Hinge knee prostheses yield pain relief, good stability and functional outcome
The use of hinge knee prostheses can provide pain relief, satisfactory stability and a good functional outcome for complex primary and revision total knee arthroplasty cases that cannot be remedied with condylar replacement designs, according to a study from researchers in the United Kingdom.
The findings were presented by Herbert Gbejuade at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011, in Dublin.
“Hinges have been in use since the advent of knee replacement,” Gbejuade said. “Earlier reports of high complication rates have concerned many surgeons who use them. More recently, improvements in instrumentation and designs coupled with a rise in demand for revision surgery have led to an increase in use.”
The authors reviewed 137 consecutive hinge knee arthroplasties — 42 primary, 95 revision — accounting for eight different models, all performed between 2004 and 2010. According to the study abstract, indications for hinge use included severe instability or bone loss, recurrent dislocations, septic or aseptic loosening of the prosthesis and finally as a salvage procedure for when other prostheses had failed.
Preoperative and postoperative American Knee Society scores were used to ascertain full clinical and radiological outcomes, with follow-up occurring at 1 year, 2 years and 5 years. The team also recorded postoperative complications.
Knee ligament deficiencies that led to severe instability were the most common indication for hinge prostheses, Gbejuade said. Patients had a mean follow-up time of 4.2 years, with mean preoperative scores of 24.4 improving to 70.6 postoperatively.
Gbejuade noted postoperative complications included six cases requiring further revision due to loosening, three cases requiring manipulation under anesthesia to treat stiffness and two cases that developed infection.
“In conclusion, we present a large series of rotating hinge replacement with good medium-term outcome,” Gbejuade said, noting a low complication rate with only one patient requiring a transfemoral amputation.
Gbejuade H, Hassaballa M, Robinson J, et al. The use of hinge prostheses in primary and revision knee surgery, the Bristol experience. Presented at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011. Sept. 13-16. Dublin.
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