Contemporary rotating hinge arthroplasty can safely be recommended in complex primary surgery

Area of Science:

• Orthopedic surgery
• Arthroplasty
• Biomedical engineering

Background:

• Complex knee deformities and instability often pose challenges for primary total knee arthroplasty.
• Contemporary rotating hinged total knee arthroplasty (CRH-TKA) offers a solution for severe cases, but its outcomes require thorough evaluation.

Purpose of the Study:

• To assess the clinical and radiological outcomes of primary CRH-TKA.
• To determine the survival rates and complication profile of CRH-TKA in challenging primary indications.

Main Methods:

• A multicenter retrospective study included 112 primary CRH-TKA procedures.
• Patients presented with severe deformities, inflammatory arthritis, ligamentous laxity, or osteoarthritis.
• Clinical scores (KSS, Oxford) and radiological assessments were performed over a mean follow-up of 7 years.

Main Results:

• Significant improvements in KSS and Oxford scores were observed post-operatively.
• A 25% complication rate was reported, including infections, stiffness, aseptic loosening, and patellofemoral instability.
• Implant survival was high at 91%, with a 6% revision rate, but mortality was significant (18%) due to comorbidities.

Conclusions:

• Primary CRH-TKA provides acceptable clinical results and survival in patients with severe knee deformities, bone loss, or ligamentous laxity.
• The high rate of complications, particularly infection, warrants careful consideration.
• CRH-TKA should be reserved for complex primary cases where less constrained implants are not suitable.