International Orthopaedics

, Volume 42, Issue 12, pp 2825–2833 | Cite as

Revision knee arthroplasty with rotating hinge systems in patients with gross ligament instability

  • Sebastian P. BoelchEmail author
  • Joerg Arnholdt
  • Boris M. Holzapfel
  • Axel Jakuscheit
  • Maximilian Rudert
  • Maik Hoberg
Original Paper



The clinical and radiographic outcomes after revision total knee arthroplasty (TKA) for instability with two rotating hinge knee prostheses were compared.


Fifty-one patients revised for TKA instability were prospectively randomized to either the Link Endo-Model (N = 26) or the EnduRo (N = 25). Clinical and radiographic outcome scores were compared pre-operatively and at 12 months’ follow-up. Failure mechanisms were recorded.


Age, BMI, operation, and tourniquet-time did not differ significantly between groups. Radiographic evaluation demonstrated correct implant alignment. The Endo-Model was implanted with a higher slope (p = 0.0001) and the mechanical lower extremity axis was straighter (p = 0.0323). Except for the patient function Knee Society Score and the Physical Health Component Summary Score in the EnduRo group, all clinical scores (range of motion/knee function Knee Society Score/Oxford Knee Score/Visual Analog Scale/Mental Health Component Summary Score) improved significantly for both prosthesis designs during the follow-up period. The Visual Analog Scale and Mental Health Component Summary score were significantly better (p = 0.045 and p = 0.0148) in the Endo-Model group at the 12 months’ follow-up. In the EnduRo group 2 patients (8%) and in the Endo-Model group 1 patient (3.8%) had to be revised for infection.


Both prosthetic designs provide significant improvement in pain and function scores after TKA revision for gross instability. We found slight advantages in favor of the Endo-Model; however, no design yielded superior results throughout the study.


Total knee arthroplasty Link Endo-Model EnduRo Revision Instability Rotating hinge 


Compliance with ethical standards

For this study protocol, we received institutional review board approval (approval no. 195/10) from the University. It was conducted according to the principles of the World Medical Association Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Choi YJ, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28(1):1–15. CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Patil SS, Branovacki G, Martin MR, Pulido PA, Levy YD, Colwell CW Jr (2013) 14-year median follow-up using the press-fit condylar sigma design for total knee arthroplasty. J Arthroplast 28(8):1286–1290. CrossRefGoogle Scholar
  3. 3.
    Indelli PF, Giori N, Maloney W (2015) Level of constraint in revision knee arthroplasty. Curr Rev Musculoskelet Med 8(4):390–397. CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468(1):45–51. CrossRefPubMedGoogle Scholar
  5. 5.
    Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R (2015) Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 97(9):715–720. CrossRefPubMedGoogle Scholar
  6. 6.
    Whittaker JP, Dharmarajan R, Toms AD (2008) The management of bone loss in revision total knee replacement. J Bone Joint Surg (Br) 90(8):981–987. CrossRefGoogle Scholar
  7. 7.
    Guenoun B, Latargez L, Freslon M, Defossez G, Salas N, Gayet LE (2009) Complications following rotating hinge Endo-Modell (Link) knee arthroplasty. Orthop Traumatol Surg Res 95(7):529–536. CrossRefPubMedGoogle Scholar
  8. 8.
    Ochs BG, Schreiner AJ, de Zwart PM, Stockle U, Gonser CE (2016) Computer-assisted navigation is beneficial both in primary and revision surgery with modular rotating-hinge knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24(1):64–73. CrossRefPubMedGoogle Scholar
  9. 9.
    Efe T, Roessler PP, Heyse TJ, Hauk C, Pahrmann C, Getgood A, Schmitt J (2012) Mid-term results after implantation of rotating-hinge knee prostheses: primary versus revision. Orthop Rev (Pavia) 4(4):e35. CrossRefGoogle Scholar
  10. 10.
    Sanguineti F, Mangano T, Formica M, Franchin F (2014) Total knee arthroplasty with rotating-hinge Endo-Model prosthesis: clinical results in complex primary and revision surgery. Arch Orthop Trauma Surg 134(11):1601–1607. CrossRefPubMedGoogle Scholar
  11. 11.
    Giurea A, Neuhaus HJ, Miehlke R, Schuh R, Lass R, Kubista B, Windhager R (2014) Early results of a new rotating hinge knee implant. Biomed Res Int 2014:948520. CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Rodriguez-Merchan EC, Gomez-Cardero P, Martinez-Lloreda A (2015) Revision knee arthroplasty with a rotating-hinge design in elderly patients with instability following total knee arthroplasty. J Clin Orthop Trauma 6(1):19–23. CrossRefPubMedGoogle Scholar
  13. 13.
    Saragaglia D, Cognault J, Refaie R, Rubens-Duval B, Mader R, Rouchy RC, Plaweski S, Pailhe R (2015) Computer navigation for revision of unicompartmental knee replacements to total knee replacements: the results of a case-control study of forty six knees comparing computer navigated and conventional surgery. Int Orthop 39(9):1779–1784. CrossRefPubMedGoogle Scholar
  14. 14.
    Bini SA, Chan PH, Inacio MC, Paxton EW, Khatod M (2016) Antibiotic cement was associated with half the risk of re-revision in 1,154 aseptic revision total knee arthroplasties. Acta Orthop 87(1):55–59. CrossRefPubMedGoogle Scholar
  15. 15.
    Shen C, Lichstein PM, Austin MS, Sharkey PF, Parvizi J (2014) Revision knee arthroplasty for bone loss: choosing the right degree of constraint. J Arthroplast 29(1):127–131. CrossRefGoogle Scholar
  16. 16.
    Osmon DR, Berbari E, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of America (2013) Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56(1):1–10CrossRefPubMedGoogle Scholar
  17. 17.
    Felli L, Coviello M, Alessio-Mazzola M, Cutolo M (2016) The Endo-Model((R)) rotating hinge for rheumatoid knees : functional results in primary and revision surgery. Orthopade 45(5):446–451. CrossRefPubMedGoogle Scholar
  18. 18.
    Pradhan NR, Bale L, Kay P, Porter ML (2004) Salvage revision total knee replacement using the Endo-Model rotating hinge prosthesis. Knee 11(6):469–473. CrossRefPubMedGoogle Scholar
  19. 19.
    Barrack RL, Engh G, Rorabeck C, Sawhney J, Woolfrey M (2000) Patient satisfaction and outcome after septic versus aseptic revision total knee arthroplasty. J Arthroplast 15(8):990–993. CrossRefGoogle Scholar
  20. 20.
    Hernandez-Vaquero D, Sandoval-Garcia MA (2010) Hinged total knee arthroplasty in the presence of ligamentous deficiency. Clin Orthop Relat Res 468(5):1248–1253. CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Farid YR, Thakral R, Finn HA (2015) Intermediate-term results of 142 single-design, rotating-hinge implants: frequent complications may not preclude salvage of severely affected knees. J Arthroplast 30(12):2173–2180. CrossRefGoogle Scholar
  22. 22.
    Joshi N, Navarro-Quilis A (2008) Is there a place for rotating-hinge arthroplasty in knee revision surgery for aseptic loosening? J Arthroplast 23(8):1204–1211. CrossRefGoogle Scholar
  23. 23.
    Gudnason A, Milbrink J, Hailer NP (2011) Implant survival and outcome after rotating-hinge total knee revision arthroplasty: a minimum 6-year follow-up. Arch Orthop Trauma Surg 131(11):1601–1607. CrossRefPubMedGoogle Scholar
  24. 24.
    Ellert U, Kurth BM (2004) Methodological views on the SF-36 summary scores based on the adult German population. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 47(11):1027–1032. CrossRefGoogle Scholar
  25. 25.
    Jiang Y, Sanchez-Santos MT, Judge AD, Murray DW, Arden NK (2017) Predictors of patient-reported pain and functional outcomes over 10 years after primary total knee arthroplasty: a prospective cohort study. J Arthroplast 32(1):92–100 e102. CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, König-Ludwig-HausJulius-Maximilians-University WürzburgWürzburgGermany
  2. 2.Centre for Regenerative Medicine, Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia

Personalised recommendations