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Rotating-Hinge Revision Total Knee Arthroplasty for Arthrofibrosis Improves Motion Without Increasing Complications:
Verdinand C B Ruelos1, Neha A Jayarajan2, Jeffrey L Shi1
1Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas.
Background:
Arthrofibrosis remains a challenging indication for revision total knee arthroplasty (rTKA), frequently resulting in persistent stiffness and limited postoperative range of motion (ROM). Rotating-hinge (RH) implants are often selected in this setting to allow for aggressive soft-tissue release and improved stability; however, the magnitude of ROM improvement and comparative effectiveness versus nonhinged revision (NHR) constructs remain incompletely defined.
Methods:
A systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Scopus, and the Cochrane Library were searched from 2005 to 2025 to identify studies reporting outcomes of rTKA performed for stiffness or arthrofibrosis. There were seven studies that met inclusion criteria, encompassing 224 RH revisions, including four comparative studies evaluating RH versus NHR implants and three RH-only case series. Random-effects meta-analyses were conducted to evaluate pooled improvement in ROM following RH revision and to compare ROM change between RH and NHR constructs. Heterogeneity was assessed using the I2 statistic.
Results:
The RH rTKA group resulted in a significant pooled improvement in ROM of 42.2° (95% confidence interval, 32.3 to 52.1; P < 0.0001). Comparative analysis of four studies (224 RH versus 108 NHR revisions) demonstrated significantly greater ROM improvement with RH implants, with a pooled between-group difference of 17.5° favoring RH constructs (95% confidence interval, 6.6 to 28.4°; P = 0.002). There was no included study that demonstrated an increased complication or reoperation burden associated with RH implants.
Conclusions:
Revision TKA using RH implants for arthrofibrosis provides substantial and clinically meaningful improvements in knee ROM. Compared with nonhinged constrained revision constructs, RH implants yield significantly greater gains in motion without an apparent increase in complications or reoperations, supporting their use in the management of severe stiffness.
