Abstract
Introduction
Patients with severe knee instability and extensive bone loss remain a surgical challenge. In such cases, regular knee implants and constrained condylar implants may not be suitable or have been attempted and failed.
Hinged knee replacements have developed an important role in the management of such complex knee cases. They also have an increasingly important role in cases such as rheumatoid arthritis and other cases of severe joint destruction.
We present a review of 138 consecutive hinge knee arthroplasties of 8 different Hinge models performed in our unit between 2004 and 2010.
Method
Combined prospective and retrospective study of 138 (42 primary and 96 revisions) consecutive cases of Hinge knee replacements at a mean follow up of 4.2 years. Outcomes were recorded and scored using the American knee score preoperatively, 1, 2 and 5 years. Complications, re-revisions, implant failures and survivorship were also assessed.
Results
Mean preoperative American knee score of 31 improved to 87 postoperatively.
Implant survivorship was greater than 81% at 4 years, with most of the failures occuring in the salvage surgery cases.
Complication rate was 19%; 15% of which required re-revisions for: loosening (4%), Infection (4%), periprosthetic fracture (3%), Implant fracture (2%), Component disassembly (1%) and dislocation (1%).
Conclusion
In our study, Hinge prostheses provide good stability and a reasonable alternative to amputation and arthrodesis in many complex cases. In addition, improvements in designs of modern Hinge prostheses, we believe has contributed to improved outcomes and a reduction in complication rate compared to earlier reports.
