Ali Abdulkarim1, Anna Keane2, Shu Yang Hu2, Lachlan Glen2, Dermot J Murphy3. 1. Trauma & Orthopaedic Department, Cambridge University Hospital, Addenbrooke's Hospital, Cambridge, United Kingdom. Electronic address: ali.abdulkarim@addenbrookes.nhs.uk. 2. Royal College of Surgeons, Ireland. 3. University of Limerick, Ireland.
Abstract
BACKGROUND: Rotating-hinge knee replacements are usually reserved for revision surgeries, when the extent of soft tissue loss makes a constrained implant more suitable. They remain an uncommon choice in primary surgery when the soft tissue loss is not as extensive. METHODS: We completed a systematic review and meta-analysis to assess patients who underwent a Total Knee Replacement (TKR) with the rotating-hinge prosthesis in the primary setting. We searched PubMed and Embase for articles published in the ten years prior June 2017: Prosthesis survival rates, causes of failure, and clinical/functional scores were the primary outcomes. Twenty-one articles met the inclusion criteria for meta-analysis. Articles were grouped into (1) non-tumour (n=11) and (2) tumour indications (n=10). Survival data was summarized in forest plots, generated using Stata. RESULTS: We found that for certain indications the prosthesis has impressive survival rates and functional outcomes. Short-term (1-5 year) prosthesis survival in non-tumour cases was 92% (95% CI, 87-98%) and 77% (95% CI, 68-87%) in tumour cases. Mid-term (6-10 year) survival was 82% (95% CI, 74-89%) and 69% (95% CI, 57-81%) in non-tumour and tumour studies respectively. In analysis of clinical scores, patients showed a significant improvement in their pain score. Infection was the most commonly cited cause of prosthesis failure in both non-tumour and tumour studies, attributing to 31.5% and 37.6% of failures respectively. Aseptic loosening, dislocation and fracture were also commonly cited complications. CONCLUSION: We concluded that the rotating-hinge knee prosthesis is a viable option in primary surgery when there is extensive soft tissue destruction surrounding the joint. LEVEL OF EVIDENCE: I.
BACKGROUND: Rotating-hinge knee replacements are usually reserved for revision surgeries, when the extent of soft tissue loss makes a constrained implant more suitable. They remain an uncommon choice in primary surgery when the soft tissue loss is not as extensive. METHODS: We completed a systematic review and meta-analysis to assess patients who underwent a Total Knee Replacement (TKR) with the rotating-hinge prosthesis in the primary setting. We searched PubMed and Embase for articles published in the ten years prior June 2017: Prosthesis survival rates, causes of failure, and clinical/functional scores were the primary outcomes. Twenty-one articles met the inclusion criteria for meta-analysis. Articles were grouped into (1) non-tumour (n=11) and (2) tumour indications (n=10). Survival data was summarized in forest plots, generated using Stata. RESULTS: We found that for certain indications the prosthesis has impressive survival rates and functional outcomes. Short-term (1-5 year) prosthesis survival in non-tumour cases was 92% (95% CI, 87-98%) and 77% (95% CI, 68-87%) in tumour cases. Mid-term (6-10 year) survival was 82% (95% CI, 74-89%) and 69% (95% CI, 57-81%) in non-tumour and tumour studies respectively. In analysis of clinical scores, patients showed a significant improvement in their pain score. Infection was the most commonly cited cause of prosthesis failure in both non-tumour and tumour studies, attributing to 31.5% and 37.6% of failures respectively. Aseptic loosening, dislocation and fracture were also commonly cited complications. CONCLUSION: We concluded that the rotating-hinge knee prosthesis is a viable option in primary surgery when there is extensive soft tissue destruction surrounding the joint. LEVEL OF EVIDENCE: I.
Authors: Fabio Mancino; Ivan De Martino; Aaron Burrofato; Carmine De Ieso; Maristella F Saccomanno; Giulio Maccauro; Vincenzo De Santis Journal: J Orthop Traumatol Date: 2020-12-02
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