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Contemporary rotating hinge arthroplasty can safely be recommended in complex primary surgery

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objective was to evaluate clinical and radiological outcomes, survival rate and complications of primary contemporary rotating hinged total knee arthroplasty (CRH-TKA).

Methods

Through a national multicenter retrospective study (14 centers), 112 primary CRH-TKA performed between 2006 and 2011 were included. Indications were: severe frontal plane deformity (55%), inflammatory, constitutional, congenital or post-trauma arthritis (26%), ligament laxity (10%), primary osteoarthritis (9%). Population was elderly (68 ± 13), sedentary (37.5% with a Devane score ≥ 3) and with important comorbidities (87% with ASA score ≥ 2). A clinical (KSS, Oxford scores) and radiological evaluation (implant loosening), as well as survival and reoperation rates assessment, were performed.

Results

At last follow-up (7 ± 3 years), KSS and Oxford scores were 64 ± 43 and 33 ± 10 each with a significant improvement of both scores overtime (respectively, p = 0.047 and p < 0.001). Twenty-eight complications (25%) were reported: 12 infections, 6 stiffness, 5 aseptic loosening and 5 patellofemoral instabilities. All in all, 91% (n = 102) of implants were still sealed and in place, 6% (n = 7) required revision and 3% (n = 3) were loose but could not undergo revision due to weak general health status. Mortality rate (18%, n = 20), linked to comorbidities, was high.

Conclusion

Clinical outcomes and survival of primary CRH-TKA are acceptable given the difficult and complex clinical situations it faced, but with high infection rate. In primary surgery, for patients with severe deformity, bone loss or ligament laxity, the use of CRH-TKA can be recommended. The choice of these implants must remain cautious and limited to situations not allowing the use of less constrained implants.

Level of evidence

Retrospective therapeutic and cohort study, Level III; retrospective case series, Level IV.

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Acknowledgement

This study was organised by the French Orthopedic and Trauma Surgery Society (SOFCOT).

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Authors and Affiliations

  1. Service de Chirurgie Orthopedique, Centre-Hospitalo-Universitaire de Saint-Etienne, Avenue Albert Raymond, Saint-Étienne, France

    Thomas Neri & Bertrand Boyer

  2. Service de Chirurgie Orthopedique, Centre-Hospitalo-Universitaire de Poitiers, Poitiers, France

    Pierre-Emmanuel Papin

  3. Service de Chirurgie Orthopedique, Centre-Hospitalo-Universitaire de Dijon, Dijon, France

    Pierre Martz

  4. Service de Chirurgie Orthopedique, Centre Médico-chirurgical des Massues, Lyon, France

    Gualter Vaz

  5. Service de Chirurgie Orthopedique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France

    David Eichler & Matthieu Ehlinger

  6. Service de Chirurgie Orthopedique, Centre-Hospitalo-Universitaire de Lille, Lille, France

    Gilles Pasquier

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  1. Thomas Neri
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Correspondence to Thomas Neri.

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For all authors, there is no conflict of interest in the present study.

Ethical approval

French Orthopedic and Trauma Surgery Society (SOFCOT) does not require an ethical approval for in-house studies on standard of care procedures.

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Neri, T., Boyer, B., Papin, PE. et al. Contemporary rotating hinge arthroplasty can safely be recommended in complex primary surgery. Knee Surg Sports Traumatol Arthrosc 28, 1780–1788 (2020). https://doi.org/10.1007/s00167-019-05589-x

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  • DOI: https://doi.org/10.1007/s00167-019-05589-x

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