Advertisement

Acceptable mid- to long-term survival rates and functional outcomes following a single design rotating hinge total knee arthroplasty

  • C. TheilEmail author
  • T. Schmidt-Braekling
  • G. Gosheger
  • B. Thuener
  • B. Moellenbeck
  • J. Roeder
  • D. Andreou
  • J. Schwarze
  • R. Dieckmann
KNEE
  • 51 Downloads

Abstract

Purpose

This study first analyzes implant survival of this single design modular rotating hinge knee and identifies potential risk factors for failure and evaluates joint function using the postoperative WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, active flexion and extension deficit.

Methods

131 prostheses implanted for failure of prior total knee arthroplasty (n = 120) or complex primary procedures (n = 11) using a single modular implant (MUTARS—modular universal tumor and revision system GenuX, Implantcast, Buxtehude, Germany) between 2006 and 2014 including 73 patients treated for periprosthetic joint infection with a two-stage revision protocol were retrospectively identified. Implant survival was assessed using the Kaplan–Meier method; potential risk factors were identified using the log-rank test, as well as non-parametric analysis. Postoperative function was assessed using the WOMAC and measurement of range of motion.

Results

After a median follow-up of 62 months, 37 implants required implant revision (28%). Five-year survival was 69.7% [95% CI (confidence interval) 60.9–78.5] with periprosthetic (re-) infection being the main cause for failure (15%), followed by aseptic loosening (9%). In cases of periprosthetic infection, infection-free survival was 83% at 5 years (95% CI 74–92) with twelve patients suffering reinfection (16%).While body mass index (p = 0.75), age (p = 0.16) or indication for rotating hinge knee arthroplasty (p = 0.25) had no influence on survival, Charlson comorbidity score (CCI) (p = 0.07) and number of previous revision surgeries (p = 0.05) correlated with implant failure. There was trend (p = 0.1) for improved survival in fully cemented implants. Mean postoperative WOMAC was 127(range 55–191), 11 patients (15%) had limited knee extension.

Conclusions

Rotating hinge total knee arthroplasty using a single modular implant shows acceptable survival rates and function compared to previous studies with (re-)infection being the most relevant mode of failure. Patients with a high CCI and multiple previous surgeries are at increased risk for failure.

Level of evidence

Retrospective cohort study, III.

Keywords

Revision knee arthroplasty TKA PJI Periprosthetic joint infection Total knee arthroplasty Rotating hinge knee 

Abbreviations

BMI

Body mass index

CCI

Charlson comorbidity index

CI

Confidence interval

IQR

Interquartile range 25–75%

MSIS

Musculoskeletal infection society

MUTARS

Modular universal tumor and revision system

PJI

Periprosthetic joint infection

PMMA

Polymethylmethacrylate

RHK

Rotating hinge knee

TKA

Total knee arthroplasty

WOMAC

Western Ontario and McMaster universities osteoarthritis index

Notes

Authors’ contributions

CT review of literature, conception and design, acquisition of data, analysis and interpretation of data, statistical analysis, drafting of the manuscript; TSB review of literature, conception and design, acquisition of data, analysis and interpretation of data, statistical analysis, drafting of the manuscript; GG conception and design, critical revision of the manuscript; BT acquisition of data, analysis and interpretation of data, critical revision of the manuscript; BM critical revision of the manuscript; JR critical revision of the manuscript; DA critical revision of the manuscript; JS critical revision of the manuscript; RD conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, administrative, technical and material support, critical revision of the manuscript. All authors read and approved the final manuscript.

Funding

A specific source of funding was not required in this study.

Compliance with ethical standards

Conflict of interest

One author has received travel expenses by Implantcast Gmbh, Buxtehude, Germany outside the submitted work.

Ethical approval

Approval of the institutional review board was obtained prior to this investigation (local ethical committee ref. no. 2018-123-f-S).

References

  1. 1.
    Barrack RL (2001) Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res 392:292–299CrossRefGoogle Scholar
  2. 2.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  3. 3.
    Cottino U, Abdel MP, Perry KI, Mara KC, Lewallen DG, Hanssen AD (2017) Long-term results after total knee arthroplasty with contemporary rotating-hinge prostheses. J Bone Joint Surg Am 99:324–330CrossRefGoogle Scholar
  4. 4.
    Davies GM, Watson DJ, Bellamy N (1999) Comparison of the responsiveness and relative effect size of the western Ontario and McMaster universities osteoarthritis index and the short-form medical outcomes study survey in a randomized, clinical trial of osteoarthritis patients. Arthritis Care Res 12:172–179CrossRefGoogle Scholar
  5. 5.
    Diaz-Ledezma C, Higuera CA, Parvizi J (2013) Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin Orthop Relat Res 471:2374–2382CrossRefGoogle Scholar
  6. 6.
    Driesman AS, Macaulay W, Schwarzkopf R (2019) Cemented versus cementless stems in revision total knee arthroplasty. J Knee Surg.  https://doi.org/10.1055/s-0039-1678686 Google Scholar
  7. 7.
    Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12Google Scholar
  8. 8.
    Farid YR, Thakral R, Finn HA (2015) Intermediate-term results of 142 single-design, rotating-hinge implants: frequent complications may not preclude salvage of severely affected knees. J Arthroplast 30:2173–2180CrossRefGoogle Scholar
  9. 9.
    Fehring KA, Abdel MP, Ollivier M, Mabry TM, Hanssen AD (2017) Repeat two-stage exchange arthroplasty for periprosthetic knee infection is dependent on host grade. J Bone Joint Surg Am 99:19–24CrossRefGoogle Scholar
  10. 10.
    Fleischman AN, Azboy I, Fuery M, Restrepo C, Shao H, Parvizi J (2017) Effect of stem size and fixation method on mechanical failure after revision total knee arthroplasty. J Arthroplast 32:S202–S208CrossRefGoogle Scholar
  11. 11.
    Gehrke T, Kendoff D, Haasper C (2014) The role of hinges in primary total knee replacement. Bone Joint J 96(B):93–95CrossRefGoogle Scholar
  12. 12.
    Holl S, Schlomberg A, Gosheger G, Dieckmann R, Streitbuerger A, Schulz D et al (2012) Distal femur and proximal tibia replacement with megaprosthesis in revision knee arthroplasty: a limb-saving procedure. Knee Surg Sports Traumatol Arthrosc 20:2513–2518CrossRefGoogle Scholar
  13. 13.
    Hossain F, Patel S, Haddad FS (2010) Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 468:1221–1228CrossRefGoogle Scholar
  14. 14.
    Inglis AE, Walker PS (1991) Revision of failed knee replacements using fixed-axis hinges. J Bone Joint Surg Br 73:757–761CrossRefGoogle Scholar
  15. 15.
    Kamath AF, Lewallen DG, Hanssen AD (2015) Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Joint Surg Am 97:216–223CrossRefGoogle Scholar
  16. 16.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  17. 17.
    Koh CK, Zeng I, Ravi S, Zhu M, Vince KG, Young SW (2017) Periprosthetic joint infection is the main cause of failure for modern knee arthroplasty: an analysis of 11,134 knees. Clin Orthop Relat Res 475:2194–2201CrossRefGoogle Scholar
  18. 18.
    Kouk S, Rathod PA, Maheshwari AV, Deshmukh AJ (2018) Rotating hinge prosthesis for complex revision total knee arthroplasty: a review of the literature. J Clin Orthop Trauma 9:29–33CrossRefGoogle Scholar
  19. 19.
    Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep Part 1 50:163–170Google Scholar
  20. 20.
    Pala E, Trovarelli G, Calabro T, Angelini A, Abati CN, Ruggieri P (2015) Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res 473:891–899CrossRefGoogle Scholar
  21. 21.
    Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ et al (2011) New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res 469:2992–2994CrossRefGoogle Scholar
  22. 22.
    Petis SM, Perry KI, Mabry TM, Hanssen AD, Berry DJ, Abdel MP (2019) Two-stage exchange protocol for periprosthetic joint infection following total knee arthroplasty in 245 knees without prior treatment for infection. J Bone Joint Surg Am 101:239–249CrossRefGoogle Scholar
  23. 23.
    Petursson G, Fenstad AM, Havelin LI, Gothesen O, Lygre SH, Rohrl SM et al (2015) Better survival of hybrid total knee arthroplasty compared to cemented arthroplasty. Acta Orthop 86:714–720Google Scholar
  24. 24.
    Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF (2007) Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am 89:1735–1741Google Scholar
  25. 25.
    Rohner E, Benad K, Zippelius T, Kloss N, Jacob B, Kirschberg J et al (2018) Good clinical and radiological results of total knee arthroplasty using varus valgus constrained or rotating hinge implants in ligamentous laxity. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-5307-6 Google Scholar
  26. 26.
    Shen C, Lichstein PM, Austin MS, Sharkey PF, Parvizi J (2014) Revision knee arthroplasty for bone loss: choosing the right degree of constraint. J Arthroplast 29:127–131CrossRefGoogle Scholar
  27. 27.
    Smith TH, Gad BV, Klika AK, Styron JF, Joyce TA, Barsoum WK (2013) Comparison of mechanical and nonmechanical failure rates associated with rotating hinged total knee arthroplasty in nontumor patients. J Arthroplast 28(62–67):e61Google Scholar
  28. 28.
    Tan TL, Goswami K, Fillingham YA, Shohat N, Rondon AJ, Parvizi J (2018) Defining treatment success after 2-stage exchange arthroplasty for periprosthetic joint infection. J Arthroplast 33:3541–3546CrossRefGoogle Scholar
  29. 29.
    Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res 467:810–817CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopedics and Tumor OrthopedicsMuenster University HospitalMünsterGermany

Personalised recommendations