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. 2019 Jul;34(7S):S271-S276.
doi: 10.1016/j.arth.2019.01.072. Epub 2019 Feb 5.

Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis

Joshua S Bingham  1 , Brandon R Bukowski  1 , Cody C Wyles  1 , Ayoosh Pareek  1 , Daniel J Berry  1 , Matthew P Abdel  1
Affiliations

Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis

Joshua S Bingham et al. J Arthroplasty. 2019 Jul.

Abstract

Background: Revision total knee arthroplasty (TKA) for arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with arthrofibrosis revised with an RH.

Methods: Thirty-four patients revised with an RH for arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m2, and mean follow-up was 6 years (range, 2-15 years).

Results: The mean arc of motion increased 20° (74°-94°) in the RH group versus 12° (87°-99°) in the non-RH group (P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group (P = .2). Knee Society scores increased significantly in both groups (P = .01 and P < .001, respectively). Survivorship free of revision for aseptic loosening at 10 years was 83% in the RH group versus 96% in the non-RH group (P = .44). Survivorship free of any revision at 10 years was 54% in the RH group and 90% in the non-RH group (P = .03). Forty percent of the revisions in the RH group were related to insert and bushing exchanges.

Conclusion: In this series, patients with arthrofibrosis revised to an RH TKA had a 20° improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group.

Level of evidence: III.

Keywords: arthrofibrosis; complications; revision total knee arthroplasty (TKA); rotating-hinge prosthesis; stiffness.

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