Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (4): 51-57.doi: 10.6040/j.issn.1671-7554.0.2025.1535

• Clinical Medicine • Previous Articles    

Application and clinical outcomes of rotating hinge knee prosthesis in complex primary total knee arthroplasty

WANG Xingshan, ZHANG Haotian, ZHANG Yunfeng, ZHOU Yixin   

  1. Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
  • Published:2026-04-09

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Abstract: Objective To investigate the clinical application of rotating hinge knee(RHK)prosthesis in complex primary total knee arthroplasty(TKA)and evaluate the clinical efficacy. Methods A retrospective analysis was conducted on 36 patients(38 knees)who underwent primary TKA using a RHK prosthesis between April 2012 and November 2024 for severe knee deformity or ligamentous insufficiency. The cohort included 15 males(16 knees)and 21 females(22 knees), with(62.1±11.4)years at surgery. Preoperative diagnoses included severe varus/valgus deformity, neuropathic arthropathy, and post-traumatic arthritis. The American Knee Society Score(KSS)was used to assess knee pain, stability and function, and the active range of motion(ROM)of the knee was measured using a gonio-meter. Preoperative and final follow-up KSS and ROM were compared. The postoperative complications and patient satisfaction were assessed. Prosthesis survival was calculated using the Kaplan-Meier method, with revision for any reason or symptomatic radiographic loosening defined as the endpoint. Results All patients were followed up for(75.8±38.1)months. At the final follow-up, significant improvements were observed: the KSS knee score increased from(26.1±12.1)to(77.2±18.5)points, the function score from(26.3±15.9)to(70.5±22.6)points, and ROM from(79.5±32.9)° to(99.6±19.4)°(P<0.001). Patient satisfaction was 86.7%. Three knees(7.9%)reached the endpoint by the final follow-up. The 5-year cumulative survival rate was 94.6%(95%CI: 87.6-100). The overall complication rate was 26.3%(10/38 knees), including intraoperative fracture, delayed wound healing, postoperative hinge post dislocation, prosthetic loosening, and joint stiffness. Conclusion The application of rotating hinge knees in complex primary TKA can significantly improve knee function and yield satisfactory mid-term prosthesis survival. However, the procedure is associated with a high complication rate. Successful outcomes depend on strict patient selection.

Key words: Arthroplasty, Replacement, Knee, Rotating hinge knee, Clinical outcome

CLC Number: 

  • R687.4
[1] Stubnya BG, Schulz M, Váncsa S, et al. Global trends in joint arthroplasty: a systematic review and future projections[J]. J Clin Med, 2025, 14(22): 8214. doi: 10.3390/jcm14228214
[2] Tigani D, Fosco M, Amendola L, et al. Total knee arthroplasty in patients with poliomyelitis[J]. Knee, 2009, 16(6): 501-506.
[3] Stroobant L, Marvellie A, Windels J, et al. Instability after total knee arthroplasty: a systematic review and meta-analysis of treatment options and outcomes[J]. Knee Surg Sports Traumatol Arthrosc, 2025, 33(11): 3817-3839.
[4] Tetteh AE, Derr T, Kurtz MA, et al. Hinge-knee megaprostheses components wear and corrode: a retrospective study of 40 devices[J]. J Am Acad Orthop Surg Glob Res Rev, 2025, 9(10): e24.00381. doi: 10.5435/JAAOSGlobal-D-24-00381
[5] Kienzle A, Walter S, von Roth P, et al. High rates of aseptic loosening after revision total knee arthroplasty for periprosthetic joint infection[J]. JB JS Open Access, 2020, 5(3): e20.00026. doi: 10.2106/JBJS.OA.20.00026
[6] Wignadasan W, Kirschbaum SM, Perka C, et al. Contemporary insights into hinged knee arthroplasties: biomechanics, indications, and outcomes in complex primary and revision total knee arthroplasty[J]. Bone Joint J, 2025, 107-B(12): 1254-1262.
[7] Oliver TC, Kayani B, Luo TD, et al. Current concepts in total knee arthroplasty: rotating hinge prostheses[J]. SICOT J, 2025, 11(18). doi: 10.1051/sicotj/2025010
[8] 黄菲, 郑秋坚. 旋转铰链膝假体在全膝关节置换翻修术后的临床效果[J]. 中华关节外科杂志(电子版), 2016, 10(1): 108-112. HUANG Fei, ZHENG Qiujian. Clinical effect of rotating hinge knee prosthesis after total knee replacement revision[J]. Chinese Journal of Joint Surgery(Electronic Edition)2016, 10(1): 108-112.
[9] Dandamudi S, Guerrero O, DeBenedetti A, et al. Rotating hinge revision total knee arthroplasty with and without porous cone adjunct fixation[J]. J Arthroplasty, 2025, 40(7S1): S277-S282.
[10] Hantouly AT, Muthu S, Shahab M, et al. What are the indications for hinged implants in revision total knee arthroplasty?[J]. J Arthroplasty, 2025, 40(2S1): S164-S167.
[11] Garabano G, Perez Alamino L, Nieto XAM, et al. Total knee replacement in severe genu recurvatum. High prosthetic survival rate without deformity recurrence, using rotating hinge prosthesis[J]. J Orthop, 2025, 61: 109-113. doi: 10.1016/j.jor.2024.10.008
[12] Von Hintze J, Ponkilainen V, W-Dahl A, et al. Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association(NARA)[J]. Acta Orthop, 2025, 96: 142-150. doi: 10.2340/17453674.2025.42999
[13] Abdel Khalik H, Cruickshank M, Nadeem SM, et al. Rotating hinge implants for primary total knee arthroplasty: a systematic review and meta-analysis of 6, 554 knees[J]. J Arthroplasty, 2025: S0883-S5403(25)01336-1. doi: 10.1016/j.arth.2025.10.057
[14] Lex JR, Entezari B, Backstein DJ, et al. Reliable outcomes provided by a rotating hinge knee arthroplasty for patients who have moderate-to-severe arthrofibrosis[J]. J Arthroplasty, 2025: S0883-S5403(25)00905-2. doi: 10.1016/j.arth.2025.07.041
[15] Schaible SF, Eberlein SC, Schaefer R, et al. Clinical outcomes of standard primary vs. primary rotating hinge total knee arthroplasty: a retrospective matched-pair analysis[J]. J Orthop Surg Res, 2025, 20(1): 575. doi: 10.1186/s13018-025-05961-3
[16] 庄至坤, 许志庆, 林行会, 等. 可旋转铰链膝在晚期夏科氏膝关节病的应用[J]. 中国矫形外科杂志, 2022, 30(3): 277-280. ZHUANG Zhikun, XU Zhiqing, LIN Hanghui, et al. Application of rotatable hinged knee in advanced Charcots knee joint disease[J]. Orthopedic Journal of China, 2022, 30(3): 277-280.
[17] 罗德素, 刘培来, 苗壮. 分期外固定架牵引联合铰链膝假体置换术治疗复杂创伤性膝关节炎1例[J]. 山东大学学报(医学版), 2022, 60(1): 121-124. LUO Desu, LIU Peilai, MIAO Zhuang. Staged external fixator distraction combined with rotating hinge knee arthroplasty for the treatment of complex post-traumatic knee arthritis: a case report[J]. Journal of Shandong University(Health Science), 2022, 60(1): 121-124.
[18] 刘朝武. 旋转铰链型膝关节假体治疗重度膝关节畸形的中期疗效分析[D]. 沈阳: 中国医科大学, 2019.
[19] 张锐, 柳海平, 尤从新, 等. 可旋转铰链膝关节假体治疗严重膝关节畸形25例[J]. 中国中医骨伤科杂志, 2016, 24(7): 65-68.
[20] Cavaignac E, Tricoire JL, Pailhé R, et al. Recurring intraprosthetic dislocation of rotating-hinge total knee prosthesis. Effect of implant design on intrinsic stability[J]. Orthop Traumatol Surg Res, 2014, 100(7): 835-837.
[21] Makiev KG, Vasios IS, Keskinis A, et al. Atraumatic dislocation of a modern rotating hinge total-knee prosthesis. A rare but devastating complication[J]. Med Eng Phys, 2023, 117: 103991. doi: 10.1016/j.medengphy
[22] Kornilov N, Wagenaar FC, Kuliaba T, et al. Dislocation of modern design rotating hinge total knee arthroplasty: case series and narrative review[J]. Acta Orthop Belg, 2020, 86(2): 303-312.
[23] Encinas-Ullán CA, Gómez-Cardero P, Ruiz-Pérez JS, et al. Dislocation of rotating-hinge total knee arthroplasty[J]. EFORT Open Rev, 2021, 6(2): 107-112.
[24] Biswas D, Haughom B, Mayle RE Jr, et al. Case report: failure of rotating-hinge total knee prosthesis by disengagement of the hinge-post extension[J]. Clin Orthop Relat Res, 2013, 471(4): 1389-1392.
[25] Digennaro V, Manzetti M, Bulzacki Bogucki BD, et al. Total knee replacements using rotating hinge implants in polio patients: clinical and functional outcomes[J]. Musculoskelet Surg, 2025, 109(2): 155-162.
[26] Moreira da Silva AG, Giglio PN, Fernandes DA, et al. Primary total knee arthroplasty in patients who have neuromuscular disorders and genu recurvatum using a rotating-hinge implant: a case series with a mean four-year follow-up[J]. J Arthroplasty, 2025: S0883-S5403(25)01238-0. doi: 10.1016/j.arth.2025.09.049
[27] Morgan-Jones R, Oussedik SI, Graichen H, et al. Zonal fixation in revision total knee arthroplasty[J]. Bone Joint J, 2015, 97-B(2): 147-149.
[28] Oh JH, Scuderi GR. Zonal fixation in revision TKA: the key is metaphyseal fixation[J]. J Knee Surg, 2021, 34(13): 1402-1407.
[29] DAmato M, Flevas DA, Salari P, et al. A novel quantitative grading system for implant fixation in revision total knee arthroplasty[J]. Bone Joint J, 2024, 106-B(5): 468-474.
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