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

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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