Rotating-hinge arthroplasty for chronic posterolateral knee fracture-dislocation

Chronic knee fracture-dislocation is an exceptionally rare and disabling condition, most often resulting from neglected trauma. In elderly patients with degenerative changes and extensive ligamentous insufficiency, total knee arthroplasty (TKA) may represent a reliable salvage procedure to restore alignment, stability, and function.

A 76-year-old woman with hypertension and type 2 diabetes presented four months after a fall with a chronic posterolateral dislocation of the left knee. Clinical examination revealed a fixed varus deformity and posterior tibial translation. Radiographs confirmed chronic fracture-dislocation with secondary osteoarthritic degeneration. Given the chronicity and poor soft-tissue quality, a rotating-hinge TKA was performed. Intraoperative findings included fibrosis, retracted cruciate ligaments, and posterior capsule shortening. After extensive soft-tissue release, the prosthesis was implanted with cemented stems.

At one-year follow-up, the patient achieved a painless and stable range of motion from 0° to 100°, with a Knee Society Score of 82, indicating excellent function.

Rotating-hinge TKA offers a valuable reconstructive option in chronic knee fracture-dislocations with severe ligament deficiency, providing stable, pain-free, and functional outcomes when anatomic reconstruction is not feasible.