Outcomes of Rotating-hinge Total Knee Arthroplasty Following Complex Primary and Revision Total Knee Arthroplasty

In complex primary and revision total knee arthroplasty (TKA), rotating-hinge TKA (RH-TKA) prostheses play an important role. Compared to early fixed-hinge knee designs, new implants that include rotating platforms and improved hinge constructs may offer improvements in both survival and clinical outcomes. We sought to evaluate early survival following complex primary and revision TKA with a rotating-hinge knee prosthesis. We retrospectively reviewed a consecutive series of patients (n=47, 48 knees) who underwent revision TKA using an RH-TKA system. The mean age was 73 years (range, 37 - 86). The mean body mass index was 29 (range, 16.3 - 45.9) and the median ASA score was 3 (IQR, 2 - 3). As mortality was high, we performed a Kaplan-Meier analysis to evaluate survival, with death as failure. The median follow-up was 2.5 years (range, 0.07 - 9.8). Revision-free survival was 97% at a median 2.5 years of follow-up. Overall mortality was 46% (17/37) and survival free from death was 69% (49% - 82%) at a median of 2.5 years. Most reoperations were due to infection (5/12), following by wound-related complications (2/12) and hematomas (2/12). A high postoperative complication rate and mortality are evident in TKA using a hinged knee prosthesis in complex revision TKA. If the indication and surgical technique are matched to the complexity of the case, this type of implant offers a feasible salvage procedure.