Comparison of Mechanical and Nonmechanical Failure Rates Associated With Rotating Hinged Total Knee Arthroplasty in Nontumor Patients

Rotating hinge total knee arthroplasty (TKA) has had acceptable to poor results in terms of clinical outcomes and survivorship, leading to skepticism with regard to its use. A total of 271 hinged TKAs performed between 1998 and 2008 were studied to determine survivorship and factors affecting survivorship. A median survivorship of 6.9 years was found for the best-case cohort (n = 111), and 4.1 years, for the worst-case group (n = 174). Of the 111 patients, 51 (45.9%) experienced a failure that required reoperation, with more than half of these (29/51, or 56.9%) due to nonmechanical modes of failure. Comparison of the kinematic hinge implants with the distal femoral replacements showed that the Kaplan-Meier survivorship was slightly higher for the patients with distal femoral replacements, although this was not significant (P = .962). Our study suggests that the hinge TKA is well designed and provides acceptable survivorship in healthy patients who do not have nonmechanical complications.