CONSTRAINED AND ROTATING HINGE TOTAL KNEE REPLACEMENTS IN THE TREATMENT OF FRACTURES INVOLVING THE KNEE

Abstract

The treatment of complex intra-articular fractures involving the knee has always proved challenging. The goals are to achieve satisfactory reduction, bony union and good functional outcome. Studies have investigated the outcome of various forms of treatment, including internal fixation and primary knee arthroplasty. In recent years there have been advances in technology bringing about more sophisticated implants such as pre-contoured peri-articular locking plates. Similar advances have been made in the production of constrained knee arthroplasty prostheses with the introduction of the Rotating Hinge Knee (RHK).

The initial non-rotating hinged prostheses for total knee arthroplasty did not enjoy a good reputation. The cumulative survival rate has been quoted as 65% at 6 years, significantly lower than that of conventional stabilised prostheses. Therefore the use of such implants was restricted to complex primary or revision arthroplasty, and tumour surgery. Studies have been published advocating the use of hinged prostheses for distal femoral fractures in elderly patients. The average age in the most recent study was 82, of whom 42% had died within the first post-operative year.

This study is a case series of 16 patients with fractures who were treated with hinged knee replacements, a subgroup of whom were treated with RHK. Demographic and outcome data has been retrospectively collected. We discuss the indications, experiences and outcomes in the management of these patients. This study also stimulates debate about the use of RHK to treat fractures in a younger population.