Background: A rotating hinged total knee prosthesis may be utilized
for the treatment of global instability or severe bone loss around the knee.
Older generations of rotating hinged designs were associated with suboptimal
outcomes. We evaluated the outcome of salvage knee reconstructions that had
been performed with use of modern-generation modular segmental kinematic
rotating hinged total knee prostheses.
Methods: The cohort included forty-three patients (twenty-nine women
and fourteen men) who underwent forty-four knee arthroplasties for the
treatment of a non-neoplastic condition with use of a modern-generation
kinematic rotating hinged prosthesis. Revision of a previous total knee
arthroplasty in the presence of massive bone loss was the most common
indication for surgery. Complete clinical and radiographic data were collected
for all patients after a mean duration of follow-up of 4.2 years.
Results: Reconstruction with a rotating hinged total knee prosthesis
provided substantial improvement in function and reduction in pain. However, a
relatively large number of complications and failures (including revision
because of periprosthetic infection [three knees], aseptic loosening [four],
and periprosthetic fracture [one]) were encountered, with a mean time to
failure of 1.7 years. The rate of prosthetic survival was 79.6% at one year
and 68.2% at five years with revision or reoperation as the end point.
Conclusions: The present study highlights the commonly held opinion
that a modular kinematic rotating hinged total knee prosthesis has a role for
salvage reconstruction of the knee. In light of the relatively high rate of
complications, we believe that this salvage procedure should be reserved
primarily for elderly and sedentary patients.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.