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Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The use of ‘hinged’ knee prostheses for primary knee arthroplasty procedures is increasing. This analysis reports the rates of implant survival, modes of failure, revision details and functional outcomes with particular reference to the primary indication for surgery for a cohort of patients treated with primary hinged knee replacement.

Methods

Systematic review with supplementary analysis using data from the National Joint Registry and Department of Health. Analysis included 964 patients undergoing primary hinged knee replacement between April 2003 and December 2010. Survival at a maximum of 7 years was calculated for the group as a whole and dependent upon the indication for surgery (osteoarthritis vs. rheumatoid/inflammatory arthritis vs. post-traumatic arthritis). Functional outcomes (pre- and post-operative Oxford Knee and Euroqol-5D scores and post-operative satisfaction) were available for 46 patients.

Results

In total, 20 cases required revision. The 5-year survival rate (96.8 % [95 % CI 95.1–98.4 %]) was not dependent upon the primary surgical indication (p = n.s.). The commonest reasons for revision were infection (8 cases), peri-prosthetic fracture (4 cases) and aseptic loosening (3 cases). Patients reported substantial improvements in their Oxford Knee Score (mean improvement = 17.6, [95 % CI 14.4–20.8]) and EQ5D index (mean improvement = 0.357, [95 % CI 0.248–0.467]). Levels of post-operative satisfaction were high.

Conclusions

Hinged knee replacement can be considered as a viable alternative to more traditional unconstrained designs in the complex primary setting. These findings are clinically relevant as they support the increasing use of hinged knee replacements for the arthritic knee in which there is concomitant severe bone loss, deformity or instability. Surgeons using these implants can have confidence that their mid-term performance is comparable to more conventional knee designs.

Level of evidence

Prospective cohort study, Level II.

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Acknowledgments

We thank the patients and staff of all the hospitals in England and Wales who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR steering committee and the staff at the NJR centre for facilitating this work. This work was funded by a fellowship from the National Joint Registry. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Register Steering committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.

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Authors and Affiliations

  1. National Joint Registry, Hemel Hempstead, UK

    Paul Baker & Simon Jameson

  2. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK

    Paul Baker

  3. Trauma and Orthopaedics, Northern Deanery, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY, UK

    Paul Baker, Rebecca Critchley & Simon Jameson

  4. Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK

    Andrew Gray & David Deehan

  5. James Cook University Hospital, Marton Road, Middlesbrough, TS3 4BW, UK

    Paul Gregg & Andrew Port

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  1. Paul Baker
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Correspondence to Paul Baker.

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Baker, P., Critchley, R., Gray, A. et al. Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery. Knee Surg Sports Traumatol Arthrosc 22, 599–608 (2014). https://doi.org/10.1007/s00167-012-2305-y

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  • DOI: https://doi.org/10.1007/s00167-012-2305-y

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