Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis

Background: Revision total knee arthroplasty (TKA) for arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with arthrofibrosis revised with an RH. Methods: Thirty-four patients revised with an RH for arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m2, and mean follow-up was 6 years (range, 2-15 years). Results: The mean arc of motion increased 20 degrees (74 degrees-94 degrees) in the RH group versus 12 degrees (87 degrees-99 degrees) in the nonRH group (P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group (P = .2). Knee Society scores increased significantly in both groups (P = .01 and P <.001, respectively). Survivorship free of revision for aseptic loosening at 10 years was 83% in the RH group versus 96% in the non-RH group (P = .44). Survivorship free of any revision at 10 years was 54% in the RH group and 90% in the non-RH group (P = .03). Forty percent of the revisions in the RH group were related to insert and bushing exchanges. Conclusion: In this series, patients with arthrofibrosis revised to an RH TKA had a 20 degrees improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group. (C) 2019 Elsevier Inc. All rights reserved.