Early complications and causes of revision after rotating-hinge TKA
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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.
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.
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.
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.
KeywordsTotal knee arthroplasty Rotating-hinge TKA Complications Infection Extensor mechanism
LR contributed to study design, data collection, statistical analysis, literature review and manuscript writing CB contributed to study design, statistical analysis, literature review and manuscript editing. BM contributed to study design, literature review and manuscript editing. PN and ES contributed to study design and manuscript editing. SL contributed to study design, supervision, literature review and manuscript editing. All authors read and approved the final manuscript.
There is no funding source.
Compliance with ethical standards
Conflict of interest
CB, LR and BM declare that they have no conflict of interest. PN declare the following conflicts of interest: consultant for Smith & Nephew, royalties from Tornier-Wright, institutional research support to Tornier-Wright and Amplitude. ES declare she is consultant for Corin. SL declare the following conflicts of interest: consultant for Smith & Nephew, institutional research support to Corin and Amplitude. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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