Dataset Information

Failure at the femoral stem extension-condylar interface in a rotating hinge knee without radiographic evidence of loosening.

ABSTRACT: Modular stem extensions have become ubiquitous in revision total knee arthroplasty systems. Although stem extensions are valuable in addressing bone deficiencies and improving implant fixation, the stem extension-condylar interface may be a point of implant failure. We report a case of failure at the femoral stem extension-condylar interface in a Zimmer NexGen Rotating Hinge Knee (Zimmer, Warsaw, IN). Currently, several published case reports describe failure at the femoral stem extension-condylar interface but only 1 case describes loosening at a taper junction without evidence of set screw failure or taper fracture. Furthermore, no published cases describe this type of failure in the Zimmer NexGen Rotating Hinge Knee (Zimmer).

SUBMITTER: Kahan M

PROVIDER: S-EPMC7083710 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Failure at the femoral stem extension-condylar interface in a rotating hinge knee without radiographic evidence of loosening.

Kahan Michael M Estes Christopher C

Arthroplasty today 20191212 1

Modular stem extensions have become ubiquitous in revision total knee arthroplasty systems. Although stem extensions are valuable in addressing bone deficiencies and improving implant fixation, the stem extension-condylar interface may be a point of implant failure. We report a case of failure at the femoral stem extension-condylar interface in a Zimmer NexGen Rotating Hinge Knee (Zimmer, Warsaw, IN). Currently, several published case reports describe failure at the femoral stem extension-condyl ...[more]

PMID: 32211472

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Project description:There is debate in the literature whether rotating hinge knee (RHK) or constrained condylar knee (CCK) prostheses lead to better clinical outcomes and survival rates in patients undergoing revision total knee arthroplasty (RTKA). The purpose of this meta-analysis is to compare the survivorship and clinical outcomes of RHK and CCK prostheses. In this meta-analysis, we reviewed studies that evaluated pain and function scores, range of motion (ROM), complications, and survival rates in patients treated with RHK or CCK with short-term (<5 years) or midterm (5-10 years) follow-up. The survivorship was considered as the time to additional surgical intervention such as removal or revision of the components. A total of 12 studies (one randomized study and 11 non-randomized studies) met the inclusion criteria and were analyzed in detail. The proportion of the knees in which short-term (<5 years) survival rates (RHK, 83/95; CCK, 111/148; odds ratio [OR] 0.52; 95% CI, 0.24-1.11; P = 0.09) and midterm (5-10 years) survival rates (RHK, 104/128; CCK, 196/234; OR 1.05; 95% CI, 0.56-1.97; P = 0.88) were evaluated did not differ significantly between RHK and CCK prostheses. In addition, there were no significant differences in ROM (95% CI: -0.40 to 9.93; P = 0.07) and complication rates (95% CI: 0.66 to 2.49; P = 0.46). In contrast, CCK groups reported significantly better pain score (95% CI: 0.50 to 2.73; P = 0.005) and function score (95% CI: 0.01 to 2.00; P = 0.05) than RHK groups. This meta-analysis revealed that 87.4% of RHK and 75.0% of CCK prostheses survive at short-term (<5 years), while 81.3% of RHK and 83.8% of CCK prostheses survive at midterm (5-10 years). The differences in standardized mean pain and function scores we detected were likely to be imperceptible to patients and almost certainly below the minimum clinically important level, despite a significant difference in both groups. Based on the findings of the current meta-analysis, RHK prostheses continue to be an option in complex RTKA with reasonable midterm survivorship.

Project description:BackgroundThere is a lack of evidence regarding long-term outcomes of rotating-hinge knee prostheses with distal femoral replacement in a large oncologic patient series. In this study, we investigated the proportion of patients experiencing complications requiring surgery in the long term, as well as the cumulative incidence of implant removal/revision and amputation at 5, 10, 15, and 20 years through competing risk analyses.MethodsWe retrospectively studied 214 patients treated with a Finn/Orthopaedic Salvage System (OSS) knee prosthesis (Zimmer Biomet) after distal femoral resection from 1991 to 2017. The study end points were postoperative complications requiring surgery. Reoperations were classified as major when there was (1) removal of the metal-body femoral component, the tibial component, or the bone-implant fixation; (2) major revision (exchange of the metal-body femoral component, the tibial component, or the bone-implant fixation); or (3) amputation. Minor reoperations were defined as all other reoperations. Competing risk analysis was used to estimate the cumulative incidence of implant removal/revision or amputation.ResultsThere were 312 reoperations in 113 patients (98 major reoperations in 68 patients and 214 minor reoperations). Seventeen patients (8%) required ≥5 additional operations, and 21 patients (10%) required >1 major reoperation. Although the number of reoperations decreased over time, major and minor reoperations continuously accrued after 10 years. The cumulative incidences of implant removal or revision for any reason at 5, 10, 15, and 20 years were 22.6%, 30.1%, 34.3%, and 42.5%, respectively. Although most implant removals/revisions occurred in the first 10 years, the risk persisted after 10 years, at a mean of 1.24%/year, mainly due to deep infection (1.06%/year).ConclusionsThe long-term outcomes of treatment with a Finn/OSS distal femoral rotating-hinge knee prosthesis showed it to be a durable reconstruction technique. The rate of implant removal/revisions after 10 years was gradual (1.24%/year). Deep infection remains a major late-failure mechanism, and lifetime surveillance for prosthetic problems is needed.Level of evidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Dataset Information

Failure at the femoral stem extension-condylar interface in a rotating hinge knee without radiographic evidence of loosening.

Publications

Failure at the femoral stem extension-condylar interface in a rotating hinge knee without radiographic evidence of loosening.

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