Aseptic revision from one rotating-hinge to another rotating-hinge prosthesis - how good are the results?

BackgroundInformation regarding the use of hinged implants in non-oncological conditions is limited in our region due to a lack of adequate data collection and follow-up. The purpose of this study is to evaluate mid-term results and risk factors affecting the survivorship of third-generation rotating hinge knee (RHK) patients in non-oncological conditions.MethodsWe retrospectively reviewed 41 single, third-generation, rotating hinge prostheses in three complex primary knee procedures and 38 revision knee surgeries in between 2007 to 2014. Implant survival was assessed using the Kaplan-Meier method. Factors influencing implant survival were identified using the log-rank test. During the study period, clinical results along with complications were assessed. Clinical outcomes were assessed by using the Knee Society Score (KSS).ResultsRHK arthroplasty was used in 41 patients. Out of 41 patients, a RHK was used in three patients with a complex primary deformed knee whereas in 38 patients, a RHK was used in revision arthroplasty surgery. The cumulative implant survival rate with re-revision due to any cause was found to be 87.8% (95% CI 69.2–90.1) at 5–7 years. Prosthetic joint infection, peri-prosthetic fracture and extensor mechanism complications were the commonest mode of failure. The P value was found to be significant when comparing KSS pre-operatively and post-operatively.ConclusionThe cumulative implant survival rate was found to be 87.8%. Prosthetic joint infection was the commonest mode of failure in patients who underwent third-generation RHK surgery for variable indications. Being a patient with a high Charlson comorbidity index is the main risk factor associated with failure of the rotating hinge implant.

Rotating-hinge prosthesis for aseptic revision knee arthroplasty: A multicentre retrospective study of 127 cases with a mean follow-up of five years

Total knee replacement in severe genu recurvatum. High prosthetic survival rate without deformity recurrence, using rotating hinge prosthesis

Condylarconstrained knee prostheses (CCK) are increasingly used in revision total knee arthroplasty (rTKA), but the clinical effectiveness and long-term survival remain a debate. The purpose of this study is to report the long-term clinical and radiographicoutcome, implant survival rate, and surgical safety of revision total knee arthroplasty with condylar constrained knee prosthesis. A retrospective cohort study was performed on patients undergoing rTKA with CCK. The cases who received rTKA with CCK from January 2005 to January 2022 were selected. The duration of operation, theestimated perioperative blood loss, and theintraoperative blood transfusion rate were recorded to evaluate surgical safety. The pain visual analog scale (VAS), range of motion (ROM), the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Oxford knee score (OKS) was recorded to assess clinical outcome. Standard anteroposterior, lateral, skyline and long-standing AP radiographs of the lower limbs were conducted to assessradiographicoutcome. Implant survival was analyzed by Kaplan-Meier survival estimates. Fifty-five cases were followed up for an average of 9.6years (1-18years), including 16 males and 38 females, with an average age of 66 and an average BMI of 26.9kg/m2. The mainreasons for revision were periprosthetic infection (32 knees, 58.2%) and aseptic loosening (13 knees, 23.6%). The duration of operation was 149 ± 56.2min. The perioperative blood loss was 973.6 ± 421.6ml. At the last follow-up, VAS (8.0 ± 1.1 to 1.3 ± 1.4), ROM (82.7° ± 26.1° to 108.4° ± 11.8°), HSS (45.0 ± 10.4 to 85.3 ± 8.6), KSKS (38.4 ± 12.1 to 88.5 ± 12.0), KSFS (19.6 ± 12.9 to 68.8 ± 15.1), WOMAC (67.9 ± 12.5 to 14.4 ± 9.5), and OKS (9.9 ± 4.2 to 41.6 ± 7.7) were significantly improved (P < 0.001). A total of five complications were observed, all of which were periprosthetic infection. Non-progressive radiolucent lines were observed in 26 knees (47.3%). The 10-year survival rate for no operation was 96.0%. The tenyear survival rate for no revision was 98.0%. The use of CCK prosthesis for rTKA can achieve good long-term efficacy and prosthesis survival.

Total knee arthroplasty (TKA) with a rotating-hinge prosthesis is considered a salvage procedure. While excellent immediate stability is achieved, the historically high failure rate has tempered its use. The goal of this study was to determine clinical outcomes, radiographic results, and survivorship after TKA with contemporary rotating-hinge components. We identified 408 consecutive TKAs performed with rotating-hinge components for nononcologic indications from 2002 to 2012 at a single academic institution. Two hundred and sixty-four knees (65%) had rotating-hinge TKA components implanted for aseptic etiologies, while 144 knees (35%) were managed with the components in 2-stage reimplantation following infection. Rotating-hinge TKA implants were used for complex primary procedures in 74 knees (18%) and as a revision construct in 334 knees (82%). Clinical outcomes were assessed with the Knee Society scoring system, survivorship analyses, and cumulative incidence of revision. The mean age of the patients at the time of the index arthroplasty was 69 years, and the mean duration of follow-up was 4 years (range, 2 to 12 years). At the most recent follow-up, the mean Knee Society knee score had increased from 51 points preoperatively to 81 points (p < 0.0001), and the mean Knee Society functional score had increased from 26 to 36 points (p < 0.0001). At a mean of 4 years, loosening of components was observed in 13 (3.7%) of 349 knees. At the most recent follow-up, 59 revision procedures and 25 reoperations had been performed. The cumulative incidence of any revision was 9.7% at 2 years and 22.5% at 10 years. The cumulative incidence of revision for aseptic loosening was 1.7% at 2 years and 4.5% at 10 years. Metaphyseal cones were used in 114 knees (28%). Survivorship analysis revealed a trend toward a lower risk of revision (hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.39 to 1.22; p = 0.20) and reoperation (HR = 0.51; 95% CI = 0.22 to 1.19; p = 0.12) in patients with metaphyseal cones, despite their use in the most severe of bone defects. Contemporary rotating-hinge TKA implants had a low 10-year cumulative incidence of revision for aseptic loosening of 4.5%. Greater use of metaphyseal fixation has aided this improvement. Patients can expect substantial improvements in clinical outcomes with this revision strategy. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Data on long-time survival and clinical function of rotating hinge knee prostheses used in revision total knee arthroplasty (TKA) are scarce. We evaluate the outcome of 42 revision TKA in 38 patients using the Endo-model rotating hinge total knee prosthesis after a minimum of 6 years, with 10-year implant survival as our primary outcome measure. Only revision TKAs performed due to aseptic loosening were included, and the Swedish Knee Arthroplasty Register was consulted in order to ensure that patients unavailable for clinical follow-up had not been revised elsewhere. Mean follow-up was after 8.8 (6-18) years, mean age at revision surgery was 72 (55-88) years, and most patients had severe medical comorbidities (n = 31). At follow-up, four knees had been re-revised due to aseptic loosening, and five further knees underwent re-revision due to other reasons. With implant revision due to aseptic loosening as the endpoint, 10-year survival was 89.2%, and with implant revision due to any reason 10-year survival was 65.1%. 11 patients (13 knees) eligible for clinical follow-up were evaluated according to the Hospital for Special Surgery score (HSSS), the Knee Society scores (KSS), and by plain radiography. Mean HSSS was 67 (36-90), mean KSS-knee was 85 (73-96), and mean KSS-function was 29 (0-100). Radiography showed that no implant was in need of revision. Our results indicate that revision arthroplasty of the knee with this rotating hinge prosthesis can be performed with satisfactory or good results in an elderly population with severe comorbidities.

Background and purpose — Total knee arthroplasty (TKA) for treatment of end-stage posttraumatic arthritis (PTA) has specific technical difficulties and complications. We compared clinical outcome, postoperative quality of life (QOL), and survivorship after TKA done for PTA with those after TKA performed for primary arthritis (PA).Patients and methods — We retrospectively reviewed patients who were operated on at our institution for PTA between 1998 and 2005 (33 knees), and compared them to a matched group of patients who were operated on for PA during the same period (407 knees). Clinical outcomes and postoperative QOL were compared in the 2 groups using Knee Society score (KSS), range of motion (ROM) of the knee, and the knee osteoarthritis outcomes score (KOOS). Implant survival rate was calculated using Kaplan-Meier analysis.Results — At a mean follow-up of 11 (5–15) years, KSS knee increased from mean 39 (SD 18) to 87 (SD 16) in the PA group (p = 0.003), and from 31 (SD 11) to 77 (SD 15) in the PTA group (p = 0.003). KSS function increased from 55 (12) to 89 (25) in the PA group (p = 0.008) and from 44 (SD 14) to 81 (SD 10) in the PTA group (p = 0.008). Postoperative ROM also improved in both groups, from 83° to 108° in the PTA group (p < 0.001) as opposed to 116° to 127° in the PA group (p = 0.001), with lower results in the PTA group (p < 0.001). KOOS was lower in the PTA group (p < 0.001). The survival rate of TKA at 10 years with an endpoint defined as “any surgery on the operated knee” showed better results in the PA group (99%, CI: 98–100 vs. 79%, CI: 69–89; p < 0.001).Interpretation — Patients and surgeons should be aware that clinical outcome and implant survival after TKA for PTA are lower than after TKA done for PA

To investigate fully edentulous patients rehabilitated with cantilever-fixed implant-supported restorations and to analyse which complications are reported for this type of treatment. Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant-fixed restorations with at least 10 patients and with a mean follow-up of at least 5years were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. The risk of bias was evaluated for each article. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5- and 10-year survival and complication rates. Fourteen papers for fully edentulous patients were selected. The estimated 5 to 10years survival rate was calculated to be 99.00% and 96.7% for the implants and the prosthesis, respectively. A total of 299 complications (technical and biological) were reported with a cumulative 5-10years complication rate of 44.41% and 39.46% for the patients and for the prosthesis, respectively. There is evidence that cantilever can be successful treatment in fully edentulous patients.

To compare clinical and radiological outcomes, implant survivorship at a minimum of 1-year follow-up using metaphyseal trabecular cones with or without impaction grafting in a complex revision TKA. A retrospective comparative matched analysis was performed and 15 patients who underwent revision surgery using the combination of porous trabecular metaphyseal cone and diaphyseal impaction grafting (MC-IBG) were matched with a group of 13 patients who also underwent revision surgery using metaphyseal cone (MC) without impaction grafting. All included patients presented severe bone defect (AORI 2,3) and a rotating-hinge prosthesis were implanted. Both groups were comparable regarding the baseline demographic and clinical data. Patients had previously undergone a mean of 4 (range, 2-12) and 3 (range, 2-5) previous proceduresin the MC-IBG and MC groups, respectively. The indications for revision were aseptic loosening in 11 (73.3%) and 11 (84.6%) patients; prosthetic joint infection in 4 (26.7%) and 2 (15.4%) in the MC-IBG and MC groups, respectively. There was no significant difference in the mean postoperative Knee Society Score between the study groups (p = 0.806). Overall, 4 patients had further revision. Two patients were revised in the MC-IBG group, one patient for aseptic loosening and the second one after 2 episodes of instability. Two patients in the MC group presented prosthetic joint infection and underwent a two-stage reimplantation. No significant difference was observed between the study groups at comparison (p = 0.92). Trabecular metal cones with diaphyseal impaction grafting provide an alternative technique in acomplex revision TKAsurgery with early clinical and radiographic success.

Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. Implant survival was calculated using the Kaplan–Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T1 than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time.

To compare the clinical, radiographic, esthetic outcomes, and success and survival rates of dental implants placed after bone augmentation techniques. This retrospective study included a total of 764 patients receiving 764 dental implants between 2009 and 2019. Four hundred implants were placed without bone augmentation (control), and 364 were placed after bone augmentation. Bone augmentation techniques were guided bone regeneration (GBR), ridge split, and onlay bone grafting. Gingival index (GI), plaque index (PI), probing depth (PD), bleeding on probing (BOP), pink esthetic score (PES) and marginal bone loss (mm) and area (mm2) were measured. The study variables of the implants among augmentation groups were compared statistically. The mean PI and GI scores, and BOP values of the implants in the augmentation and control groups were comparable (p = 0.365, p = 0.230, and p = 0.371 resp.) The mean PD scores of the implants were 2.82 ± 1.22 in the augmentation and 2.54 ± 1.29 in the control groups; the difference was significant (p = 0.002). The mean vertical bone loss of the implants was 0.78 ± 0.70 in augmentation and 0.82 ± 0.82 in the control groups, which was comparable (p = 0.461). The mean PES total values of the implants were 8.30 ± 1.55 in augmentation and 10.04 ± 2.43 in the control groups; the difference was significant (p < 0.001). There were no significant differences between the augmentation and control groups in implant survival (99.18% vs. 98%, p = 0.228) and success (82.97% vs. 85.50%, p = 0.389) rates. Significant differences in some study variables were observed among the augmentation groups. The survival and success rates of the implants in GBR (99.21% and 85.04%), ridge split (99.19% and 79.68%), onlay (99.12% and 84.21%), and control (98.00% and 85.50%) groups were similar (p = 0.630 and p = 0.479, resp.) in the 6-year mean follow-up. The implants placed in augmented bone showed similar cumulative success and survival rates compared to implants placed in natural bone with a 6-year mean follow-up. The augmentation group showed lower esthetic scores. There are some differences in clinical parameters among augmentation groups; however, all the augmentation groups showed similar success and survival rates.

revision joint replacement surgery presents a surgical challenge. The use of rotating hinge prostheses is an option in patients with femorotibial bone defects, ligament insufficiency, or significant deformities. The aim of this study was to evaluate the clinical, functional, and radiological outcomes of a series of patients who underwent surgery using the GMK Hinge (Medacta®) rotational hinge model. a descriptive, retrospective, and analytical study was conducted on a series of 36 patients, with a mean age of 72.5 years (47-85), operated on by the same surgical team between January 2015 and January 2022. The etiology of revision was chronic infection in 38.9% of cases, instability in 33.3%, aseptic loosening in 19.4%, and stiffness in 8.4%. The Knee Society Score (KSS) and the Forgotten Joint Score (FJS) were used to assess functional outcomes. The degree of femorotibial bone defect was evaluated using the Anderson Orthopaedic Research Institute (AORI) classification. Postoperative complications are also recorded. a total of 36 patients, 17 males and 19 females, were included, with a mean follow-up of 30 months (12-66). Twelve patients had type 1 defects, ten had 2A defects, ten had 2B defects, and two had type 3 defects on the femoral side, with the use of wedges required for asymmetrical defects (21 patients). The predominant tibial defect was type 1 without the need for wedges. The majority achieved a satisfactory outcome on the KSS scale (72.2 ± 9.4), with significant differences compared to the previous KSS (54.3 ± 8.9). A score of 31 (12-67) was also obtained on the FJS scale. Postoperative complications were present in 16.7% of patients. complex prosthetic revision surgery using a rotating hinge prosthesis represents a suitable therapeutic option, yielding appropriate clinical and functional outcomes, albeit not without complications.

Multicenter 14-year follow-up of fibula vascular grafts of mandibles and maxillae restored with short and extra-short implants.

Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years

In this study, we present medium- and long-term data on implant survival in a cohort of patients with severe maxillary atrophy rehabilitated using reconstructive implant site development with calvarial bone grafts. We obtained clinical records from patients treated with implant rehabilitation supported by calvaria bone grafts in the Oral Surgery Department of IRCSS San Raffaele (Milan, Italy). Implant and prosthetic survival and success rates were retrospectively evaluated. Graft survival and postoperative complications were also assessed. A total of 207 implants placed in 32 patients were evaluated for a mean period of 10.0 years from loading. After 10 years, the cumulative survival rate was 97.10%, the implant success rate was 92.75%, and the prosthetic complication rate was 9.76%. A graft survival percentage of 96.88% was observed, and postoperative complications occurred in 28.13% of cases. The 10-year survival rate and prosthetic complications for patients treated with implant rehabilitation supported by calvarial bone grafts are excellent, as implant loss was relatively rare, although limited subjects were available for the 10-year follow-up.