Abstract
The aim of the study was to determine the effectiveness and complications of hinged TKA revisions and the results of periprosthetic joint infection (PJI) treatment in such cases.
We have retrospectively reviewed 14 hinged TKA (Orthopedic Solution System, OSS, Biomet) in 14 patients. The patient average age was 70 years (range 56 to 83). The indication for the hinged TKA was: implant loosening (4 cases), periprosthetic fracture (3 cases), TKA instability (1 case) revision after spacer removal (1 case), advanced knee instability during primary TKA (3 cases), pseudoarthrosis due to previous tibial osteotomy (1 case) and tumor resection of the distal femur (1 case). The mean follow up was 26 months (range 6 to 60).
There have been 8 revisions in six patients. The indications for revision have been: infection (5 cases), skin necrosis (1 case), flexion contracture (1 case), and patellar luxation with extensor mechanism rupture (1 case). No aseptic loosening has been noted. In septic cases debridement was performed in 4 knees (debridement, antibiotics, implant retention, DAIR) and in one case two-stage revision with spacer. The average time from hinged TKA to revision due to any of the reasons was 13 months (range 2 to 41 months) and in case of septic revision 17 months (range 2 to 41). The mean follow up after septic revision was 30 months (range 24 to 41). In all the cases infection has healed. All the patients have been satisfied with the procedure and reported significant increase in the quality of life (mean HSS score 85). The mean pain score (NRS) has decreased from 7 preoperatively to 1. All the patients have reached at least 90 degrees of knee flexion.
The revisions of large implants are both demanding and expensive. In 4 of 5 cases DAIR has been successful in the treatment of PJI even though performed over the recommended time. The authors believe it could be considered in some PJI cases when implant removal is not an option.
