Risk Factors for Aseptic Loosening After Total Knee Arthroplasty with a Rotating-Hinge Implant: A Case-Control Study.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
17 03 2021
17 03 2021
Historique:
pubmed:
29
12
2020
medline:
28
9
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
Successful results have been reported in association with the use of a rotating-hinge prosthesis for primary total knee arthroplasty (TKA). The objective of the present study was to identify risk factors for aseptic loosening in patients who underwent primary TKA with rotating-hinge knee prostheses. The records of 1,235 patients who underwent primary TKA with a rotating-hinge prosthesis at our center were evaluated. A total of 125 patients who underwent revision were further evaluated according to the inclusion and exclusion criteria, and 33 patients who underwent revision because of aseptic loosening were then compared with a group of 30 patients who did not require revision surgery. All data, including radiographic measurements, were obtained from records prior to the primary TKA. On the basis of our review of demographic, anthropometric, clinical, surgical, and radiographic findings, we found that higher body mass index (BMI) was associated with revision. The majority of patients with aseptic loosening had loosening of the femoral component. Furthermore, the inner femoral diameter at 20 cm proximal to the knee joint (on both anteroposterior and lateral images) was found to be predictive of revision among those with aseptic loosening. Receiver operating characteristic curve analysis showed that an inner diameter of the femur of >19 mm on anteroposterior images had a sensitivity of 91% and specificity of 87% for predicting the need for revision surgery in patients with aseptic loosening. This is one of few studies that has focused on determining risk factors for the failure of rotating-hinge prostheses following TKA surgery. Our findings indicate that a novel variable, the inner (diaphyseal) diameter of the femur at the point 20 cm proximal to the knee joint, is an extremely reliable predictor of revision surgery in patients with aseptic loosening. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
Successful results have been reported in association with the use of a rotating-hinge prosthesis for primary total knee arthroplasty (TKA). The objective of the present study was to identify risk factors for aseptic loosening in patients who underwent primary TKA with rotating-hinge knee prostheses.
METHODS
The records of 1,235 patients who underwent primary TKA with a rotating-hinge prosthesis at our center were evaluated. A total of 125 patients who underwent revision were further evaluated according to the inclusion and exclusion criteria, and 33 patients who underwent revision because of aseptic loosening were then compared with a group of 30 patients who did not require revision surgery. All data, including radiographic measurements, were obtained from records prior to the primary TKA.
RESULTS
On the basis of our review of demographic, anthropometric, clinical, surgical, and radiographic findings, we found that higher body mass index (BMI) was associated with revision. The majority of patients with aseptic loosening had loosening of the femoral component. Furthermore, the inner femoral diameter at 20 cm proximal to the knee joint (on both anteroposterior and lateral images) was found to be predictive of revision among those with aseptic loosening. Receiver operating characteristic curve analysis showed that an inner diameter of the femur of >19 mm on anteroposterior images had a sensitivity of 91% and specificity of 87% for predicting the need for revision surgery in patients with aseptic loosening.
CONCLUSIONS
This is one of few studies that has focused on determining risk factors for the failure of rotating-hinge prostheses following TKA surgery. Our findings indicate that a novel variable, the inner (diaphyseal) diameter of the femur at the point 20 cm proximal to the knee joint, is an extremely reliable predictor of revision surgery in patients with aseptic loosening.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 33369984
doi: 10.2106/JBJS.20.00788
pii: 00004623-202103170-00009
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
517-523Informations de copyright
Copyright © 2020 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G263).
Références
Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ. Knee replacement. Lancet. 2012 Apr 7;379(9823):1331-40. Epub 2012 Mar 6.
Gehrke T, Kendoff D, Haasper C. The role of hinges in primary total knee replacement. Bone Joint J. 2014 Nov;96-B(11)(Supple A):93-5.
Bistolfi A, Lustig S, Rosso F, Dalmasso P, Crova M, Massazza G. Results with 98 Endo-Modell rotating hinge prostheses for primary knee arthroplasty. Orthopedics. 2013 Jun;36(6):e746-52.
Efe T, Roessler PP, Heyse TJ, Hauk C, Pahrmann C, Getgood A, Schmitt J. Mid-term results after implantation of rotating-hinge knee prostheses: primary versus revision. Orthop Rev (Pavia). 2012 Dec 11;4(4):e35.
Mavrodontidis AN, Andrikoula SI, Kontogeorgakos VA, Babis GC, Xenakis TA, Beris AE, Soucacos PN. Application of the Endomodel rotating hinge knee prosthesis for knee osteoarthritis. J Surg Orthop Adv. 2008 Fall;17(3):179-84.
Rodríguez-Merchán EC, Gómez-Cardero P, Martínez-Lloreda Á. Revision knee arthroplasty with a rotating-hinge design in elderly patients with instability following total knee arthroplasty. J Clin Orthop Trauma. 2015 Mar;6(1):19-23. Epub 2014 Nov 20.
Yang JH, Yoon JR, Oh CH, Kim TS. Primary total knee arthroplasty using rotating-hinge prosthesis in severely affected knees. Knee Surg Sports Traumatol Arthrosc. 2012 Mar;20(3):517-23. Epub 2011 Jul 20.
Gudnason A, Milbrink J, Hailer NP. Implant survival and outcome after rotating-hinge total knee revision arthroplasty: a minimum 6-year follow-up. Arch Orthop Trauma Surg. 2011 Nov;131(11):1601-7. Epub 2011 Jun 9.
Helito CP, Giglio PN, Cavalheiro CM, Gobbi RG, Demange MK, Camanho GL. Knee arthroplasty with rotating-hinge implant: an option for complex primary cases and revisions. Rev Bras Ortop. 2018 Feb 21;53(2):151-7.
Felli L, Coviello M, Alessio-Mazzola M, Cutolo M. The Endo-Model(®) rotating hinge for rheumatoid knees : functional results in primary and revision surgery. Orthopade. 2016 May;45(5):446-51.
Lozano LM, López V, Ríos J, Popescu D, Torner P, Castillo F, Maculé F. Better outcomes in severe and morbid obese patients (BMI > 35 kg/m2) in primary Endo-Model rotating-hinge total knee arthroplasty. ScientificWorldJournal. 2012;2012:249391. Epub 2012 Apr 30.
Argenson JN, Aubaniac JM. Total knee arthroplasty in femorotibial instability. Orthopade. 2000 Jun;29(Suppl 1):S45-7.
Brown LR, Clement ND, MacDonald DJ, Breusch SJ. The survivorship of the Link endo-rotational hinge total knee arthroplasty: 5-12-year follow-up of 100 patients. Arch Orthop Trauma Surg. 2019 Jan;139(1):107-12. Epub 2018 Nov 9.
Sanguineti F, Mangano T, Formica M, Franchin F. Total knee arthroplasty with rotating-hinge Endo-Model prosthesis: clinical results in complex primary and revision surgery. Arch Orthop Trauma Surg. 2014 Nov;134(11):1601-7. Epub 2014 Sep 2.
Abdulkarim A, Keane A, Hu SY, Glen L, Murphy DJ. Rotating-hinge knee prosthesis as a viable option in primary surgery: literature review & meta-analysis. Orthop Traumatol Surg Res. 2019 Nov;105(7):1351-9. Epub 2019 Oct 3.
Rodríguez-Merchán EC. Total knee arthroplasty using hinge joints: indications and results. EFORT Open Rev. 2019 Apr 25;4(4):121-32.
Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am. 2007 Aug;89(8):1735-41.
Kouk S, Rathod PA, Maheshwari AV, Deshmukh AJ. Rotating hinge prosthesis for complex revision total knee arthroplasty: a review of the literature. J Clin Orthop Trauma. 2018 Jan-Mar;9(1):29-33. Epub 2017 Dec 5.
Giurea A, Neuhaus HJ, Miehlke R, Schuh R, Lass R, Kubista B, Windhager R. Early results of a new rotating hinge knee implant. Biomed Res Int. 2014;2014:948520. Epub 2014 Jun 25.
Wang CJ, Wang HE. Early catastrophic failure of rotating hinge total knee prosthesis. J Arthroplasty. 2000 Apr;15(3):387-91.
Smith TH, Gad BV, Klika AK, Styron JF, Joyce TA, Barsoum WK. Comparison of mechanical and nonmechanical failure rates associated with rotating hinged total knee arthroplasty in nontumor patients. J Arthroplasty. 2013 Jan;28(1):62-7.e1.
Cottino U, Abdel MP, Perry KI, Mara KC, Lewallen DG, Hanssen AD. Long-term results after total knee arthroplasty with contemporary rotating-hinge prostheses. J Bone Joint Surg Am. 2017 Feb 15;99(4):324-30.
Yang RS, Lin HJ. Contact stress on polyethylene components of a new rotating hinge with a spherical contact surface. Clin Biomech (Bristol, Avon). 2001 Jul;16(6):540-6.
Kabo JM, Yang RS, Dorey FJ, Eckardt JJ. In vivo rotational stability of the kinematic rotating hinge knee prosthesis. Clin Orthop Relat Res. 1997 Mar;336:166-76.