholar
  5. 5.
    David HG, Bishay M, James ET (1998) Problems with the Rotaflex: a 10 year review of a rotating hinge prosthesis. J Arthroplasty 13(4):402–408PubMedCrossRefGoogle Scholar
  6. 6.
    Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68(7):1035–1040PubMedGoogle Scholar
  7. 7.
    Gustke KA (2005) Preoperative planning for revision total knee arthroplasty: avoiding chaos. J Arthroplasty 20(4 Suppl 2):37–40PubMedCrossRefGoogle Scholar
  8. 8.
    Heisel C, Kinkel S, Bernd L, Ewerbeck V (2006) Megaprostheses for the treatment of malignant bone tumours of the lower limbs. Int Orthop 30(6):452–457PubMedCrossRefGoogle Scholar
  9. 9.
    Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429PubMedCrossRefGoogle Scholar
  10. 10.
    Joshi N, Navarro-Quilis A (2008) Is there a place for rotating-hinge arthroplasty in knee revision surgery for aseptic loosening? J Arthroplasty 23(8):1204–1211PubMedCrossRefGoogle Scholar
  11. 11.
    Kawai A, Healey JH, Boland PJ, Athanasian EA, Jeon DG (1999) A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty 14(2):187–196PubMedCrossRefGoogle Scholar
  12. 12.
    Konig C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO (2009) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 28(1):1–5Google Scholar
  13. 13.
    Manning DW, Chiang PP, Freiberg AA (2005) Hinge implants. In: Bono JV, Scott RD (eds) Revision total knee arthroplasty. Springer Science+Business Media, Inc, New York, pp 219–236CrossRefGoogle Scholar
  14. 14.
    McDermott B (2005) Restoration of stability, maintaining joint line, gap balancing, and constraint selection. In: Bono JV, Scott RD (eds) Revision total knee arthroplasty. Springer Science+Business Media, Inc, New York, pp 145–151CrossRefGoogle Scholar
  15. 15.
    Nelson CL, Gioe TJ, Cheng EY, Thompson RC Jr (2003) Implant selection in revision total knee arthroplasty. J Bone Joint Surg Am 85(A Suppl 1):S43–S51PubMedGoogle Scholar
  16. 16.
    Pacha-Vicente D, Malik A, Castellet-Feliu E, Nardi-Vilardaga J (2008) Dislocation of rotating-hinge knee prostheses with antidislocation mechanism. J Arthroplasty 23(2):299–303PubMedCrossRefGoogle Scholar
  17. 17.
    Park DH, Jaiswal PK, Al-Hakim W, Aston WJ, Pollock RC, Skinner JA, Cannon SR, Briggs TW (2007) The use of massive endoprostheses for the treatment of bone metastases. Sarcoma 2007:62151PubMedCrossRefGoogle Scholar
  18. 18.
    Petrou G, Petrou H, Tilkeridis C, Stavrakis T, Kapetsis T, Kremmidas N, Gavras M (2004) Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up. J Bone Joint Surg Br 86(6):813–817PubMedCrossRefGoogle Scholar
  19. 19.
    Rand JA, Chao EY, Stauffer RN (1987) Kinematic rotating-hinge total knee arthroplasty. J Bone Joint Surg Am 69(4):489–497PubMedGoogle Scholar
  20. 20.
    Schwarzkopf R, Chaudhry S, Kummer FJ, Marwin SE (2011) Failure of the tibial insert in a rotating hinge total knee arthroplasty. J Arthroplasty 26(6):977, e5–8PubMedCrossRefGoogle Scholar
  21. 21.
    Torbert JT, Fox EJ, Hosalkar HS, Ogilvie CM, Lackman RD (2005) Endoprosthetic reconstructions: results of long-term followup of 139 patients. Clin Orthop Relat Res 438:51–59PubMedCrossRefGoogle Scholar
  22. 22.
    Wang CJ, Wang HE (2000) Early catastrophic failure of rotating hinge total knee prosthesis. J Arthroplasty 15(3):387–391PubMedCrossRefGoogle Scholar
  23. 23.
    Ward WG, Haight D, Ritchie P, Gordon S, Eckardt JJ (2003) Dislocation of rotating hinge total knee prostheses. A biomechanical analysis. J Bone Joint Surg Am 85-A(3):448–453PubMedGoogle Scholar
  24. 24.
    Ward WG, Haight D, Ritchie P, Gordon S, Eckardt JJ (2005) Dislocation of rotating hinge knee prostheses. A report of four cases. J Bone Joint Surg Am 87(5):1108–1112PubMedCrossRefGoogle Scholar
  25. 25.
    Westrich GH, Mollano AV, Sculco TP, Buly RL, Laskin RS, Windsor R (2000) Rotating hinge total knee arthroplasty in severely affected knees. Clin Orthop Relat Res 379:195–208PubMedCrossRefGoogle Scholar
  26. 26.
    Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res 420:239–250PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Joerg Friesenbichler
    • 1
  • Ran Schwarzkopf
    • 2
  • Patrick Sadoghi
    • 1
  • Scott E. Marwin
    • 2
  • Mathias Glehr
    • 1
    Email author
  • Werner Maurer-Ertl
    • 1
  • Andreas Leithner
    • 1
  1. 1.Department of Orthopaedic SurgeryMedical University of GrazGrazAustria
  2. 2.Department of Orthopaedic SurgeryNYU Hospital of Joint DiseaseNew YorkUSA

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