Purpose. Rotating hinge knee prostheses should provide a stable situation following reconstruction. We performed a biomechanical analysis to establish the association between design of the central rotational stem (peg) and implant’s stability, in a theoretical setting. Methods. Six different rotating hinge designs were tested, and three observers performed two different measurements with a custom made biomechanical apparatus and laterally directed pressure. The aim was to assign the degree of tilting of the peg within the vertical post-in channel by extending the distraction as well as the maximum amount of distraction before the peg’s dislocation. An intraclass-correlation coefficient (ICC) was calculated to determine the observer’s reliability. Results. Implant designs with cylindrical pegs of different lengths were superior to implant designs with conical or other shaped pegs concerning stability and maximum amount of distraction before dislocation, showing steep rising distraction-angular displacement curves. The ICC at 15？mm and 25？mm of distraction revealed high interobserver reliability ( ). Conclusion. The biomechanical analysis showed that rotating hinge prostheses with long and cylindrical pegs have the highest stability at any given amount of distraction. Designs with shorter and markedly tapered pegs may become unstable under conditions of mild joint distraction which has to be proven in future in vivo investigations. 1. Introduction Limb salvage surgery and revision arthroplasty are more demanding procedures than primary total arthroplasty. Components of these procedures are a stable fixation of the prostheses to the host bone, joint line restoration, and a stable range of motion consistent with the patient’s daily activities. These goals should be accomplished with the least degree of prosthetic constraint possible. Therefore, implant selection should be based on the amount of bone loss, the status of ligaments, and the soft-tissue stabilizing structures [1–5]. In cases of global insufficiency or complete loss of all joint ligaments the increasing constraint from a posterior stabilized prosthesis to a nonlinked constrained, hinged or rotating hinge device is required [1, 2, 6–11]. In cases of gross segmental bone loss, modular prostheses or allograft-prosthesis composites are used for reconstruction [8, 12]. Modular knee prostheses with a rotating hinge articulation are used for reconstruction following tumor resections around the knee, complex primary knee arthroplasty, and revision total knee arthroplasties. Such devices provide a stable
References
[1]
R. L. Barrack, T. R. Lyons, R. Q. Ingraham, and J. C. Johnson, “The use of a modular rotating hinge component in salvage revision total knee arthroplasty,” Journal of Arthroplasty, vol. 15, no. 7, pp. 858–866, 2000.
[2]
N. Joshi and A. Navarro-Quilis, “Is there a place for rotating-hinge arthroplasty in knee revision surgery for aseptic loosening?” Journal of Arthroplasty, vol. 23, no. 8, pp. 1204–1211, 2008.
[3]
D. W. Manning, P. P. Chiang, and A. A. Freiberg, “Hinge implants,” in Revision Total Knee Arthroplasty, V. J. Bono and R. D. Scott, Eds., pp. 219–236, Springer Science+Business Media, New York, NY, USA, 2005.
[4]
S. Riaz and M. Umar, “Revision knee arthroplasty,” Journal of the Pakistan Medical Association, vol. 56, no. 10, pp. 456–460, 2006.
[5]
P. S. Walker and A. R. J. Manktelow, “Comparison between a constrained condylar and a rotating hinge in revision knee surgery,” Knee, vol. 8, no. 4, pp. 269–279, 2001.
[6]
E. Engelbrecht, A. Siegel, J. Roettger, and H. W. Buchholz, “Statistics of total knee replacement. Partial and total knee replacement, design St. Georg. A review of a 4 year observation,” Clinical Orthopaedics and Related Research, vol. 120, pp. 54–64, 1976.
[7]
R. E. Jones, R. L. Barrack, and J. Skedros, “Modular, mobile-bearing hinge total knee arthroplasty,” Clinical Orthopaedics and Related Research, no. 392, pp. 306–314, 2001.
[8]
C. L. Nelson, T. J. Gioe, E. Y. Cheng, and R. C. Thompson Jr., “Implant selection in revision total knee arthroplasty,” Journal of Bone and Joint Surgery A, vol. 85, supplement 1, pp. 43–51, 2003.
[9]
N. R. Pradhan, L. Bale, P. Kay, and M. L. Porter, “Salvage revision total knee replacement using the Endo-Model？ rotating hinge prosthesis,” Knee, vol. 11, no. 6, pp. 469–473, 2004.
[10]
R. J. Harrison Jr., M. M. Thacker, J. D. Pitcher, H. T. Temple, and S. P. Scully, “Distal femur replacement is useful in complex total knee arthroplasty revisions,” Clinical Orthopaedics and Related Research, no. 446, pp. 113–120, 2006.
[11]
R. Schwarzkopf, S. Chaudhry, F. J. Kummer, and S. E. Marwin, “Failure of the tibial insert in a rotating hinge total knee arthroplasty,” The Journal of arthroplasty, vol. 26, no. 6, pp. 977.e5–977.e8, 2011.
[12]
R. D. Bauman, D. G. Lewallen, and A. D. Hanssen, “Limitations of structural allograft in revision total knee arthroplasty,” Clinical Orthopaedics and Related Research, vol. 467, no. 3, pp. 818–824, 2009.
[13]
J. A. Rand, E. Y. S. Chao, and R. N. Stauffer, “Kinematic rotating-hinge total knee arthroplasty,” Journal of Bone and Joint Surgery A, vol. 69, no. 4, pp. 489–497, 1987.
[14]
P. S. Walker, R. Emerson, T. Potter, R. Scott, W. H. Thomas, and R. H. Turner, “The kinematic rotating hinge: biomechanics and clinical application,” Orthopedic Clinics of North America, vol. 13, no. 1, pp. 187–199, 1982.
[15]
W. G. Ward, D. Haight, P. Ritchie, S. Gordon, and J. J. Eckardt, “Dislocation of rotating hinge total knee prostheses. A biomechanical analysis,” Journal of Bone and Joint Surgery A, vol. 85, no. 3, pp. 448–453, 2003.
[16]
H. G. David, M. Bishay, and E. T. R. James, “Problems with the Rotaflex: a 10-year review of a rotating hinge prosthesis,” Journal of Arthroplasty, vol. 13, no. 4, pp. 402–408, 1998.
[17]
A. Kawai, J. H. Healey, P. J. Boland, E. A. Athanasian, and D.-G. Jeon, “A rotating-hinge knee replacement for malignant tumors of the femur and tibia,” Journal of Arthroplasty, vol. 14, no. 2, pp. 187–196, 1999.
[18]
D. Pacha-Vicente, A. Malik, E. Castellet-Feliu, and J. Nardi-Vilardaga, “Dislocation of rotating-hinge knee prostheses with antidislocation mechanism,” Journal of Arthroplasty, vol. 23, no. 2, pp. 299–303, 2008.
[19]
C.-J. Wang and H. E. Wang, “Early catastrophic failure of rotating hinge total knee prosthesis,” Journal of Arthroplasty, vol. 15, no. 3, pp. 387–391, 2000.
[20]
W. G. Ward, D. Haight, P. Ritchie, S. Gordon, and J. J. Eckardt, “Dislocation of rotating hinge knee prostheses: a report of four cases,” Journal of Bone and Joint Surgery A, vol. 87, no. 5, pp. 1108–1112, 2005.
[21]
E. N. Zeegen, L. A. Aponte-Tinao, F. J. Hornicek, M. C. Gebhardt, and H. J. Mankin, “Survivorship analysis of 141 modular metallic endoprostheses at early followup,” Clinical Orthopaedics and Related Research, no. 420, pp. 239–250, 2004.
[22]
G. Petrou, H. Petrou, C. Tilkeridis et al., “Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up,” Journal of Bone and Joint Surgery B, vol. 86, no. 6, pp. 813–817, 2004.
[23]
J. M. Hoenig and D. M. Heisey, “The abuse of power: the pervasive fallacy of power calculations for data analysis,” American Statistician, vol. 55, no. 1, pp. 19–24, 2001.
[24]
K. A. Gustke, “Preoperative planning for revision total knee arthroplasty: avoiding chaos,” Journal of Arthroplasty, vol. 20, supplement 2, pp. 37–40, 2005.
[25]
J. M. Kabo, R.-S. Yang, F. J. Dorey, and J. J. Eckardt, “In vivo rotational stability of the kinematic rotating hinge knee prosthesis,” Clinical Orthopaedics and Related Research, no. 336, pp. 166–176, 1997.
[26]
A. Unnanuntana, J. E. Murphy, and W. J. Petersilge, “Management of chronic lateral instability due to lateral collateral ligament deficiency after total knee arthroplasty: a case report,” Journal of Medical Case Reports, vol. 4, article 144, 2010.
[27]
M. S. S. Leopold, C. McStay, K. Klafeta, J. J. Jacobs, R. A. Berger, and A. G. Rosenberg, “Primary repair of intraoperative disruption of the medial collateral ligament during total knee arthroplasty,” Journal of Bone and Joint Surgery A, vol. 83, no. 1, pp. 86–91, 2001.
