Rotating hinge prosthesis for complex revision total knee arthroplasty: A review of the literature

The rotating hinge prosthesis was originally used and designed as a primary total knee arthroplasty implant, but was hampered due to poor outcomes and catastrophic failures. Newer rotating hinge implants can be utilized in complex revision total knee arthroplasties when appropriately indicated, but their outcome data is very difficult to interpret due to the strict and varied indications for use and subsequently small number of procedures performed. The goal of this review is to evaluate the current evidence on large cohort, rotating hinge knee prostheses used in the revision setting, in order to provide a clearer understanding of the indications, outcomes and complications.

The PubMed database was utilized to search the available literature regarding "hinged knee," or "rotating hinge" devices. Exclusion criteria included papers focusing on primary arthroplasty, revision for oncologic issues, one-stage revision for infection or studies with less than fifty cases.

Review of 115 abstracts after initial search, led to ten studies in the literature that met our inclusion and exclusion criteria. The data shows that rotating hinge knee implants have good survivorship ranging from 51% to 92.5% at 10 years post-operatively. Complication rates range from 9.2% to 63% with infection and aseptic loosening as the most common complications.

Rotating hinge knee prostheses are most commonly indicated for infection, aseptic loosening, instability and bone loss in the literature. They have good outcome scores and survivorship, but continue to have high complication and revision rates. The implant is a good option when utilized appropriately for patients that are not candidates for less constrained devices.