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The Endo-Model® rotating hinge for rheumatoid knees

Functional results in primary and revision surgery

Die Rotations- und Scharnierprothese Endo-Model® bei rheumatoider Arthritis am Knie

Funktionelle Ergebnisse chirurgischer Primär- und Revisionseingriffe

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Abstract

Background

Major joints of the lower limbs are commonly affected by rheumatoid arthritis (RA), with consequent pain, loss of function, and progressive disability. Knee replacement represents a useful solution, but a highly constrained implant design is often needed in order to face the severe anatomical deformities and the gross instability that the surgeon may encounter in the rheumatoid knee.

Objectives

The aim of this work was to evaluate the Endo-Model® rotating hinge knee prosthesis implanted in patients affected by RA and severely damaged knees.

Patients and methods

We retrospectively evaluated a series of 38 patients with RA implanted with the Endo-Model® rotating hinge knee prosthesis for primary or revision surgery (mean follow-up 6.1 years; mean age at surgery 71.5 years). At the time of surgery, the mean duration of RA was 13.2 years. Patients were evaluated clinically and radiographically and the Knee Society Score (KSS) was used.

Results

Implant survival at most recent follow-up was 91.7 %. Mean final knee flexion was 102.7 °. The mean KSS was 93.5 (excellent) and 67.1 (good) for clinical and functional score, respectively. Mild pain was present in 10 patients. No sign of malalignment or residual instability was found. No evidence of loosening or implant failure was observed in x-rays.

Conclusion

The Endo-Model® rotating hinge knee prosthesis provides excellent pain relief, functional recovery, and intrinsic knee stability both in complex primary and in revision knee arthroplasty in the majority of patients with severely affected rheumatoid knees.

Zusammenfassung

Hintergrund

Die großen Gelenke der unteren Extremitäten sind häufig von rheumatoider Arthritis (RA) betroffen. Schmerz, Funktionsverlust und eine fortschreitende Behinderung sind die Folge. Eine Kniegelenkprothese ist in diesem Zusammenhang eine hilfreiche Behandlungsoption. Oft ist aber ein Implantat mit hochgradiger Koppelung erforderlich, um den schwerwiegenden anatomischen Deformitäten und der ausgeprägten Instabilität zu begegnen, die der Chirurg im betroffenen Knie vorfinden kann.

Zielsetzung

Ziel dieser Arbeit war es, die Rotations- und Scharnierknieprothese Endo-Model® nach Implantation in Patienten mit RA und schwer geschädigten Knien zu bewerten.

Patienten und Methoden

Eine Gruppe von 38 Patienten mit RA, denen die Rotations- und Scharnierknieprothese Endo-Model® in chirurgischen Primär- oder Revisionseingriffen eingesetzt worden war, wurde retrospektiv untersucht (durchschnittliches Follow-up 6,1 Jahre; durchschnittliches Alter bei Operation 71,5 Jahre). Zum Zeitpunkt des chirurgischen Eingriffs lag die durchschnittliche Erkrankungsdauer der RA bei 13,2 Jahren. Die Patienten wurden klinisch sowie röntgenologisch untersucht und mithilfe des Knee Society Score (KSS) beurteilt.

Ergebnisse

Der Implantaterhalt lag in der aktuellsten Follow-up-Untersuchung bei 91,7 %. Der letzte Kniebeugewinkel betrug 102,7 °. Die durchschnittlichen Werte des KSS beliefen sich auf 93,5 (hervorragend) und 67,1 (gut) für den klinischen bzw. funktionellen Score. Bei 10 Patienten bestand ein leichter Schmerz. Zeichen einer Fehlstellung oder verbleibenden Instabilität fanden sich nicht. Die Röntgenuntersuchung ergab keine Hinweise auf eine Lockerung oder ein Implantatversagen.

Schlussfolgerung

Die Rotations- und Scharnierknieprothese Endo-Model® bietet der Mehrzahl der Patienten, die von einer schweren RA am Knie betroffen sind, eine hervorragende Schmerzlinderung, funktionelle Erholung und intrinsische Kniestabilität sowohl bei komplexer Primäroperation als auch bei Revisionsendoprothetik.

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References

  1. Sledge CB (2001) Introduction to surgical management of patients with arthritis. In: Saunders WB (ed) Kelley’s textbook of rheumatology. Saunders WB, Philadelphia

  2. Louie GH, Ward MM (2010) Changes in the rates of joint surgery among patients with rheumatoid arthritis in California, 1983–2007. Ann Rheum Dis 69(5):868–871

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bongartz T, Halligan CS, Osmon DR et al (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59:1713–1720

    Article  PubMed  PubMed Central  Google Scholar 

  4. Berend KD, Lombardi AV (2009) Distal femoral replacement in nontumor cases with severe bone loss and instability. Clin Orthop Relat Res 467:485–492

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pacha-Vincente D, Malik A, Castellet-Feliu E et al (2008) Dislocation of rotating hinge knee prosthesis with antidislocation mechanism. J Arthroplasty 23:299–303

    Article  Google Scholar 

  6. Wang CJ, Wang HE (2000) Early catastrophic failure of rotating hinge total knee prosthesis. J Arthroplasty 15(3):387–391

    Article  CAS  PubMed  Google Scholar 

  7. Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol 18:481–491

    Article  CAS  Google Scholar 

  8. Goodman SM, Figgie M (2013) Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management. J Am Acad Orthop Surg 21(6):355–363

    PubMed  Google Scholar 

  9. Insall JN, Dorr LD, Scott RD et al (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  10. Skyttä ET, Honkanen PB, Eskelinen A et al (2012) Fewer and older patients with rheumatoid arthritis need total knee replacement. Scand J Rheumatol 41:345–349

    Article  PubMed  Google Scholar 

  11. James D, Young A, Kulinskaya E et al (2004) Orthopaedic intervention in early rheumatoid arthritis. Occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years. Rheumatology (Oxford) 43:369–376

    Article  CAS  Google Scholar 

  12. Bongartz T, Halligan CS, Osmon DR et al (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59:1713–1720

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stanley D, Stockley I, Getty CJ (1990) Simultaneous or staged bilateral total knee replacements in rheumatoid arthritis. A prospective study. J Bone Joint Surg Br 72:772–774

    CAS  PubMed  Google Scholar 

  14. Lindahl H, Malchau H, Oden A et al (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88:26–30

    Article  CAS  PubMed  Google Scholar 

  15. Matta F, Singala R, Yaekoub AY et al (2009) Risk of venous thromboembolism with rheumatoid arthritis. Thromb Haemost 101:134–138

    CAS  PubMed  Google Scholar 

  16. Petrou G, Petrou H, Tilkeridis C et al (2004) Medium-term results with a primary cemented rotating-hinge total knee replacement. J Bone Joint Surg 86-B:813–817

    Article  Google Scholar 

  17. Morgan H, Battista V, Leopold SS (2005) Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg 13:515–524

    Article  PubMed  Google Scholar 

  18. Laskin RS, O’Flynn HM (1997) The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop Relat Res 24:8

    Google Scholar 

  19. Goldberg VM, Figgie MP, Figgie HE 3rd et al (1988) Use of a total condylar knee prosthesis for treatment of osteoarthritis and rheumatoid arthritis. Long-term results. J Bone Joint Surg Am 70:802–811

    CAS  PubMed  Google Scholar 

  20. Kristensen O, Nafei A, Kjaersgaard-Andersen P et al (1992) Long-term results of total condylar knee arthroplasty in rheumatoid arthritis. J Bone Joint Surg Br 74:803–806

    CAS  PubMed  Google Scholar 

  21. Nieder E (1991) Sled prosthesis, rotating knee and hinge prosthesis: St. Georg model and ENDO-model. Differential therapy in primary knee joint arthroplasty. Orthopäde 20(3):170–180

    CAS  PubMed  Google Scholar 

  22. Argenson J, Aubaniac JM (2000) Total knee arthroplasty in femorotibial instability. Orthopäde 29:S45–S47

    Article  PubMed  Google Scholar 

  23. Back DL, David L, Hilton A et al (2008) The SMILES prosthesis in salvage revision knee surgery. Knee 15:40–44

    Article  CAS  PubMed  Google Scholar 

  24. Barrack RL, Lyons TR, Ingraham RQ et al (2000) The use of a modular rotating hinge component in salvage revision total knee arthroplasty. J Arthroplasty 15:858–866

    Article  CAS  PubMed  Google Scholar 

  25. Barrack RL (2001) Evolution of rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res 392:292–299

    Article  PubMed  Google Scholar 

  26. Jones RE, Barrack RL, Skedros J (2001) Modular, mobile-bearing total knee arthroplasty. Clin Orthop Relat Res 392:306–314

    Article  PubMed  Google Scholar 

  27. Jones RE, Skedros JG, Chan AJ et al (2001) Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis. J Arthroplasty 16:279–287

    Article  CAS  PubMed  Google Scholar 

  28. Lombardi AV Jr, Mallory TH, Eberle RW et al (1997) Rotating hinge prosthesis in revision total knee arthroplasty: indications and results. Surg Tech Int 6:379–382

    Google Scholar 

  29. Pour AE, Parvizi J, Slenker N et al (2007) Rotating hinged knee replacement: use with caution. J Bone Joint Surg 89:1735–1741

    Article  PubMed  Google Scholar 

  30. Pradhan NR, Bale L, Kay P et al (2004) Salvage revision total knee replacement using the Endo-Model rotatine hinge prosthesis. The Knee 11:469–473

    Article  CAS  PubMed  Google Scholar 

  31. Springer BD, Hanssen AD, Sim FH et al (2001) The kinematic rotating hinge prosthesis for complex knee arhtroplasty. Clin Orthop Relat Res 392:283–291

    Article  PubMed  Google Scholar 

  32. Springer BD, Sim FH, Hanssen AD et al (2004) The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res 421:181–187

    Article  PubMed  Google Scholar 

  33. Ward WG, Haight D, Ritchie P et al (2003) Dislocation of rotating hinge total knee prosthesis: a biomechanical analysis. J Bone Joint Surg Am 85:448–453

    Article  PubMed  Google Scholar 

  34. Westrich GH, Mollano AV, Sculco TP et al (2000) Rotating hinge total knee arthroplasty in severely affected knees. Clin Orthop Relat Res 379:195–208

    Article  PubMed  Google Scholar 

  35. 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):1204–1211

    Article  PubMed  Google Scholar 

  36. Baker P, Critchley R, Gray A et al (2014) Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery. Knee Surg Sports Traumatol Arthrosc 22(3):599–608

    Article  PubMed  Google Scholar 

  37. Burnett RS, Bourne RB (2004) Indications for patellar resurfacing in total knee arthroplasty. Instr Course Lect 53:167

    PubMed  Google Scholar 

  38. Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 85-A:212

    CAS  PubMed  Google Scholar 

  39. Deehan DJ, Phaltankar PM, Pinder IM (2008) Do we need to replace the patella in knee arthroplasty for rheumatoid disease? Acta Orthop Belg 74(4):478–482

    PubMed  Google Scholar 

  40. Holt G, Miller N, Kelly MP, Leach WJ (2006) Retention of the patella in total knee arthroplasty for rheumatoid arthritis. Joint Bone Spine 73 523–526

    Article  CAS  PubMed  Google Scholar 

  41. Bhan S, Malhotra R, Eachempati KK (2006) Total knee arthroplasty without patellar resurfacing in patients with rheumatoid arthritis. Clin Orthop Relat Res 450:157–163

    Article  CAS  PubMed  Google Scholar 

  42. Jujo Y, Yasui T, Nagase Y, Kadono Y, Oka H, Tanaka S (2013) Patellar fracture after total knee arthroplasty for rheumatoid arthritis. J Arthroplasty 28 (1):40–43

    Article  PubMed  Google Scholar 

  43. Ravi B, Escott B, Shah PS et al (2012) A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Reum 64(12):3839–3849

    Article  Google Scholar 

  44. Hanssen AD, Trousdale RT, Osmon DR (1995) Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty. Clin Orthop Relat Res 321:55

    PubMed  Google Scholar 

  45. Smith TH, Gad BV, Klika AK et al (2013) Comparison of mechanical and nonmechanical failure rates associated with rotating hinged total knee arthroplasty in nontumor patients. J Arthroplasty 28(1):62–67

    Article  PubMed  Google Scholar 

  46. Crova M, Cenna E, Olivero C (2000) Rotating knee prosthesis. Surface or hinge replacement? Orthopäde 29(Suppl 1):S43–S44

    Article  PubMed  Google Scholar 

  47. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al (2008) American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 59:762–784

    Article  CAS  PubMed  Google Scholar 

  48. Ding T, Ledingham J, Luqmani R, Westlake S, Hyrich K, Lunt M, et al (2010) BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies. Rheumatology 49:2217–2219

    Article  PubMed  Google Scholar 

  49. Anstead GM (1998) Steroids, retinoids, and wound healing. Adv Wound Care 11:277–285

    CAS  PubMed  Google Scholar 

  50. Clement ND, Breusch SJ, Biant LC (2012) Lower limb joint replacement in rheumatoid arthritis. J Orthop Surg Res 7:27

    Article  PubMed  PubMed Central  Google Scholar 

  51. Grennan DM, Gray J, Loudon J, Fear S (2001) Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 60:214–217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic surgery, University of Genova, IRCCS – San Martino – IST, Largo Rosanna Benzi 10, 16159, Genova, Italy

    L. Felli, M. Coviello &  M. Alessio-Mazzola

  2. Department of Rheumatology, University of Genova, IRCCS – San Martino – IST, Largo Rosanna Benzi 10, Genova, 16159, Italy

    M. Cutolo

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  1. L. Felli
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  2. M. Coviello
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  4. M. Cutolo
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Correspondence to M. Alessio-Mazzola.

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Conflict of interest

L. Felli, M. Coviello, M. Alessio-Mazzola and M. Cutolo state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies

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Felli, L., Coviello, M., Alessio-Mazzola, M. et al. The Endo-Model® rotating hinge for rheumatoid knees. Orthopäde 45, 446–451 (2016). https://doi.org/10.1007/s00132-015-3193-x

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  • DOI: https://doi.org/10.1007/s00132-015-3193-x

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