Indications for primary rotating-hinge total knee arthroplasty. Is there consensus?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Rotating-hinge knee (RHK) systems are typically used in revision total knee arthroplasty (TKA) due to bone loss or instability.
• Increasing use of RHK in primary TKA necessitates a review of appropriate indications.
• Third-generation RHK devices offer advanced constraint features.

Purpose of the Study:

• To review existing literature on third-generation rotating-hinge knee devices.
• To identify and analyze the specific indications for using RHK in primary total knee arthroplasty.
• To establish evidence-based guidelines for primary RHK implantation.

Main Methods:

• Comprehensive literature search using terms like 'total knee arthroplasty,' 'primary indication,' and 'rotating hinge knee.'
• Screening of identified papers and relevant articles.
• Exclusion of studies on first/second-generation RHK and revision cases.

Main Results:

• Third-generation RHK implants are primarily indicated for specific complex primary TKA cases.
• Ligamentous tibiofemoral instability emerged as the core indication for primary RHK use.
• The review identified limited, yet critical, indications for primary RHK implantation.

Conclusions:

• Third-generation rotating-hinge implants should be considered for primary total knee arthroplasty in select patient populations.
• The primary indication for primary RHK use is significant ligamentous tibiofemoral instability.
• Careful patient selection is crucial for optimal outcomes with primary RHK implantation.