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

• DOI: 10.1186/s12891-021-04205-9
• Publication Date: 2021-04-07T16:05:30Z
• Authors: Jake von Hintze; Mika Niemeläinen; Harri Sintonen; Jyrki Nieminen; Antti Eskelinen
• Keywords: Reoperation; 3126; Knee Joint; Revision total knee arthroplasty; Health-related quality of life; Surgery, anesthesiology, intensive care, radiology; 610; Diseases of the musculoskeletal system; Prosthesis Design; Public health care science, environmental and occupational health; 03 medical and health sciences; 0302 clinical medicine; 617; Humans; Rotating hinged knee; Prospective Studies; Arthroplasty, Replacement, Knee; Retrospective Studies; 3126 Surgery, anesthesiology, intensive care, radiology; General medicine, internal medicine and other clinical medicine; Knee replacement; Treatment Outcome; RC925-935; Patient-reported outcome measures; Hinged knee; Quality of Life; Knee Prosthesis; Research Article; Follow-Up Studies

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.