The Journal of Arthroplasty, Volume 34, Issue 7, S271 - S276

Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis

Joshua S. Bingham, Brandon R. Bukowski, Cody C. Wyles, Ayoosh Pareek, Daniel J. Berry, Matthew P. Abdel


Revision total knee arthroplasty (TKA) for arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with arthrofibrosis revised with an RH.


Thirty-four patients revised with an RH for arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m 2, and mean follow-up was 6 years (range, 2-15 years).


The mean arc of motion increased 20° (74°-94°) in the RH group versus 12° (87°-99°) in the non-RH group ( P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group ( P = .2). Knee Society scores increased significantly in both groups ( P = .01 and P < .001, respectively). Survivorship free of revision for aseptic loosening at 10 years was 83% in the RH group versus 96% in the non-RH group ( P = .44). Survivorship free of any revision at 10 years was 54% in the RH group and 90% in the non-RH group ( P = .03). Forty percent of the revisions in the RH group were related to insert and bushing exchanges.


In this series, patients with arthrofibrosis revised to an RH TKA had a 20° improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group.

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