Short- to Midterm Outcomes of a Novel Guided-Motion Rotational Hinged Total Knee Arthroplasty

AbstractHinged prostheses have been increasingly utilized in complex and revision total knee arthroplasty (TKA) cases requiring additional mechanical support and global stability. However, there is limited data detailing the outcomes of modern hinge designs in these procedures. The aim of this study is to report a minimum 2-year functional outcomes and survivorship of a novel-guided motion-hinged knee TKA system. A multicenter, retrospective cohort study was conducted on consecutive TKA patients between March 2013 and August 2017 with a novel-guided motion-hinged knee system. Demographics, change in range of motion (ΔROM), quality metrics, and implant survivorship were collected with a minimum of 2-year follow-up. Implant survival was analyzed by using the Kaplan–Meier method. Overall, 147 hinged knee cases (18 complex primaries and 129 revisions) were identified with an average follow-up duration of 3.8 ± 1.2 years. Patients presented with an average of 2.4 ± 1.6 prior knee surgeries, and 51 (34.7%) had a history of knee infections. The ROM improved postoperatively: Δ extension = 2 ± 1 degrees, Δflexion = 7 ± 3 degrees, Δtotal ROM = 9 ± 4 degrees. Kaplan–Meier survivorship analysis for implant revision at 2- and 5-year follow-up showed a survival rate of 100 and 98.5% (95% confidence interval: 94.3–99.6%), respectively, with one patient undergoing two-stage revision for infection and another undergoing femoral revision for aseptic loosening. Survivorship for aseptic all-cause reoperation at 2- and 5-year follow-up was 93.2% (87.7–96.3%) and 88.2% (80.0–93.2%), respectively. Fourteen patients underwent aseptic reoperation (patellar complications: n = 7 [4.8%]; instability: n = 5 [3.4%]; tuberosity fixation: n = 1 [0.7%]; extensor mechanism failure: n = 1 [1.1%]). Survivorship for all-cause reoperation at 2- and 5-year follow-up were 85% (78.2–90.0%) and 77.7% (68.8–84.3%), respectively. Fifteen patients underwent reoperation for infection (DAIR: n = 14 (9.5%); two-stage revision: n = 1 [0.7%]). Despite some reoperations, this guided-motion hinged-knee TKA system demonstrates excellent survivorship for component revision compared to other modern hinged knee implants reported in the literature. Patients also displayed an improvement in knee ROM at their latest follow-up.

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Custom-made Articulating Spacer in Two-stage Revision Total Knee Arthroplasty. An Early Follow-up of 14 Cases of at Least 1 Year After Surgery

HSS Journal ® ◽

10.1007/s11420-007-9048-1 ◽

2007 ◽

Vol 3 (2) ◽

pp. 159-163 ◽

Cited By ~ 15

Author(s):

Valerio Pascale ◽

Walter Pascale

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Two Stage ◽

Articulating Spacer ◽

Custom Made ◽

Total Knee

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Long-term result of a second or third two-stage revision total knee arthroplasty for infected total knee arthroplasty

Arthroplasty ◽

10.1186/s42836-020-00062-4 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Young-Hoo Kim ◽

Jang-Won Park ◽

Young-Soo Jang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Recurrent Infection ◽

Revision Total Knee Arthroplasty ◽

Two Stage ◽

Total Knee ◽

The Mean ◽

Revision Tka

Abstract Background Persistent or recurrent infection after two-stage revision total knee arthroplasty (TKA) for the treatment of an infected TKA is a dreaded complication. The purpose of the current study was to determine the ability of a second or third two-stage revision TKA to control infection, evaluate the long-term survivorship of the TKA prosthesis, and measure the functional outcome after a second or third two-stage revision TKA for reinfection. Methods We evaluated 63 patients (65 knees) with failed two-stage TKA treated with a second or a third two-stage revision TKA. There were 25 men and 38 women (mean age, 67 ± 10.2 years). The mean follow-up from the time of a second two-stage TKA revision was 15.1 years (range, 10 to 19 years) and the mean follow-up from the time of a third two-stage TKA revision was 7 years (range, 5 to 10 years). Results Overall, infection was successfully controlled in 49 (78%) of 65 knees after a second two-stage revision TKA was performed. In the remaining 16 knees, recurrent infection was successfully controlled in 12 knees (75%) after a third two-stage revision TKA. Survivorship, free of implant removal for recurrent infection, was 94% at 15.1 years (95% CI, 91 to 100%). Survival free of revision TKA for mechanical failure was 95% (95% CI, 92 to 100%). Conclusions The results of the current study suggest that a second or a third two-stage revision TKA is a reasonable option for controlling infection, relieving pain, and achieving a satisfactory level of function for patients with infected TKAs.

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Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04205-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jake von Hintze ◽

Mika Niemeläinen ◽

Harri Sintonen ◽

Jyrki Nieminen ◽

Antti Eskelinen

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Survival Rate ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Patient Reported ◽

Total Knee ◽

Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

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Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection

The Bone & Joint Journal ◽

10.1302/0301-620x.103b8.bjj-2021-0224.r1 ◽

2021 ◽

Vol 103-B (8) ◽

pp. 1373-1379

Author(s):

Hosam E. Matar ◽

Benjamin V. Bloch ◽

Susan E. Snape ◽

Peter J. James

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Joint Infection ◽

Recurrent Infection ◽

Primary Outcome Measure ◽

Revision Total Knee Arthroplasty ◽

Single Stage ◽

Two Stage ◽

Joint Infections ◽

Total Knee

Aims Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. Methods A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. Results A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). Conclusion Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373–1379.

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