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



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.


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.


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.


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.


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



Body mass index


Charlson comorbidity index


Confidence interval


Interquartile range 25–75%


Musculoskeletal infection society


Modular universal tumor and revision system


Periprosthetic joint infection




Rotating hinge knee


Total knee arthroplasty


Western Ontario and McMaster universities osteoarthritis index


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.


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).


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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

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