Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Oct;90(5):467-472.
doi: 10.1080/17453674.2019.1627638. Epub 2019 Jun 18.

Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994-2017

Mona Badawy  1 , Anne Marie Fenstad  2 , Ove Furnes  2   3   4
Affiliations
Comparative Study

Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994-2017

Mona Badawy et al. Acta Orthop. 2019 Oct.

Abstract

Background and purpose - The number of primary, highly constrained knee arthroplasty implants has increased with a theoretically increased risk of early failure. Therefore we analyzed the risk of all revision following total knee arthroplasty (TKA) in patients receiving a hinged or condylar constrained knee (CCK) compared with a conventional unconstrained TKA. Patients and methods - The analyses included 401 primary highly constrained or hinged implants from 1994 to 2017. Kaplan-Meier survival curves were used to evaluate time to first revision with a maximum follow-up of 20 years. Cox regression was used to calculate hazard ratio (HR) comparing condylar constrained knee (CCK), hinged, and unconstrained TKA. Results - Kaplan-Meier estimated prosthesis survival after 2 years was 94.8% (95% CI 91.4-98.2) and 93.5% after 5 years for the primary CCK and 91.0% (CI 86.6-95.4) after 2 years and 85.5% after 5 years for the primary hinged TKA. Adjusted for sex, age groups, diagnosis, time period, previous surgery, and surgery time HR was 1.4 (CI 0.8-2.3) for the CCK and 2.4 (CI 1.6-3.7) for the hinged implants. The most common cause of revision in hinged implants was infection: 14 of 22 revisions. When excluding infection as revision cause, there were no differences in survival between the implant types. Estimated survival excluding infection revisions at 5 years was 96% for unconstrained, CCK, and hinged primary TKA implants. Interpretation - Primary rotating hinge total knee arthroplasty had a higher risk of revision compared with conventional TKA after 2 and 5 years' follow-up. Infection was the most common cause of revision. When excluding infection revisions from the survival analysis, hinged and CCK implants had similar performance to unconstrained TKA.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
401 cases of constrained or hinged implants were included from the Norwegian Arthroplasty Register from 1994 to 2017. 53 cases were excluded due to oncological indication for surgery. digits are number of implants.
Figure 2.
Figure 2.
Increasing usage of primary CCK and hinged TKA in the from 1994 to 2017 in the Norwegian Arthroplasty Register.
Figure 3.
Figure 3.
Kaplan–Meier survival curve with revision for any reason (a) and excluding infection revision (b) from 1994 to 2017 for TKA by implant type; blue = primary hinged knee replacement, red = primary condylar constrained knee replacement, black = unconstrained total knee replacement.
See this image and copyright information in PMC

References

    1. Aalirezaie A, Arumugam S S, Austin M, Bozinovski Z, Cichos K H, Fillingham Y, Ghanem E, Greenky M, Huang W, Jenny J-Y, Lee G-C, Manrique J, Manzary M, Oshkukov S, Patel N K, Reyes F, Spangehl M, Vahedi H, Voloshin V. Hip and knee section, prevention, risk mitigation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34(2S): S271–S8. - PubMed
    1. Badawy M, Espehaug B, Fenstad A M, Indrekvam K, Dale H, Havelin L I, Furnes O. Patient and surgical factors affecting procedure duration and revision risk due to deep infection in primary total knee arthroplasty. BMC Musculoskeletal Disord 2017; 18(1): 544. - PMC - PubMed
    1. Baker P, Critchley R, Gray A, Jameson S, Gregg P, Port A, Deehan D. Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery. KSSTA 2014; 22(3): 599–608. - PubMed
    1. Barrack R L. Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Rel Res 2001; (392): 292–9. - PubMed
    1. Cholewinski P, Putman S, Vasseur L, Migaud H, Duhamel A, Behal H, Pasquier G. Long-term outcomes of primary constrained condylar knee arthroplasty. Orthop Traumatol Surg Res 2015; 101(4): 449–54. - PubMed

Publication types

MeSH terms