Dislocation of modern design rotating hinge total knee arthroplasty : case series and narrative review

Knee dislocation is an infrequent complication after rotating hinge total knee arthroplasty (RHTKA). The aim of the present study was to describe our experience with dislocating RHTKA in a consecutive prospective large series, its occurrence rate, causative mechanisms and to perform a review of available literature. In total, six dislocations were observed in 303 RHTKA procedures (NexGen RHK, ZimmerBiomet, Warsaw, Indiana, US) at a mean of 10 (range, 2 - 24) months after surgery. This results in a 2% dislocation rate, which is lower than the 3.1% cumulative rate reported earlier in literature. Men and women were distributed equally, with a mean age of 56 years old. The indication for RHTKA among the six dislocations was revision in 4 cases and primary arthroplasty for the other 2 cases. Analysis revealed that the main mechanism of hinge dislocation was forced knee flexion with concomitant extensor mechanism insufficiency (4/6 cases). The second cause was unscrewing of the locking pin (2/6 cases). This is probably caused by the screw home mechanism that results in a counterclockwise torque -and therefore a loosening- effect on locking bolts, specifically in right-sided RHTKA. Obesity probably predisposes to hinge dislocation since 83% of patients in this series were obese (BMI, range 34 to 52). The findings of this study suggest that dislocation of RHTKA is a rare complication that could happen to obsese patients without an adequate extensor mechanism. Level of evidence : IV.