Dislocation of Rotating Hinge Total Knee Prostheses

Background: Symptomatic instability and implant dislocation are occasionally encountered in patients with a rotating hinge total knee prosthesis. A biomechanical study of rotating hinge total knee implants was performed to determine the association between the design (length and taper) of the central rotational stem and the stability of the implant.

Methods: The stem lengths and tapers of knee implants made by seven manufacturers were measured. The tilting laxity of each design was tested by measuring the degree of tilting of the central rotational stem within the tibial housing that occurred with increasing amounts of distraction. The maximum amount of distraction that was possible before the stem dislocated was determined for each design.

Results: Implant designs with a short and/or markedly tapered central rotational stem had the greatest tilting, laxity, and instability of that stem. The Howmedica, Techmedica, Intermedics/Sulzer Medica, and Wright Medical Technology/ Dow Corning Wright designs required 39 mm of distraction before they dislocated. The Biomet knee implant required 33 or 44 mm of distraction to dislocate, depending on the thickness of the polyethylene tray that was utilized. The S-ROM knee required only 26 mm of distraction before dislocation occurred.

Conclusions: The measurements confirmed that the shorter the stem and the greater its taper, the greater the instability and laxity at any given amount of joint distraction.

Clinical Relevance: Rotating hinge knee designs with a short, tapered central rotational stem (in the absence of a mechanical stop to distraction) should be used with caution in patients with bone and soft-tissue compromise that may allow excessive distraction and implant dislocation, especially when the patient has a flexion-extension gap mismatch or a flexion gap laxity.