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Case Report: Failure of Rotating-hinge Total Knee Prosthesis by Disengagement of the Hinge-post Extension

  • Case Report
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Although modern-generation rotating-hinge knee implants have been modified to mitigate earlier complications related to aseptic loosening with these devices in revision TKAs, there are few, if any, reports of failure related to the hinge mechanism in these prostheses.

Case Description

We present a case of disengagement of the hinge-post extension in a contemporary rotating-hinge knee prosthesis originally implanted during revision surgery for instability and extensor mechanism insufficiency. We hypothesize the screw home kinematics of the knee resulted in a counterclockwise torque, contributing to the hinge post locking screw disengagement in this case.

Literature Review

Although some authors have reported complications and failures related to aseptic loosening with rotating-hinge knee prostheses, there have been no reports regarding complications related to the hinge mechanism, which simultaneously links and permits rotation between the femoral and tibial components.

Clinical Relevance

Arthroplasty surgeons who use rotating-hinge knee prostheses need to be aware of this potential mode of failure. Design modifications, including more secure locking mechanisms and side-specific implants, may avoid this complication.

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Acknowledgments

We thank Brett Levine, MD, for assistance and guidance in the preparation of this manuscript.

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Authors and Affiliations

  1. Section of Adult Reconstruction, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL, 60612, USA

    Debdut Biswas MD, Bryan Haughom MD, Robert E. Mayle Jr MD & Craig J. Della Valle MD

Authors
  1. Debdut Biswas MD
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  2. Bryan Haughom MD
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  3. Robert E. Mayle Jr MD
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  4. Craig J. Della Valle MD
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Corresponding author

Correspondence to Craig J. Della Valle MD.

Additional information

The institution of one of the authors (CDV) has received, in any one year, research funding from Zimmer (Warsaw, IN, USA), Smith & Nephew (Memphis, TN, USA), and Stryker (Kalamazoo, MI, USA). One of the authors (CDV) certifies that he has or may receive payments or benefits, during the study period of an amount of less than USD 10,000 from Biomet (Warsaw, IN, USA), and less than USD 100,000 from Smith & Nephew. CDV holds stock in and is on the Scientific Advisory Board for CD Diagnostics.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Biswas, D., Haughom, B., Mayle, R.E. et al. Case Report: Failure of Rotating-hinge Total Knee Prosthesis by Disengagement of the Hinge-post Extension. Clin Orthop Relat Res 471, 1389–1392 (2013). https://doi.org/10.1007/s11999-012-2736-2

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  • DOI: https://doi.org/10.1007/s11999-012-2736-2

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