Management of Gonarthrosis with a Rotating Hinge Prosthesis: Minimum 10-Year Follow-up

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Arthroplasty

Background:

• Hinged prostheses in total knee arthroplasty (TKA) are typically reserved for severe deformities or instability.
• Previous studies report mixed results and a high incidence of complications with hinged TKA.
• This study evaluates the long-term outcomes and survivorship of primary TKA using hinged prostheses.

Purpose of the Study:

• To present the results of primary TKA performed with hinged prostheses.
• To identify factors influencing the survivorship of hinged TKA.
• To assess clinical and radiologic outcomes at a minimum 10-year follow-up.

Main Methods:

• 238 primary TKA procedures using hinged prostheses were analyzed.
• Indications included osteoarthritis, rheumatoid arthritis, posttraumatic deformity, and arthritis.
• Clinical outcomes were assessed using the Hospital for Special Surgery score; survivorship was determined by the Kaplan-Meier method.

Main Results:

• Mean follow-up was 13.5 years with a mean flexion of 118°.
• Excellent or good functional scores were reported by 74% of patients.
• Survivorship was higher in patients over 60 (94%) and those with varus deformity (96%) compared to younger patients (77%) and valgus knees (79%).

Conclusions:

• Rotating hinges in primary TKA yield optimal results in patients over 60 years old.
• Indications for hinged TKA include significant deformities, severe bone loss, and ligamentous laxity.
• Hinged TKA can provide durable outcomes for select patient populations with complex knee conditions.