Indications, Survivorship, and Clinical Outcomes of a Rotating Hinge Total Knee and Distal Femoral Arthroplasty System

Abstract Introduction Rotating hinge knee prostheses (with or without distal femoral replacement) are indicated in cases of unreconstructible bony or soft tissue compromise. Despite their versatility, these implants have demonstrated high rates of mechanical failure. We aimed to review clinical outcomes a novel hinged knee arthroplasty system. Methods We reviewed all cases in a prospective database of hinged total knee arthroplasty (with and without distal femoral arthroplasty) involving a single manufacturer’s implant system at a large tertiary-level academic health sciences center. We collected reasons for surgery, implant survivorship, reasons for revision, and clinical outcomes (SF-12, WOMAC, and Knee Society Scores). Results Seventy-six cases of hinged knee implants using the knee system under investigation were performed (39 hinged total knee and 37 distal femoral replacements) between 2011 and 2018, inclusive. Indications for surgery varied, with second stage re-implantation most common for rotating hinge and fracture most common for distal femoral arthroplasty. There were 6 revisions in the rotating hinge group (none for aseptic loosening) and 5 in the distal femoral arthroplasty group (one for aseptic loosening). Average follow-up was 2.89 ± 2.09 years. Post-operative SF-12 (Physical Component), WOMAC, and Knee Society Scores were 30.12 ± 10.17, 55.90 ± 21.51, and 115.62 ± 45.20, respectively. Conclusion This novel hinged knee system is a highly durable option for complex and revision knee arthroplasty. Early failures tend to be secondary to infection. We observed only a single case of aseptic loosening. Although these early results are encouraging, ongoing follow-up is required to determine long-term prognosis in patients receiving this implant.